Before anything else, please just breathe and stop panicking.
This article is for you if you have just found a lump and are freaking out. Or if you found a lump and are not concerned about it.
First, pick up the phone and call your family doctor / GP / leading physician. If you don’t have one, google the nearest doctor’s office and find their phone number. Make an appointment to get it checked out, even if you think it is nothing (and also keep in mind that it probably is nothing).
Once you’ve scheduled your appointment, read the rest of this article. You are probably thinking that you have breast cancer. Statistically, you probably don’t.
Risk of Developing Breast Cancer (Absolute Risk)
TL;DR: if you are a young woman, your risk of developing breast cancer is really not that high. Take solace in the statistics.
By absolute risk we mean the chances of developing the disease within a certain population group, in this case all women and women within specific age groups. We don’t differentiate the women based on their individual risk factors (e.g. whether or not they drink alcohol or where they live).
Breast cancer is not super common, especially among young women. Statistically 1 in 8 women will develop breast cancer within her lifetime. The current average lifespan in developed countries is 82 years for women, and that’s what the 1 in 8 stat refers to.
By the time you are 40, your risk is about 1 in 65.
In your 30s, the risk is about 1 in 225.
In your 20s, it’s about 1 in 1,750.
You know from my example that it’s not impossible of course, but statistically breast cancer (and cancer in general) tends to affect older people. The median age for a breast cancer diagnosis is 63.
Risk Factors for Developing Breast Cancer (Relative Risk)
TL;DR: the chances of developing risk cancer might be higher for somebody who ticks all the boxes on the list of risk factors. Take a hard look at these and honestly tell me how many of these relate to you. Maybe one or two? Unless you have had breast cancer in your immediate family (i.e. mom, sister, aunt, grandma) - in which case you are probably already well aware and closely monitoring your breasts - your risk is probably not that high.
By relative risk we mean the chances of one person developing the disease compared to another person within a certain population group, differentiated by certain characteristics or behaviours, for example women who drink alcohol versus women who don’t.
There are certain factors that increase the risk of developing breast cancer, some we have little or no control over, and some we are able to influence a bit more.
Factors you have little to no control over are those you were born with (genetics) or into (your upbringing and history) which can increase your relative risk of developing breast cancer can include:
Biological sex: unfortunately just being a woman is the single biggest risk factor for developing breast cancer.
Age: cancer forms when mutations in the cells accumulate - more of these mutations as we age.
History of breast cancer: having breast cancer, either invasive or in situ, in the past increases the risk of developing it again (not related to the previous one, i.e. not a recurrence).
History of breast cancer in your immediate family: your mom, aunt, grandma, daughter or sister having breast cancer increases your risk of developing it as well.
Genetics: about 5 to 10% of breast cancers are thought to be caused by mutations to certain genes in our DNA, specifically the genes BRCA1 and BRCA2. These mutations can either be hereditary (i.e. you get the faulty gene from your parents) or acquired (i.e. the mutation occurs on its own - the risk of this happening is about 6-7% in the general population or 13-17% if you have Ashkenazi Jewish ancestry). If detected, BRCA1 carriers have a lifetime 55% to 72% risk of developing breast cancer, for BRCA2 it’s 45% to 69%.
This is important: 23andme is a great mass market genetic testing company and they also offer BRCA1 and BRCA2 genotyping. However these tests will only check for a total of 3 of the mutations most common in the general population, which is not enough to confidently rule out BRCA1 and BRCA2 mutations for breast cancer. If you want to get a test for the BRCA genes, please speak to your doctor about the best options for this.
Dense breast tissue: more fibrous than fatty.
Reproductive history: having children after the age of 35 or not having them at all increases the risk of developing breast cancer. This sounds weird (and unfair), but the reason for this is because hormones produced during pregnancy help breast cells mature and regulate their growth. Not having exposure to these hormones increase the risk that breast cells will mutate and grow abnormally.
This can be genetic, related to infertility, as well as a lifestyle choice.
Menstrual history: getting your first period below the age of 12. Again, sounds weird and unfair, but also has to do with hormones: early onset menstruation increases a woman’s lifetime exposure to oestrogen.
Being overweight: especially for older women after menopause, as at that point most of the oestrogen in the body is stored in fat tissue versus being produced by ovaries. Obesity is also related to higher levels of insulin, which can also increase the risk of breast cancer.
This can be genetic, related to diseases, as well as a result of lifestyle choices.
Race: without differentiating by age, White women are at a higher risk of developing breast cancer vs other races. In younger women, Black women have a slightly higher risk of developing breast cancer vs other races.
Exposure to radiation: especially in young women, having previous chest exposure to radiation as a result of cancer treatment increases the risk of developing breast cancer.
Factors you have some control over are those that are environmental (e.g. where you live, what you expose yourself to at home and in your surroundings) and related to lifestyle (e.g. decisions you make with regards to your nutrition, exercise, work-life balance, etc). These can include:
Studies have proved the link between the factors below and an increased risk of breast cancer:
Drinking alcohol: studies have shown that alcohol consumption increases the risk of developing breast cancer, and this risk increases with the amount of alcohol consumed. 1 drink per day increases the risk by about 10% vs non-drinkers, 2-3 drinks per day increases the risk by about 20%. Alcohol consumption also increases the risk of developing other types of cancer.
