Breast Health Begins With You

1. Breast Health Begins With You What you need to know about breast cancer.

2. National Breast Cancer Awareness Month is October

3. Breast cancer impacts over 240,000 new patients a year in the United States alone. • Approximately every 3 minutes a woman is diagnosed with breast cancer and approximately every 12 minutes breast cancer claims another life. • 70% of breast cancer cases occur in women who have no identifiable risk factors. The Numbers Don’t Lie

4. Statistics on Breast Cancer • An estimated 40,600 deaths (40,200 women, 400 men) from breast cancer are expected next year. • Breast cancer ranks second among cancer deaths in women. • Breast cancer also strikes a small percentage of men. • An estimated 192,200 new invasive cases of breast cancer are expected to occur among women in the United States this year alone. • About 1,500 new cases of breast cancer are expected to be diagnosed in men next year.

5. Nobody knows for certain why some women develop breast cancer and others do not. What is known is: • You have not done anything "wrong" in your life that caused breast cancer.  • You CANNOT "catch" breast cancer.  • It is NOT caused by stress or by injury to the breast. • Most women DO NOT have any known risk factors or a history of the disease in their families.  • Getting older DOES increase your risk of getting breast cancer, starting at the age of 40 and continuing into your 80s. What do we know about causes?

6. Factors that increase risk • Family History • Lifestyle • Personal History

7. Family History FAMILY HISTORY: If your mother, sister, or daughter has developed breast cancer before menopause, you are three times more likely to develop the disease. If two or more close relatives (e.g., cousins, aunts, grandmothers) have/had breast cancer, you are at increased risk as well. Recently, scientists have found that mutations in genes BRCA1 and BRCA2 increase one's susceptibility to breast cancer. A simple blood test can tell you if you have such a condition.

8. Personal History If you've had breast cancer, you have an increased risk of getting it again. Also, if you've had benign breast disease (e.g., fibrocystic breast disease), you are at an increased risk. The following also put you at greater risk: • If you began menstruating early (before age 12) • If you take birth control pills (though evidence is not conclusive)

9. Additional Risk Factors • If you never have children • If you have children when you are 30 or older • If you have menopause at 55 or older • If you take Hormone Replacement Therapy (HRT) • Higher estrogen levels are strongly linked with susceptibility to breast cancer.

10. Lifestyle • Several studies found a lower incidence of breast cancer among women who exercise regularly • Higher proportion of breast cancer among obese women. • There is increased risk of breast cancer with increased alcohol use (i.e., 3 or more drinks per week); perhaps due to the fact that alcohol increases blood estrogen levels.

11. Resources to Check Out • Women’s Information Network Against Breast Cancer: www.winabc.org/newweb/resources/Index.htm • American Cancer Society's Breast Cancer Resource Center: www3.cancer.org/cancerinfo/res_home.asp?ct=5 • Breast Cancer Action: www.bcaction.org • Celebrating Life Foundation: www.celebratinglife.org/index.html The promotion of charitable endeavors that encourage the advancement of knowledge and awareness of breast cancer risk and risk management in the African American community and for women of color.

12. Department of Defense Breast Cancer Decision Guide: www.bcdg.org For individuals diagnosed with breast cancer and their family members. • National Alliance of Breast Cancer Organizations: www.nabco.org Provides information, assistance and referral to anyone with questions about breast cancer, and acts as a voice for the interests and concerns of breast cancer survivors and women at risk. • Imaginis.net - the Breast Health Specialists: www.imaginis.net/breasthealth Comprehensive, up-to-date information on breast health and related breast cancer prevention, screening, diagnosis and treatment procedures.

13. Why Do a Breast Self Exam? Be Safe, Be Sure

14. It is easy to do and the more you do it, the better you will get at it. • When you get to know how your breasts normally feel, you will quickly be able to feel any change, and early detection is the key to successful treatment. A breast self-exam could save your breast - and your life. • Most breast lumps are found by women themselves, but in fact, most lumps in the breast are not cancer. Breast Self Exam Information

15. When to do a Breast Self-Exam The best time to do breast self-exam is right after your period, when breasts are not tender or swollen. If you do not have regular periods or sometimes skip a month, do it on the same day every month.

16. About Your Breast Self Exam… • Remember, you are looking for changes, so you need to collect a month or two of data before you really understand what change looks or feels like. You must also realize that 9 out of every 10 breast lumps found, thank heavens, are not cancerous.

17. There are two basic steps to conducting a Breast Self Exam (BSE): first you look at your breasts, and then you touch them.

18. Step 1 a Visual Examination • During the first part of the BSE, the visual examination, you are looking for changes in each breast. So if your breasts have always been mushy, that's not a concern unless this is a new change.

