Kristin (Moderator) - 11:50 AM:
Welcome to ENH’s latest chat: Breast Self Exams: Do They Really Save Lives?, with
Dr. Elaine Lee Wade. The chat will not start for another ten minutes, but feel free to start submitting questions to be answered shortly.
Dr. Elaine Lee Wade (NorthShore University HealthSystem) - 12:03 PM:
Hello, I'm Dr. Elaine Lee Wade, Associate Director of the Center for Breast Health at Glenbrook Hospital. I'm thrilled to lead this online discussion and would like to kick it off by addressing recent headlines questioning breast self exams.
While a recent study concludes that these exams may not save lives, I'm here to tell you that there's no harm in doing them, and they're free so I encourage women to continue this as one part of maintaining breast health.
So now I would like to open it up to questions about this issue or any other issue related to breast health.
Carol (HIghland Park) - 12:03 PM:
I occasionally have minor aches/pains in my breasts. I haven't found any indication of lumps or irregularities through self exams. I have just turned 30 - should I request mammograms immediately to determine the reason for discomfort?
Dr. Elaine Lee Wade (NorthShore)
Typically, mammograms are ordered by the physician or nurse practitioner taking care of you, so my first step for you would be to visit that individual and have them physically examine you. They can use that as the basis for decision-making in terms of the next best step such as use of mammogram or ultrasound versus clinical follow-up.
kat (Chicago, IL) - 12:08 PM:
Hi Doctor,
Are there any other benefits to a self exam than early detection of breast cancer?
Dr. Elaine Lee Wade (NorthShore)
Knowing how to do a good self-exam typically leads to increased self-awareness for the patient with regards to breast and even global health. Keeping up on routine exams such as pap smears, mammograms, general checkups and paying better attention to day to day health issues such as healthy diet and exercise typically follow.
Veronica (Naperville, IL) - 12:09 PM:
Hello, I was wondering how often are men diagnosed with breast cancer?
Dr. Elaine Lee Wade (NorthShore)
For every 100 cases of breast cancer in women, there is one case of male breast cancer diagnosed. This is why many of the treatment methods we use for them are based on treatments that work well for women. Men from families that carry a genetic predisposition, particularly BRCA 2 may have increased risk of breast cancer than the initial figure.
Jenn (Chicago) - 12:12 PM:
At what age should I start performing breast self-exams?
Dr. Elaine Lee Wade (NorthShore)
Anyone who has undergone puberty and has breast tissue to assess is old enough to undergo self-exam. Primary care physicians may be ideally-suited to teaching patients in their office how to do this.
Sarah (Glenview, IL) - 12:14 PM:
There seems to be a lot of new research saying that if you started your periods by a certain age, didn't breast feed your children, ate a high fat diet, and now if you were a certain size when you were born, you might be more likely to be diagnosed with breast cancer. Is there a definitive variable that women can control that will prevent breast cancer?
Dr. Elaine Lee Wade (NorthShore)
You are correct in that there are variables such as family history, age at first childbirth or having had no children that we as women do not have a great deal of control. There are, however, several things that all women can be adding to their lives that may help reduce their risk no matter how high. These steps include regular physical activity, maintaining a healthier weight, eating a more mediterranean diet-more grains, less animal fat, more vegetables, as well as limiting or avoiding intake of alcohol.
For women with an elevated risk of breast cancer, some of them may be eligible for preventive treatment with tamoxifen as well.
Carol (Highland Park) - 12:19 PM:
What are typical causes of breast pain? Could diet or stress cause this?
Dr. Elaine Lee Wade (NorthShore)
Breast pain can come from a number of causes-hormonal stimulation, caffeine, breast size,menstrual cycling,etc. Persistent pain, particularly in one location may be something that merits an assessment by a health care professional.
Veronica (Naperville, IL) - 12:21 PM:
Thanks, Doctor. My husband’s mother was diagnosed with breast cancer recently and I am worried about him. Are there treatments specifically geared towards men?
Dr. Elaine Lee Wade (NorthShore)
You speak of treatments for men. Typically, breast cancers in men are approached similarly to those in women-surgery,and/or radiation, chemotherapy and even Tamoxifen are treatments that are available. Typically, breast cancers in men are often found on physical exam. If he has a concern, his physician would be an ideal place to start.
