What to Know About Breast Cancer at Every Stage of Your Life, According to Experts

October is Breast Cancer Awareness Month. Hear what Dr. Heather Richardson, mastectomy surgeon at Bedford Breast Center and Dr. Kelly Hunt, chair of MD Anderson Cancer Center's Department of Breast Surgical Oncology, have to say about what you should know about how to prevent and detect breast cancer in your 20s, 30s, 40s and beyond 

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In Your 20s You Should ... Get Comfortable With Your Breasts

A beautiful young woman is suffering from pain in the breast. She is touching her body to check that everything is ok. BSE or Breast Self-Exam. Guidelines to check for breast cancer.

"It's important to start early with regular breast checks," says Dr. Heather Richardson, mastectomy surgeon at Bedford Breast Center. "You usually want to perform these self-exams at day 7-10 of your period, when the tissue is calmest and even."

In your 20s, your breast tissue is usually at its most dense, lumpy and complicated, that you get used to what your tissue feels like. "The more you appreciate the way your tissue normally feels like, the more likely you are to sense a change," Richardson says, noting that it is normal to feel rubbery, tender lumps.

Things to look out for:

  • Painless, hard lumps that stand out against regular tissue.
  • Areas that the breast pulls in or dimples.
  • The nipple sinking into the breast.
  • Shadowing or skin-color change.
  • Fluid coming out of the nipple when you are not touching your breast (you may notice this as staining on your bra).
  • Dr. Kelly Hunt, chair of MD Anderson Cancer Center's Department of Breast Surgical Oncology adds, "If you develop a mass that is enlarging and not going down later in your menstrual cycle, that is something of concern that should be brought forward to your doctor."

Dr. Richardson says that there are plenty of healthy reasons for these occurrences, so no need to be alarmed, but it is best to go get it checked out by your doctor.

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In Your 20s You Should ... Be Aware of Your Family History

Mother and daughter sitting on sofa and looking at photo album, at home.

When you're aware of your family history and the potential presence of breast cancer, you can more accurately determine if you should be screened for breast cancer at a younger age, or get a genetic test. ("Father's history is just as important as mother's," Dr. Richardson says.)

Dr. Hunt explains, "Women who have a strong family history of breast or ovarian cancer can have gene mutations, especially in BRCA1 and BRCA2, and so if their family does have a history of breast or ovarian cancer, they need to know that. Depending on age of presentation of their other family members, even women in their 20s can get breast cancer."

Dr. Richardson echoes that sentiment: "Talk to your relatives and get to the bottom of your family history. This is especially important for people of color and people with Ashkenazi Jewish heritage because those patient populations have a higher risk of having hereditary disease. And especially people of color have a higher risk of having younger, more deadly cancers."

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In Your 20s You Should ... Talk to Your Doctor

Female healthcare worker explaining medical records to young patient in office

As part of your annual gynecologist appointment, you should expect to receive a breast exam; this is the time to open up dialogue about your breast health, especially if you have noticed changes in your breasts while conducting self-examinations, have a history of breast or ovarian cancer in your family or are a person of color.

Dr. Hunt says being prepared with your full family history can help your doctor know if you're a candidate for advanced screenings. "Sometimes, when I see individuals who have a lot of cancer in their family, they never really talked to anyone about whether or not they are good candidates for genetic testing," she says. "Whether you're in your 20s or your 30s or even 40s, it's really important that people know about their family history and other risk factors."

Dr. Hunt adds that "If you were treated for lymphoma in your teens or early 20s, you may be a candidate for increased screening with MRIs as well."

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In Your 20 and 30s You Should ... Adopt Healthy Habits Early

Asian women at home making healthy meal

Taking care of your overall health is important to prevention of breast cancer. Dr. Richardson gives the following advice to help lower your risk factors:

  • Lay down the foundation of exercising regularly.
  • Keep your BMI down and a healthy body weight.
  • Avoid alcohol.
  • Keep red meat and dairy consumption to a minimum and try to maximize a plant-based diet.
  • Dr. Richardson suggests "one cup of soy a day and ground flax seed — it's one of the only food sources of lignans, which are incredibly protective of the breast tissue. They act like plant-based estrogen and calm the breast tissue down and really soothe it. Also, nice, high vitamin D levels."
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In Your 30s You Should ... Calculate Your Risk

Shot of a young woman using a laptop and having a salad while working from home

If you hadn't already been flagged as having an elevated risk (for family history or gene mutations), in your 30s, you can begin to calculate your risk for developing breast cancer. You can do this either with the help of your doctor or with accredited online tools.

"National Cancer Institute has a risk calculator that is available for all women," says Dr. Hunt. "It calculates the risk of breast cancer for the next 5 years and also for your lifetime risk."

That knowledge can be useful to formulate a plan for your health. "Once you know your risk and whether you're at average risk or increased risk, what can you do to reduce your risk?" she says. "For each individual, that is going to be a different plan."

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In Your 30s You Should ... Be Aware of How Pregnancy Changes Your Breast Tissue

A pregnant woman looks out of the window in the living room of her home with her hands gently holding her stomach.

"With pregnancy and breastfeeding there are a number of changes in the breast," Dr. Hunt points out, which is a change that might affect women in their 20s and 30s who are having children. "It's important to understand these changes and work with your OB-GYN to sort through all of them."