Physical inactivity: this is related to body weight, but also hormonal levels, inflammation and balancing energy.
Using hormonal birth control and/or hormone replacement therapy: increases the exposure to oestrogen, which can increase the risk of breast cancer.
Being overweight (discussed above)
Reproductive history (discussed above)
The following risk factors have not been clearly linked to an increased risk of breast cancer in studies:
Diet: it could result in being overweight (which is proven to increase the risk of BC), but otherwise research hasn’t been super consistent and clear on how your diet can impact your risk of breast cancer. There are some studies that show instances of breast cancer are lower in countries where a low fat diet is typical (e.g. Asian countries), but it’s very difficult to isolate the impact of just diet across the population of an entire country.
Exposure to chemicals: exposure to certain plastics, cosmetic ingredients and pesticides seem to increase the risk of developing risk cancer, but studies haven’t confirmed this as of yet.
Smoking: smoking can cause a plethora of health-related issues, and has been linked to increasing the risk of developing several types of cancer (especially lung cancer). Cigarette smoke contains at least 70 chemicals that have been proved to cause cancer. However, so far research has not been conclusive with regards to proving it can cause breast cancer as well. Bottom line though, it is best to be absolutely avoided.
Things that have been proven to NOT be linked to developing breast cancer, despite internet-circulated rumours:
Antiperspirant deodorants,
Bras,
Abortions.
With all the above in mind, research shows that only 30% of instances of breast cancer can be tied back directly to the risk factors, including 10% caused by BRCA mutations. The remaining 70% of breast cancer cases are not directly linked to risk factors. This works both ways:
You might be genetically at risk of developing breast cancer and tick every item on the lifestyle list and still not get cancer,
You might be BRCA negative and have the healthiest, fittest lifestyle ever and you might still get cancer.
That being said, there are risk factors you have absolute control over, and it’s never too late to start working out, switch to a healthier diet, quit smoking, limit your alcohol consumption and reduce exposure to unsafe chemical agents and radiation.
Symptoms of Breast Cancer
TL;DR: the most common sign of breast cancer is a lump in the breast, but that doesn’t mean every lump is cancerous. If you find a lump, please get it checked out by your doctor. Don’t panic - it’s probably nothing!
Signs of early breast cancer:
The first and foremost sign of early breast cancer is a new lump or mass in the breast. 43% of breast cancer instances are self-discovered: through regular self-examination (25%) or by accident (like in the shower) - 18%.
These are the “classic” features of a breast cancer lump:
it usually doesn’t go away with your period,
it usually doesn’t move around in your boob when you poke or try to roll it,
it usually feels like a hard marble,
it’s usually not round but rather irregular - it could be elongated, spiky, wobbly, cloud-shaped,
it’s usually not painful.
That being said, it can also be soft, round, tender, painful, mobile, and it can also feel very different depending on where you are in your menstrual cycle. In my experience, my lump was soft and rather round, and it sort of came and went away depending on my period. The morning of my ultrasound appointment I almost cancelled it, because I swear I couldn’t feel it anymore.
Other possible signs of breast cancer:
swelling of the breast, even if no lump is detected,
dimpling in the skin, kind of resembling orange peel,
pain or itchiness in the breast or nipple,
nipple inversion,
one nipple being lower or higher than the other,
flakiness or redness of the skin,
nipple discharge,
swollen lymph nodes, in the armpit or neck.
Breast cancer can present itself with any or none of the symptoms above though, especially when it’s early stage. The lump has to be at least 0.5 cm to be felt by your fingers and be found in a self-examination. Changes smaller than that can be detected in routine imaging, like with an ultrasound, mammogram or MRI (see my post about imaging diagnostics here).
What To Do If You Find a Lump?
Ok, so you found a lump.
You’ve read through the risk factors and possible early warning signs above.
You’re breathing (if you need some help calming your breathing, I use this video religiously and this grounding method).
You’ve already called your doctor and signed up for an appointment.
Waiting for your appointment can be incredibly stressful, I know. Try to distract yourself while you wait - do some work, go out for a run or a yoga class, go watch a mindless Netflix show. Please try to stay away from googling symptoms, diagnoses and prognoses - it won’t do you any favours. Keep in mind it probably is not breast cancer (read through the stats above and the risk factors). You can message me on instagram if you want to chat - my DMs are always open 💌
What to expect when you see your doctor?
Your doctor will examine you, and depending on the characteristics of your lump and other symptoms you might be presenting, they might refer you to a breast clinic or for diagnostic imaging. You can read more about the diagnostic process in my post about it here. A lot of times this is just to be sure and give you peace of mind. The only way to diagnose cancer is through a biopsy, and even if you get to that stage, 80% of biopsies are NOT cancer.
What if it is cancer?
Try not to get ahead of yourself!
If it is cancer, it is totally manageable, I promise. Breast cancer is the most common cancer in the world and because of this, it is very well researched and funded, and new treatments are being developed all the time. The earlier it is detected, the higher the chances of a full recovery - more than 90% at this point. You will be fine.
Stay calm, connect with other breasties (my DMs are always open), stay away from google and listen to your doctors. You will be fine.
Onwards!