As Breast Cancer Awareness Month progresses, it is a prime time to raise awareness about breast cancer; celebrate survivors; highlight the importance of scheduling mammograms; and become better educated about the disease. Dr. Ken Lin Tai, Director and Medical Director of the Center for Cancer Prevention and Control, Maryland Department of Health, helped to sort fact from fiction by providing answers to questions about breast cancer, in this first part of a two-part series.

Q: What are a few common observations that a woman should consider informing her doctor about in terms of breast health concerns?

A: Signs and symptoms that a woman should consider informing her doctor about include any new lump in the breast or underarm; thickening or swelling of part of the breast; skin changes on the breast, such as redness, crusting, dimpling, or puckering; changes in the nipple such as discharge (besides breast milk), redness, change in direction or retraction, scaliness, or flakiness; pain in any area of the breast; and changes in the size or shape of the breast.

Q: What is dense breast tissue? Who commonly has it and how is it detected? How may having dense breasts impact mammography or breast cancer screening results? What course of action may be taken to better screen women with dense breast tissue?

A: Breasts contain glandular, fibrous, and fatty tissue. Dense breasts have relatively high amounts of glandular tissue and fibrous tissue and relatively low amounts of fatty breast tissue. About half of women ages 40 years and older are found to have dense breasts. Women who are younger, taking hormone replacement therapy, or have a lower body weight are more likely to have dense breasts. The breast density is determined by the radiologist reading the mammogram, and the levels of density are described using a reporting system called the Breast Imaging Reporting and Data System (BI-RADS). Breast density is important because women with dense breasts have a higher chance of getting breast cancer compared to women who don’t have dense breasts. Also, mammograms can be more difficult to read in women with dense breasts as it can be hard to tell the difference between the dense breast tissue and a possible tumor. This makes it more likely to miss a cancer on the mammogram. Women with dense breasts should talk to their healthcare providers about their personal risk of getting breast cancer, as dense breasts are only one of several risk factors for breast cancer. Additional screening tests may be recommended for some women, such as a breast magnetic resonance imaging (MRI) or ultrasound.

Q: Can men have breast cancer? Are their symptoms typically the same as women? If not, what observations may indicate that men should be screened for breast cancer? Can factors such as breast cancer of a mother or close member in a man’s family increase his risk of being diagnosed with breast cancer?

A: Men can get breast cancer too, although the occurrence is rare compared to women. Symptoms include a lump or swelling in the breast tissue; changes to the skin covering the breast, such as redness, flakiness, dimpling, or scaling; and changes to the nipple, such as redness, pain, discharge, or a nipple that starts turning inward. Risk factors for male breast cancer include a family history of breast cancer in close family members.

Q: How often should a woman be screened for breast cancer? When should screenings begin and end in a woman’s life?

A: Different medical organizations have developed their own breast cancer screening recommendations. For instance, the United States Preventive Services Task Force recommends that women who are 50 to 74 years old receive a screening mammogram once every two years, and for women who are 40 to 49 years old, the decision to start screening should be an individual one. Other organizations with breast cancer screening guidelines include the American Cancer Society; American College of Obstetricians and Gynecologists; the American College of Radiology; the American College of Physicians; and the American Academy of Family Physicians. Women should discuss their breast cancer screening options with their healthcare provider so that a shared decision can be made, taking into consideration the potential benefits and harms of screening, the patient’s risk factors for breast cancer, and the patient’s personal preferences.

Learn more about cancer and the state of Maryland’s Breast and Cervical Cancer Program via  FAQs are provided by The Maryland Department of Health.

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