What to look for? Lumps might occur with the normal breast enlargement during pregnancy, but "we do have to be a little bit more concerned ... and have it evaluated with ultrasound right away," Dr. Hunt says. "That's because the hormones of pregnancy may influence or increase the growth of breast cancer."

And while mastitis during breastfeeding can cause normal redness and tenderness that can usually be addressed, "if the breast stays red, swollen and engorged, that can be the presentation of inflammatory breast cancer, which is a particularly aggressive form of cancer that we tend to see more in younger women."

"That is not to say that every time someone has a red, swollen breast that it is inflammatory breast cancer," she adds, "but if it does not respond appropriately to interventions, then you need to get it evaluated."

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In Your 30s You Should ... Talk to Your Doctor About Breast Imaging

Doctor woman examining her patient breast for cancer

Usually, doctors recommend breast imaging in your 40s and 50s, but your 30s are a good time to talk to (or continue talking to) your doctor about whether or not you need any imaging done on your breasts earlier. Depending on your breast tissue, which changes over time, this can include mammograms, ultrasounds or MRIs.

Dr. Richardson says, "Especially if you're a person of color or of Ashkenazi Jewish heritage, you should be asking your doctor if these images need to be captured earlier."

Dr. Hunt adds, "Women who have family history, we often say that you should start screening 10 years before the age that your mother was diagnosed. So that's something to talk to your doctor about."

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In Your 40s You Should ... Get Your First Mammogram

Friendly female doctor talking to her patient and adjusting her position to do a mammogram at the clinic

If you've talked to your doctor, calculated your risk, and found that you do not need early screening or imaging, then your 40s is when you should be scheduling your first mammogram and continuing to get them annually (or at a frequency discussed with your doctor).

If you have dense breast tissue, talk to your doctor about potentially adding in ultrasounds, and if you are at high risk of breast cancer, ask your doctor about whether she recommends adding in MRIs as well.

Dr. Hunt advises consulting the National Cancer Institute's website to educate yourself on the options and being fully informed of your family history, so you can advocate for the best imaging course of action for you.

"We want [the imaging] to be appropriate for each individual," Dr. Hunt says. "You can take the information that you learn and bring that to your physician and personalize it. It's definitely not a one-size-fits-all approach. We all have different family histories and they evolve over time, of course."

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In Your 50s You Should ... Optimize Your Health

Mature fitness woman tie shoelaces on road. Cheerful runner sitting on floor on city streets with mobile and earphones wearing sport shoes. Active latin woman tying shoe lace before running.

Continue to build on your healthy habits (you know, the ones you put into place in your 20s and 30s). "In your 50s, you want to be sure that you're doing everything in your body to keep cancerous changes from happening," says Dr. Richardson. That includes:

  • Consuming cruciferous vegetables. These contain sulforaphane, which are protective against breast cancer changes
  • Avoiding processed foods and sugars. These can trigger insulin receptors which can drive the creation of cancers.
  • Getting good sleep! Melatonin, which is created during sleep, is a cancer fighter.
  • Avoiding stress.
  • Optimizing your health with exercise and balanced diet.
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In Your 50s You Should ... Continue Speaking With Your Doctor

African American doctor and patient talking in office

In your 50s, continue having conversations with your doctor about what is right for you and your body and attending your annual screening.

You should also re-calculate your risk assessment, says Dr. Hunt: "All of the parameters in the risk calculator change over time. If you do it in your 20s it could change, so you need to understand it as it changes over time."

Dr. Richardson says that this would be the time to "discuss with your doctors if you need to be on hormone replacement therapy. If you're perimenopausal and having symptoms, talk about the risks and benefits of hormonal changes that may or may not impact the risk of breast cancer."

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In Your 60s You Should ... Discuss Potential Preventative Treatments

Mature doctor using digital tablet to explain to female patient
Hero Images/Getty Images

The average age of breast cancer development is 59. In your 60s you should be understanding your screening process, the types of screenings you should have and understanding your risk. Additionally, if you have had a breast biopsy and there were findings on them that signify increased risk, you should be considering options for chemoprevention (taking medicines that can reduce your risk levels).

For example, Dr. Hunt says, that the treatments or preventions for osteoporosis (for which aging women are also at higher risk) can also be useful for risk reduction for breast cancer.

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In Your 60s and 70s ... Revisit Your Screening and Treatment Plan

Mammography result

Breast tissue starts to thin and become less dense in your 60s, which means "the screening can sometimes become less complicated," Dr. Richardson says, which means "sometimes women in their 60s sometimes can back away from extra screening modalities."

That does not mean you should be cancelling your next mammogram — just that you should be talking with your doctor about your specific needs.

"We still want to stay on top of things," says Dr. Richardson. "It's not that we don't need to look at [less complicated breast tissue] anymore, it's that we may not need to look at it with as many studies."

So how will you and your doctor decide what cadence is right? "There's not really a lot of good data in breast cancer screenings of older women," Dr. Hunt says. "If you're in good health and you and your physician have discussed it, then you should continue to do your screenings. But if ... you have multiple other medical issues that are competing risks that are more critical, you might choose not to continue breast cancer screenings [in order to focus on your other higher-risk factors]. That is a conversation that older women need to have with their doctors."

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