Pink Edition: Tending to your body, decade by decade

October 2, 2013 

Dr. Elizabeth Prier

Every woman recognizes that as she ages, her breasts will change. Some women might be concerned that they are not as firm and youthful as they once were. But regardless of shape or size, the one thing every woman wants is healthy breasts.

So just what can you expect as you age? The following is a brief summary to help you stay informed and know when to speak with your doctor about changes in your breasts.

IN YOUR 30S

Younger women commonly experience fibrocystic breast changes, a broad term that is characterized by breast pain, cysts and noncancerous lumpiness. Breast pain can be cyclic, coming with menstrual periods, or it might be more persistent. If you experience breast pain, your physician might suggest that you avoid or decrease caffeine intake, and you could consider supplements that can help decrease pain.

Fibroadenomas (rubbery lumps made of fibrous and glandular tissue) "also affect women in their 30s," said Dr. Elizabeth Prier, a Saint Alphonsus breast surgeon.

"Although they might be painful, they are not cancerous and they do not increase your risk of developing breast cancer. If these lumps become too bothersome, they can be surgically removed."

LOW RISK

Fortunately for woman ages 30-39, breast cancer is uncommon. According to the National Cancer Institute, only one in 229 is diagnosed with breast cancer.

Unless there's a strong family history of breast cancer, women in their 30s don't need mammogram screening. In fact, younger women's denser breast tissue makes it harder to detect breast cancers on mammograms.

However, regular breast exams by your doctor can help to check for lumps, skin dimpling and other signs of breast cancer, according to experts.

Furthermore, Prier encourages women in their 30s to report persistent breast changes or pain to their physician. Although breast symptoms in younger women are typically due to something that is benign, they should always consult their doctor, because there are breast cancers that happen in young women.

As for monthly breast self-exams, the American Cancer Society has declared them optional, citing a lack of evidence that they reduce breast cancer deaths. What is now stressed is breast awareness, as well as being familiar with normal consistency of the breast and underlying tissue.

By performing self-exams - at the very least - women familiarize themselves with their breasts so that they can report changes to their doctors.

If you are premenopausal, the ideal time to check your breasts is five to 10 days after the beginning of your period, before premenstrual lumpiness appears. During this time, you will have the least hormonal effect and the most accurate exam.

IN YOUR 40S

The breast now has less glandular tissue but more fat, leading to more sagging and changes in breast shape.

The most common type of lumps found during this decade of life are fibroadenomas and a combination of fibrous breast tissue and cysts. A cyst is a fluid-filled sac that is noncancerous, but might be painful. If they become too bothersome, they can be drained or surgically removed.

Cellular changes such as atypical ductal hyperplasia also might begin during this decade. These abnormal cells in the milk ducts increase a woman's chances of breast cancer.

The numbers show that breast cancer risk rises during this decade; a woman between the ages of 40 and 49 now has a one in 68 chance. Therefore, women in their 40s should consider routine mammogram screening.

The National Cancer Institute recommends getting a first mammogram at age 40 and then one subsequently every one to two years afterward. However, women with a strong family history of breast or ovarian cancer should ask their doctors about starting mammogram screening earlier, as well as other cancer screening modalities that might be relevant based on their family history.

The National Cancer Institute also urges all women to report the following breast changes to their doctors:

• A lump in or near your breast or underarm.

• Thick or firm tissue in or near your breast or underarm.

• Nipple discharge or tenderness.

• A nipple pulled back or inverted into the breast.

• Itching or skin changes, such as redness, scales, dimples or puckers.

• A change in breast size or shape.

But don't worry about underwire bras, antiperspirants or trauma to the breast increasing your risk, Prier said. None of these has been linked to the promotion of breast cancer.

IN YOUR 50S

The average age of a woman going through menopause in the United States is 51. After menopause, the breasts not only become fattier but they can also decrease in size because women no longer have the same volume of milk-producing glands for breast-feeding.

"In her 50s a woman loses the hormonal effects in her glandular tissue of the breasts. Over time this tissue atrophies, which is when women notice their breasts are less firm, certainly less tender (if they've experienced such issues) and they are often less lumpy," said Prier.

Benign lumps might come and go with the menstrual cycle in younger women; however, any new lump that appears after menopause requires a doctor's attention, Prier said.

Starting in her 50s, a woman is advised to have mammograms every year or every other year because it is in the age group of 50 to 75 that mammograms have been shown to have the greatest absolute benefit in reducing breast cancer mortality.

It's also smart to keep your weight under control. Research has shown that the chances of developing breast cancer after menopause are higher in overweight or obese women.

In addition, alcohol consumption has been linked to an increased risk of developing breast cancer. While this doesn't mean that you can't enjoy a glass of wine, limiting your intake to a couple of drinks a week and being cognizant of your intake can help decrease your risk of developing breast cancer.

IN YOUR 60S AND 70S

A lot of the changes that occur after menopause continue as you age. The breast tissue continues to become less dense. The good news with these changes is that doctors have an easier time detecting breast cancers in older women because breast density is less likely to obscure tumors, plus digital mammograms have improved mammogram technology. The actual exam is quick and use of the new mammo pad makes this life-saving screening more comfortable than in years past.

The average age of a diagnosis of breast cancer in the United States is 61, so the women in this age range get the greatest benefit from screening mammograms.

So, in summary, the simple message is this:

The value of screening mammograms is in early detection. Regular screening decreases the rate of advanced breast cancers, and therefore decreases the rate of breast cancer deaths. The earlier and smaller a breast cancer is at the time it is diagnosed, the greater the chance of cure. Early detection truly is the best protection.

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