Jenn (Chicago) - 12:24 PM:
Does breast cancer in my family mean I should start doing self-exams at a younger age?
Dr. Elaine Lee Wade (NorthShore)
Anyone with development of breast tissue can start doing self-exam. Depending on how significant the family history is,consideration for earlier screening with clinical exams, mammograms or even MRI of the breast may add good information for that individual.Specifically how early to start and what tools to use would be based on the extent of family history and whether or not it is related to an underlying genetic cause. The NorthShore University HealthSystem online tool, MyGenerations, is a great resource anyone can use by going to northshore.org.
Kat (Chicago, IL) - 12:28 PM:
Is there anything I should do differently during my self-exam during pregnancy and even while I am breast feeding?
Dr. Elaine Lee Wade (NorthShore)
Sometimes self-exam can be a bit challenging during these times, given the heightened sensitivity and increased size that can occur. Focusing on changes that are new, different and persistent is prudent. Lastly, taking an extra half-hour at your doctor's office to be assessed and hopefully reassured is never a waste of time.
CJ (Longview, Texas) - 12:30 PM:
I am 46 years old. The last ten day I have had pains in my left breast. I went to the doctor yesterday and they found a lump. I'm schedule for a mammogram on the 20th of the month. The doctor did not say much about it. Should I be worried?
Dr. Elaine Lee Wade (NorthShore)
It sounds as though your physician is taking appropriate steps to evaluate your breast health. Ideally, patients with abnormalities benefit most from diagnostic mammograms because they are typically are read at the time they are taken by a physician. If extra pictures or other studies are needed, they can be appropriately requested at that time.
Sarah (Glenview, IL) - 12:33 PM:
Being a breast cancer survivor I am concerned for my daughter, especially since she takes birth control. What cautions should I give her?
Dr. Elaine Lee Wade (NorthShore)
This is a difficult question to answer as your history(family, age at diagnosis,etc.) is not available. In general, oral contraceptives are thought to be safe with regards to breast cancer given the low-dose in which they are typically prescribed. Even without other family history of genetic predisposition, she may be at slightly increased risk for breast cancer and should follow her doctor's recmmendations for screening tests and physical exams.
Veronica (Naperville, IL) - 12:37 PM:
That's good advice, doctor. How is a man’s self-exam different from a woman’s? Should he be looking for anything different?
Dr. Elaine Lee Wade (NorthShore)
Sometimes a change in the tissue present beneath the skin can be felt. Other changes such as an actual lump, a change in the appearance of the nipple or actual nipple discharge can be other signs.
RR (Chicago, IL) - 12:38 PM:
I have 2 questions. What is BRCA 2 that you mentioned earlier? What is the %age of men having breast cancer compared to women?
Dr. Elaine Lee Wade (NorthShore)
BRCA 2 is one of the better-known gene abnormalities that can be present in 5-10% of all breast cancers and when present are associated with increased risk for developing the disease as well. It is more common in certain populations and is sometimes looked for when patients are diagnosed at a very early age or when many family members have a history of the disease.
In terms of percentages, if for instance there are 180,000 cases of breast cancer diagnosed this year, 1% or so of those cases or 1800 cases would be diagnosed in men.
Kat (Chicago) - 12:42 PM:
Would a woman with breast implants do a self-exam the same way as a woman without?
Dr. Elaine Lee Wade (NorthShore)
These days, many women with implants have implants that are beneath the muscle, making a breast exam or even a mammogram pretty much the same as if the implants were not present.
Jenn (Chicago) - 12:43 PM:
Thanks a lot. I've recently started to perform self exams (I'm 20) and wanted to know: How do I know what's normal if I haven't done the Breast Self Exam before?
Dr. Elaine Lee Wade (NorthShore)
Starting with your own physician to guide you can be helpful. Also, resources in the community can sometimes be found with educators including breast health specialists(usually nurses) who occasionally teach classes in this regard. Web sites such as Y-Me/Breast Cancer network of Strength or Susan G.Komen may also provide instruction for proper exam.
