Why breast awareness should become as normal as nail trimming

Let's face it, none of us are immune. The UK national screening programme might only kick in at age 50 for most, but the risk is ever present; from age 8 to 80 and beyond.

It's the most common cancer in the UK. And it's by far the most common cancer in women; impacting around 1 in 7 women. Or, to put it another way, 30% of all new female cancer cases are attributed to breast cancer. For men, that figure is just 1%. Although rare in children and young adults, it's often diagnosed in its later stages and can be more aggressive, which means the risk of mortality (death) is higher.

And, on the subject of risk, as well as getting to know what normal feels like, there are various 'risk factors' that we all need to be aware of. Anything that increases the risk of getting a disease is called a risk factor. Many of these things, such as physical activity, are within your control throughout life. More on this later.

So, let's all fly the flag for making breast awareness a personal hygiene factor; as commonplace as hand washing, brushing your teeth or trimming your nails.

The national screening programme is amazing, but it cannot replace personal responsibility

The national breast cancer screening programme helps save lives. There's no denying that. Overall, the screening programme finds cancer in around 9 out of every 1,000 women. And thanks to a combination of screening, improved treatment and personal awareness, breast cancer survival in the UK has doubled in the last 40 years from 40% to 78%.

This is truly amazing.

However, it's very existence might make people a little lazy when it comes to taking personal responsibility. The fact that it starts at age 50 for most people perhaps sends the message that the risk only kicks in at that age.

Right now, we face an extraordinary set of circumstances, thanks to the pandemic, of around 3 million missed screenings last year - for all cancers for which there is a national programme – and tens of thousands of undiagnosed patients.

Experts have indicated that the NHS' task of trying to simultaneously tackle the backlog while operating 'normal' service levels seems like mission impossible, leaving some to call for a complete overhaul to cancer screening and diagnosis in the UK. An All-Party Parliamentary group recently handed over a paper to government, stating just that and advising that clearing the NHS post-Covid-19 backlog wouldn't be enough.

In short, the need to take personal responsibility has always been ever present. And never more so than right now.

So, what does 'being breast aware' look like at different life stages?

Age 18 - 34

You could certainly start being breast aware before age 18 but, for argument's sake, let's start here. And what better place to start than by building regular breast checks into your personal hygiene routine.

There's no right or wrong way to do this. It's simply about getting to know how your breasts usually look and feel. That way, you can spot any changes quickly and report them to your GP.

Your breasts will feel different at different times of the month. For example, some women have tenderness and maybe some lumpiness, especially near the armpit, around the time of their period. In other words, breast changes can happen for many reasons and most of them are not serious. Plus, most breast lumps are not cancerous.

Look at your breasts and feel each breast and armpit, and up to your collarbone. Perhaps do this in the shower or bath. Also look at your breasts in the mirror, with your arms by your side and also with them raised.

When should you see your GP?

A change in the size, outline or shape of your breast.
A change in the look or feel of the skin on your breast, such as puckering or dimpling, a rash or redness.
A new lump, swelling, thickening or bumpy area in one breast or armpit that was not there before.
A discharge of fluid from either of your nipples.
Any change in nipple position, such as your nipple being pulled in or pointing differently
A rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple.
Any discomfort or pain in one breast, particularly if it's a new pain and does not go away (although pain is only a symptom of breast cancer in rare cases).

Breast cancer is rare in your 20s and 30s, accounting for less than 5% of all cases, but it's the most common cancer for women in this age group.

Of course, being breast aware isn't only about checking. It's also about those risk factors, as mentioned earlier. This is about living a healthy lifestyle; limiting alcohol intake (no more than 14 units a week); eating a healthy, balanced diet; and being physically active - current government guidelines indicate a minimum of 150 minutes of moderate exercise a week. This is anything that makes you a bit warmer and slightly out of breath.

Fact or fiction?

Does using an aluminium-based anti-perspirant increase your risk of breast cancer? Although some people wonder whether aluminium in some deodorants affects cancer risk, there is currently no good evidence to suggest a link.

Age 35 – 49

Regular breast checks and the maintenance of a healthy lifestyle should continue throughout life, even when it can sometimes seem like you're juggling too much; the work life balance, maybe even acting as a carer to your elderly parents as well as your own children. Your health should never take a back seat.

The earlier you spot a potential problem, the better. The statistics on this speak for themselves. For example, 97.9% of women survive early breast cancer (stage 1) where there is no spread beyond the breast for at least 5 years.

Your breasts might change again at this stage in life, especially because of pregnancy, breastfeeding and perimenopause. Again, a lot of lumps and bumps will be normal but if anything at all worries you, don't hesitate to see your GP.

Also, bear in mind that you might be offered health checks, even well-woman through your employee benefits programme at work, so take advantage of these, along with any other relevant health and wellbeing services provided.

Fact or fiction?

Should you avoid the Mirena coil if you have a family history of breast cancer? The Mirena coil is a type of contraception for women that releases a small amount of hormone - a manufactured version of progesterone - into your womb every day, helping to prevent pregnancy. The manufacturers do not recommend using the Mirena coil if you have had any hormone dependent cancers, including breast cancer. Whether or not it increases the risk of getting cancer in the first place is unknown. The results from research studies have reportedly been mixed.

Age 50+

Now is the time to attend routine screening, wherever possible. The NHS Breast Screening Programme invites all women from the age of 50 to 70 for screening every three years. It's also available for some trans or non-binary people. Talk to your GP or Gender Identity Clinic about this.

Cancer screening is designed to test healthy people for signs that could show that a cancer is developing. So, it shouldn't be considered a replacement for regular personal checks.

Women will be going through various stages of the menopause now and the breasts will change again. After the menopause, normal breasts feel softer, less form and not as lumpy.

It's worth noting that women who are overweight after their menopause have a higher risk of breast cancer than women who are not overweight. So, try to keep a healthy weight throughout life by being physically active and eating a healthy, balanced diet.

Fact or fiction?

Is HRT a complete no-no if you have a family history of breast cancer? HRT has changed dramatically in the last 20 years and can bring numerous health benefits to women so shouldn't be immediately ruled out if you have a family history of breast cancer.

There are two main types of HRT: combined HRT (oestrogen and progesterone); and oestrogen only HRT. According to experts, there is a higher risk from using the combined version. The risk increases the longer you take it.

Informed decision-making is key. It's vital to speak to your GP - and cancer specialists if possible, access to which might be available via your employee benefits programme - about your personal circumstances and premenopausal symptoms to help balance the risks and benefits.

And if you decide to take HRT, have an idea in your head at the start about how long you're going to take it for and stick with that.

About the author

Suzanne Clarkson is the Managing Director of Coach House Communications.