Breast Cancer awareness month: Know your normal: the breast changes women shouldn’t ignore
A breast cancer diagnosis is something most women would rather not think about.
But Community Breast Nurse Educator Debra Leutenegger says breast awareness is not about being frightened. It is about knowing your own body well enough to recognise when something changes.
“Knowing your normal” is a phrase women hear often, but Leutenegger says it means becoming genuinely familiar with how your breasts normally look and feel.
“What’s normal for me won’t necessarily be normal for you or someone else,” she says.
One breast may naturally be slightly larger than the other, nipples may look different from one another, and some women simply have lumpier breast tissue.
Breasts also change throughout different ages and stages of life.
The important thing is recognising when something is new.
Leutenegger encourages women to remember TLC: touch, look and check.
When checking breasts, women should feel through the breast tissue rather than simply touching the surface, working from below the collarbone down to the bra line and around into the armpit.
Looking is equally important.
Changes can include a new lump or thickening, a nipple becoming inverted or pulled to one side, clear or bloodstained nipple discharge, dry or crusty skin around the nipple, puckering or dimpling of the skin, an area that may look like orange peel, or a change in the size or shape of a breast.
Persistent pain in one breast should also be investigated, particularly when it is unrelated to the menstrual cycle.
While most breast lumps are benign, Leutenegger says every new lump should still be checked.
Screening is not the same as diagnosis
One distinction Leutenegger believes women need to understand is the difference between routine breast screening and investigating a symptom.
A screening mammogram is designed for women who do not have breast symptoms. Its purpose is to find changes before they can be felt.
If a woman discovers a lump, nipple change or another new symptom, she should not simply wait for her next routine mammogram.
“If you have a symptom, no matter what age you are, your first port of call should be your GP, not your screening mammogram,” Leutenegger says.
That remains the case even if a woman has recently received a normal mammogram result.
A mammogram provides information about the breasts at a particular point in time. Changes can develop between routine screenings, which is why remaining breast aware is important.
What are dense breasts?
Breast density is another area Leutenegger says many women know little about.
Breasts contain different proportions of fatty, glandular and fibrous tissue. Younger women generally have denser breast tissue, although some women continue to have dense breasts as they get older.
The difference matters when it comes to mammography.
On a mammogram, fatty tissue appears darker or grey, while cancer can appear white. Dense breast tissue also appears white, potentially making abnormalities more difficult to see.
“You’ve essentially got white on white,” Leutenegger explains.
Women cannot tell whether they have dense breasts simply by looking at or feeling them.
Leutenegger says women with questions about their individual breast density or screening needs should discuss these with their doctor.
Not all breast imaging is the same
A standard mammogram is a two-dimensional, low-dose X-ray of the breast.
Ultrasound uses sound waves to examine breast tissue and can provide additional information when a particular area or symptom is being investigated.
Three-dimensional mammography, or tomosynthesis, takes multiple images through layers of breast tissue, providing a more detailed view.
There is also contrast-enhanced mammography, which combines mammography with an intravenous contrast agent to help highlight areas of abnormal blood flow that may be associated with tumours. This is currently only available at some private specialist clinics in New Zealand.
Which investigation is appropriate depends on the individual woman and why the imaging is being carried out.
Breast health in rural communities
For rural women, access can be another piece of the breast health puzzle.
Distance from screening services, time away from the farm or work, and fitting appointments around family and other commitments can make looking after their own health easier to put off.
Leutenegger says mobile services are helping bring breast health information and screening closer to rural communities, although the two services are sometimes confused.
Breast Cancer Foundation NZ’s pink campervans travel throughout the country, including into rural and remote communities, offering free breast health education and helping women learn how to check their breasts.
BreastScreen Aotearoa operates separate mobile screening units, which provide mammograms to eligible women in communities around New Zealand.
“They’re not into every little town, but it’s closer than maybe going to a city to get your mammograms,” Leutenegger says.
For women juggling farming, work and family, she says it is important not to continually put their own health at the bottom of the list.
“We look after elderly parents, husbands, children and grandchildren, we work, and we tell ourselves we don’t have time.
“But we want to be around for our whānau. Looking after our own health is part of that.”
Talk about it
Leutenegger’s message this Breast Cancer Awareness Month is simple.
“Know what is normal for you.”
And if something changes, get it checked.
“Don’t be afraid to have something checked, even if you’ve recently had a mammogram. That decision could save your life.”
Leutenegger also wants women to talk about breast health more openly.
“We need to support and encourage each other.
“Ten years ago, when I started working at the Foundation, I didn’t know whether my girlfriends were having their mammograms. I do now, because we talk about it.”
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