Except for skin cancers, breast cancer is the most common cancer in women in the U.S., but it can be successfully treated. To support screening and early detection, Susan G. Komen promotes breast self-awareness messages. These messages consist of knowing your risk, getting screened, knowing what is normal for you and making healthy lifestyle choices. More than 20 years ago, studies showed that monthly breast self-exams don’t reduce breast cancer mortality. Joining us on today’s show is Komen’s Senior Director of Health Information and Publication, Susan Brown. Susan has lived through these changes in recommendations and is here today to explain them to us and to clear up any confusion on what we are supposed to be doing to best protect ourselves.
Adam Walker: 00:03 From Susan g Komen. This is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room,
Adam Walker: 00:17 Except for skin cancers. Breast cancer is the most common cancer in women in the us, but it can be successfully treated to support screening and early detection. Susan g Komen promotes breast self-awareness messages. These messages consist of knowing your risk, getting screened, knowing what is normal for you, and making healthy lifestyle choices. More than 20 years ago, studies showed that monthly breast self-exams don’t reduce breast cancer mortality. Joining us on today’s show is Komens Senior Director of Health Information and publication, Susan Brown. Susan has lived through these changes in recommendations and is here today to explain them to us and declare up any confusion on what we are supposed to be doing to best protect ourselves. Susan, welcome to the show.
Susan Brown: 01:06 Thanks so much for having me.
Adam Walker: 01:08 Well, this is a really important topic, so I really appreciate you taking the time to be with us today. Um, I think there’s, there’s, you know, some confusion around this topic of, of monthly breast self exams. Should women do them, should they not do them? So I’m, I’m happy to, to get to talk to you about this and, and to understand what Susan’s g KO’s recommendation is and how it’s shifted over the years. So let’s just get to it. Um, what is Susan g KO’s recommendations related to breast self exams?
Susan Brown: 01:35 Okay, so while we don’t recommend monthly breast self exams as defined as a prescribed procedure of multiple steps to be performed every month, we do stress the importance of knowing the warning signs of breast cancer, the importance of learning what is normal for you, the importance of talking with the doctor, if you notice any of the warden signs or any other changes in your breast or underarm area.
Adam Walker: 02:00 Gotcha. And, and so, so it sounds like you said, I think you said we’re moving to a more holistic approach, I think is the word I heard you say. And so why was the decision made to move away from recommending like a monthly breast self exam to this kind of more holistic approach?
Susan Brown: 02:16 Well, Komen is an evidence-based organization, and the evidence does not show that teaching BSE lowers breast cancer mortality. At the same time, we stress the importance of knowing what it’s normal for you, how your breast look and feel, and the importance of reporting any changes to your doctor. You might hear me say that a few times this morning.
Adam Walker: 02:35 Well, it’s good to have a, a, a clear line to communicate that. Uh, so I I actually very much appreciate that. A very good, clear message. So, so then I guess my next question is like, is there any harm in doing a regular breast self exam?
Susan Brown: 02:51 So for individuals, there’s no real harm as long as it’s used as a tool to become familiar with your breast. And I wouldn’t ever tell anyone not to GBSE, the comb is an evidence-based organization, and we don’t promote behaviors that certainly were meant to reduce breast cancer mortality that have been shown in studies not to reduce breast cancer mortality screening tests or tests that are used on large numbers of people who have no signs or symptoms of the disease to find the problem early. So you think you go to the doctor and they take your blood pressure? Well, that’s a screening test. BSE isn’t a screening test. Mammography is the best screening test we have today for finding breast cancer early, and BSE isn’t a substitute for that substitute. It doesn’t really find breast cancer early, but mammography isn’t a perfect test either. And if you notice a change in your breast, even after a recent mammogram showed no problem, it still needs to be checked by a doctor. I really like to shift the conversation away from BSE instruction and steps toward the broader set of breast self-awareness messages.
Adam Walker: 04:00 Okay. Okay. So you, you mentioned that that phrase breast self-awareness messages. Tell me a little bit more about that. Like what does that mean? What are the messages right now?
Susan Brown: 04:10 So we have four key messages. As you noted in the introduction, there are talking points for each message and actions associated with each message. So know your risk is the first key message gathering family health history is one action. Some families are private about health issues, particularly breast health issues about breast cancer sharing information with younger generations, especially with the boys or men. So it just may not be done. But as we learn more about the possible shared genetic components of breast cancer and other cancers and other health conditions such as diabetes or obesity, this family history may become even more important in the future, in in ways we don’t understand yet today. So we have a family history tool on common.org where this information can be gathered, shared with other family members and healthcare providers. And this actually leads to the next action related to this message, sharing what you’ve learned about your family health history with your doctor.
Susan Brown: 05:10 This information along with your personal health history can help your provider understand your risk of breast cancer. So getting screened is the second key message naturally following a conversation with your doctor about risk is a conversation about the screening plan that’s right for you. Um, for women at average risk, uh, annual screening mammography beginning at the age of 40 will likely be that recommendation for other women at higher risk breast MRI may be added to that annual screening manner. Clinical breast exams every three years starting at 40, provide an opportunity to update that family history. And continuing to discussion about your risk and screening, knowing what’s normal for you, uh, is the third key message. Learn the warning signs of breast cancer and if you notice a change, please don’t try to figure out what it is or sit home and worry about it. See a doctor for examination and a discussion about next steps.
