October is recognized as Breast Cancer Awareness Month, and experts emphasize the importance of regular self-exams to help detect early signs of breast cancer. Dr. Julie Nangia, medical director of breast oncology at the Dan L Duncan Comprehensive Cancer Center and associate professor of medicine – oncology at Baylor College of Medicine, advises women to perform monthly self-examinations.
“The idea is to get to know your breasts – how they feel and what they look like – so that you notice when something is different,” said Nangia. “I tell my patients the best time to do your breast exam is two weeks after your period. I do not recommend examinations more than once a month because you may not notice changes on a day-to-day basis.”
Dr. Nangia recommends using the flat part of three middle fingers in a circular motion around the breast tissue during self-exams, making sure not to skip any areas. She also advises extending the examination into the armpit area since breast cancer can sometimes appear in lymph nodes there. She notes that it is normal for breasts to feel lumpy, so understanding what feels normal for each individual is important.
When conducting a self-exam, women should look for any masses that are hard and may vary in size or shape. “A mass may not be cancer. It could be a cyst or a benign fibroadenoma, but it’s important to get any mass checked out by a doctor and to have a mammogram and/or an ultrasound,” Nangia said.
Temporary changes in the breasts can occur around menstruation or due to caffeine intake, which can aggravate cysts or cause pain. “If there’s a change lasting more than two weeks, I recommend showing it to a doctor,” Nangia said.
Visual inspection in front of a mirror is also recommended. Women should check for skin changes such as redness that does not improve after two weeks or other visible differences. According to Nangia, persistent redness may indicate infection or inflammatory breast cancer. Changes in nipple appearance or direction should also be brought to medical attention.
For screening beyond self-exams, Dr. Nangia suggests annual clinical exams with healthcare providers and starting annual mammograms between ages 40-50 for women at average risk, with timing individualized through discussion with their doctor. Mammograms are used to identify masses, abnormal calcium deposits, asymmetry between breasts, and year-to-year changes.
However, some cancers may not be detected by mammogram alone due to dense tissue or certain cancer types such as infiltrating lobular carcinoma (ILC), which can be harder to see on imaging tests.
Women with family histories of breast cancer are advised to begin screening earlier—typically 10 years before the age at which their closest relative was diagnosed—and may benefit from genetic risk assessments if multiple family members have had cancer or if known gene mutations like BRCA1 or BRCA2 are present.
“If you have a family history of breast cancer, especially at age 50 or younger, or if you have had a breast biopsy that shows a precancer change, we recommend a risk assessment at the Duncan Cancer Center’s Breast Cancer Prevention Center,” Nangia said.
Lifestyle choices can influence risk levels for developing breast cancer. “Studies have shown that 20 to 30% of breast cancers can be prevented by lifestyle changes,” Nangia said. Regular exercise—such as walking three to five hours per week—is encouraged; maintaining healthy body weight is particularly important after menopause when obesity increases risk; breastfeeding provides protective benefits; and reducing alcohol consumption lowers risk as well.
“There is a process the milk ducts go through when you breastfeed that protects against breast cancer,” Nangia said. “No one should feel ashamed or upset if they can’t breastfeed. For those who are able to do it, each year of breastfeeding will be protective against cancer.”
Nangia also points out that limiting alcohol intake—three drinks per week or fewer—is advisable and notes evidence suggesting folic acid may offer additional protection for women who consume alcohol regularly: “Folic acid is naturally found in leafy green vegetables, or you can take a folic acid supplement.”