Sarah (Glenview, IL) - 12:46 PM:
What does breast discharge indicate, and do certain colors of discharge indicate a problem?
Dr. Elaine Lee Wade (NorthShore)
Breast discharge can mean many things, including infection, inflammation, hormonal stimulation or cancer. Persistent nipple discharge, particularly if blood is seen, is an indication for medical assessment.
Kristin (Moderator) - 12:47 PM:
Thank you everyone for your great participation, but unfortunately we only have ten minutes left, so please submit any final questions you have.
Veronica (Naperville, IL) - 12:48 PM:
Should a man do a self-exam as often as a woman?
Dr. Elaine Lee Wade (NorthShore)
Since breast cancer in men is so much less common, there are not standard recommendations in this regard. Being aware of changes is the best rule of thumb, with medical assessment for new findings most prudent.
kat (Chicago, IL) - 12:49 PM:
I have read reports that state that breast self-exams might not be helpful to early detection at all. Do you think the self exam is still relevant and helpful?
Dr. Elaine Lee Wade (NorthShore)
Specifically, the literature on self-exam did not find a survival benefit in those women in whom cancer was diagnosed. Being in touch with what is normal for you and being aware of changes is typically a good idea. Self-exam is not harmful and can lead to diagnosis. It,however, is not a substitute or replacement for clinical exams or screening studies such as mammograms.
Jenn (Chicago) - 12:51 PM:
I read an article a while ago about alcohol causing an increased risk of breast cancer. Is that true or just a misrepresentation of statistics?
Dr. Elaine Lee Wade (NorthShore)
There is thought to be an increased risk for breast cancer in women who drink more than one serving of alcohol daily.
Veronica (Naperville, IL) - 12:52 PM:
What other kinds of precautions should men take against breast cancer?
Dr. Elaine Lee Wade (NorthShore)
It sounds as though this may be an area of concern for members of your family. I would advise further discussion with your family member's physician who has better access to family and personal history so that this issue can be more acurately addressed for him.
Jenn (Chicago) - 12:54 PM:
When is it best to check myself, any time in the month, every other month, etc?
Dr. Elaine Lee Wade (NorthShore)
Once monthly the week after your menstrual cycle is typically what is recommended.
Kim Kurey - 12:57 PM:
Dr. Wade,
I am 41 with a family history of breast cancer. My grandmother went through a mastectomy and eventually died from cancer. My mother has never had a lump in her breast or any other breast cancer scare. She is diligent about receiving mammograms, as am I. Is it a myth or fact that breast cancer will skip a generation? Is there something more my sister and I should be doing to guard our breast health? Thank you for your time and for sharing on this forum.
Dr. Elaine Lee Wade (NorthShore)
It is not clear that genes will necessarly "skip" a generation. They can sometime present at a different time in a person's life than seen previously in other relatives. Other relevant history such as ethnicity, how many other female relatives such as sisters of your grandmother,etc. can help clarify one's own genetic risk or need for genetic screening. One relative with the diagnosis does not make it a given that there was or is a genetic reason for the disease or that you will be guaranteed to get it. Following standard American Cancer Society guidelines with annual mammograms would be ideal as a place to start.
Kristin (Moderator) - 1:01 PM:
Thank you everyone for participating in the chat. A transcript of the complete chat will be available shortly. More information about NorthShore’s breast cancer services can be found on the Breast Cancer Center’s website.
Rachel (Winnetka, IL) - 1:02 PM:
I am hearing more about women under 40 getting breast cancer. I am 36 with no history of breast cancer in my family, but still concerned about my heath. Can I ask for a mammogram although I am under the recommended age requirement?
Dr. Elaine Lee Wade (NorthShore)
Typically patients under 40 without family history or physical abnormality creating the request for mammogram are not necessarily covered by insurance. Everyone's coverage does vary, and if there is an abnormality present that needs to be assessed imaging is supported, so it would not hurt to ask your physician.
Dr. Elaine Lee Wade (NorthShore) - 1:06 PM:
I truly enjoyed today's discussion and appreciate everyone's interest in maintaining their health. I encourage you to go to northshore.org for resources and educational tools available for you.