Susan Brown: 06:07 And then finally, make healthy lifestyle choices. We don’t know what causes breast cancer to develop an an individual at a certain point in time, and we dunno how to prevent it, but there are things that can help reduce the risk. And the bonus is that there also for overall health as well, maintain a healthy weight during your lifetime. Weight gain or being overweight as an adult is associated with a higher risk of breast cancer include exercising your routine. It’s a factor by itself that seems to offer some protection against breast cancer. And it also helps with weight control, limit alcohol intake. Many studies have shown that drinking alcohol is associated with increased risk, and the higher the alcohol intake, the higher risk. So the recommendation is to limit alcohol. If you drink to one drink a day limit menopausal hormone use, the use of some of these hormones, uh, is linked to a higher risk of breast cancer. And if you need these hormones to manage menopause symptoms, the recommendation is to use the lowest dose for the shortest amount of time. And finally, breastfeed, if you can. Breast studies show that this offers protection against breast cancer.
Adam Walker: 07:18 Well, those are great messages and, and very, uh, simple and, and actionable action steps. I I kind of love that. Um, so you mentioned, uh, knowing your normal right. And, and knowing your normal is so important. So, so I wonder related to that, like what are the breast changes that women should be watching out for?
Susan Brown: 07:39 Well, first of all, any change in the breast or underarm area should be reported. Changes that can be felt such as a lump or a warm area on skin, visual changes such as swelling, redness, or darkening at the skin. A change in the size or shape of the breast dimpling or puckering of the skin, itchy, scaly sore, a rash on the nipple or other parts of the breast nipple discharge that starts suddenly and appears from only one breast. Breast cancer often isn’t associated with pain, but persistent pain in one focal area is something else that should be checked.
Adam Walker: 08:15 Hmm. So, you know, of the things that you just mentioned, quite a few of them are visual. So I wonder if you could talk to us a little bit about like what you observed when you were teaching breast self exams in a clinical setting.
Susan Brown: 08:27 Yeah. So when I worked in imaging center years ago, I taught DSC and I found that women were so focused on the process, especially if I was using a breast model to teach the procedure, that they really weren’t paying attention to what I was saying about warning signs. They were focused on that model and the lumps that were built into the model and not paying attention to the warning signs except for the lumps that were built into that model. But a lump, as I mentioned a moment ago, is only one of eight warning signs that could be linked to breast cancer. And many women don’t think about anything, um, except a lump in their breast as being a warning sign of breast cancer.
Adam Walker: 09:03 Gotcha. Okay. So that’s, and again, I mean, it kind of goes back to that whole like, know your normal and what’s normal and what’s not normal so you can focus, again, it’s a holistic approach, right? You can focus on the whole thing, not just one small aspect of it. So, um, so a lot of times on this show, I’ve interviewed women that have discussed, uh, their breast cancer journey, and it started by them feeling a lump in their breasts. Um, and, and then they go to get it checked out. So I just wonder, like what, what would you say about that, that circumstance or that example?
Susan Brown: 09:35 I would say that, um, they knew that a lump could be a warning sign of breast cancer. They knew what was normal for them. They recognized the lump as a change in their breast. They had it evaluated by a healthcare provider to get the test they needed for diagnosis and treatment. I, I don’t believe I’ve ever met a woman who found a change in her breast that turned out to be cancer that she found on the day she had circled on her calendar for performing her monthly breast self exam, but rather they found the change in their breast or the lump when they were showering, dressing or a partner found the lab Yeah. And recognized it was not normal for them. And this is what the literature showed years ago too, when BSE was recommended that women knew they should do monthly breast health exams, but they didn’t actually do it.
Adam Walker: 10:27 Hmm. Yeah, I mean, that makes sense because I, I, you know, as I do think back, most of them are like, I was in the shower and this happened, or this and this, you know? So it, it does seem a little more, uh, you know, it just sort of ha happens in the normal course of things. So, but I, but again, I mean, it goes back to, to what you said earlier, like, they knew their normal, that wasn’t normal, therefore you go get it checked out. So. All right. So then what about women under 40, you know, they’re not doing mammograms. Uh, are there any different recommendations for them? Anything they should consider?
Susan Brown: 10:58 No, the breast self-awareness messages, uh, would be the same. Know your risk by talking to your family, your doctor, get screened with a clinical breast exam, uh, orano or a mammogram or other imaging. Uh, test based on the discussion with your doctor, based on your risk as well as your age. Know what is normal for you, learn the warning signs and see a doctor if you notice any change in your breast. And then finally, make healthy lifestyle choices to help reduce your risk of breast cancer and to promote overall.
Adam Walker: 11:29 Oh, I love that. Okay. Sorry, Susan. Uh, this is, this is complex. So let me, let me just see if I can sum up what I’ve heard so far and then ask you a final question. So, um, obviously we’re not in the business of telling anyone not to become familiar with their bodies. And so what I think you’re really just saying is that we want to take a more holistic approach to breast health and recognize the importance of information regarding your risk of breast cancer, the screening plan that’s right for you, knowing the warning signs of breast cancer and taking action if you notice a change and making healthy lifestyle choices. Uh, is that right? And do you have anything else you’d like to add or, or leave us with?
Susan Brown: 12:07 That’s right. And the only thing I would add is that we do have illustrations that describe the warning signs that can be found on Coorg as well as all other sorts of information about breast health and breast cancer.
Adam Walker: 12:21 Well, I really appreciate that, Susan. I appreciate the work that you’re doing. Uh, thank you so much for joining us on the show today and, and just trying to talk through this, uh, this complex issue.
Susan Brown: 12:31 Thank you so much for having me.
Adam Walker: 12:37 Thanks for listening to Real Pink, a weekly podcast by Susan g Komen. For more episodes, visit real pink.koman.org. And for more on breast cancer, visit koman.org. Make sure to check out at Susan g Komen on social media. I’m your host, Adam. You can find me on Twitter at AJWalker or on my blog, adamjwalker.com.