19. Step 1 b • Stand in front of a mirror and look for the above changes in your breasts (from both a frontal and profile view) in 3 different positions: • With your arms up behind your head • With your arms down at your sides • Bending forward

20. The changes you are looking for include: Step 1 c • Size • Shape • Bumps/lumps – NOTE: normal lumpiness, like in the week before and of your menstrual cycle, will appear as very small and separate lumps like the texture of an orange. • Contour or symmetry (is there a difference in the level between your nipples? Do both breasts look symmetrical?)

21. Step 1 d Other Changes to Look For… • Sores or scaly skin • Skin discoloration or dimpling • Discharge or puckering of the nipple

22. Step 2a Tactile Examination Begin by looking for the changes while standing up. Some women find it useful to do this part of the BSE in the shower, since soap or bath gel will aid in the ease of feeling your breasts.

23. Step 2b For the BSE, you need to pick a pattern to feel your breasts and surrounding areas, which include: • the breast itself • between the breast and underarm • the underarm itself • the area above the breast up to the collarbone and across to your shoulder

24. Step 2c • It is important to check surrounding areas because breast cancer may be found in the lymph node tissue around your breast and underarm.

25. Step 2d • You use the pads (where your fingerprints are) of your three middle fingers on your right hand pressed together flat to check your left breast, and do the opposite for the right breast.

26. Step 2e • You should press on your breast with varying degrees of pressure: • light (move the skin without moving the tissue underneath) • medium (midway into the tissue) • hard (down to the ribs "on the verge of pain")

27. Patterns Step 2f • Spiral (concentric circles): begin with a large circle around the perimeter of your breast and make smaller and smaller circles as you work your way toward the nipple.

28. Step 2g • Pie shape wedges: pretend your breast is divided into sections like pieces of a pie, begin in the nipple area and feel your breast in a small circular motion within one pie shape section, then move on to the next wedge starting in the nipple area again.

29. Step 2h • Up and down: pretend your breast is divided into vertical stripes, begin on one side and feel your breast in a small circular motion up and down in a zig zag pattern.

30. Step 2i • When using any of the 3 patterns, you should always be using a circular rubbing motion (in dime-sized circles) without lifting up your fingers.

31. Once you've performed the tactile examination while standing up in front of a mirror, you should do the whole examination again, this time while lying down. Step 3a

32. Step 3b • Put your left arm behind your head and use your right hand to examine your left breast. • Put a small pillow or towel under your left shoulder to aid you. • Again, use the pads of your 3 fingers of your right hand to check your left breast in the pattern of your choice (spiral, pie shape wedges, or up and down). • Be sure to always use the same pattern (it's the best way to know if there are changes).

33. Step 3c • And again, don't forget to feel your breast using light, medium, and hard pressure. • After you're finished, you must repeat the procedure again for your right breast.

34. Here’s what you might find during your breast exam: • Tender, lumpy breastsThis is usually part of your regular menstrual cycle due to swelling because you retain more water. • Overall small lumps and a bumpy/grainy textureIf this texture is found on both breasts in the area around your nipples and the upper and outer parts of your breasts, you might only have fibrocystic breasts.

35. Single lump that feels like an oval and is hard on the outside, squishy on the insideThis may be a cyst. You can usually move a cyst under the skin and they sometimes produce a dull pain. A cyst is a fluid-filled sac that can vary in size from a pea to a half-dollar. Cysts appear most often in women aged 35 to 50 and increase as menopause approaches. They are benign.

36. Single, solid lump that feels round like a small rubber ball and can be movedThis may be a fibrodenoma, a benign and painless tumor made up of connective tissue and other cells. A fibrodenoma may vary in size from a marble to a lemon. They are more common in women in their late teens and early 20s or older women on Hormone Replacement Therapy.

37. Overall distinct large lumpsThese may be just exaggerated lumpiness, called pseudolumps. These may be caused by scar tissue, a clump of fat cells, or an abscess (pus-filled sac). Sometimes nursing women experience mastitis, when bacteria enters the breast from dry cracks in the skin.

38. Single, solid lump that can NOT be movedLook for hard, irregular borders to the lump. Also, determine if the lump appears in only one breast and if it remains the same size throughout your menstrual cycle. Note that thickened or dimpled skin is a sign of a lump that can NOT be moved (other benign lumps are movable because they are filled with fluid or lumps of fat). If all of the above occur, these are symptoms of breast cancer. Get it checked out immediately.

39. Sores or scaly skinAn open, itchy sore could just be a simple skin irritation (like from a new lacy bra that's cutting into you, or from switching your laundry detergent). However, in a few women, this could be a sign of Paget's disease, a rare form of breast cancer.

40. Discharge or puckering of the nipplePersistent clear or bloody discharge from one nipple may indicate cancer in your breast ducts. Also, an inverted or puckered nipple (e.g., pulled back into the breast) may be a symptom of breast cancer.

41. If you find that you exhibit any characteristics that are abnormal or concern you (aside from normal menstrual lumpiness or retention of water), don't screw around. Go see your physician immediately for a clinical breast exam and other tests. While some of the abnormalities mentioned are usually benign, nothing is 100% and it's good to keep your doctor in the loop.