Dr Sundar Shrestha: The basics of breast health

No matter your age, it’s important to keep your breasts healthy and have a basic understanding of what’s normal. That way you can nip problems in the bud, should they arise. Dr Sundar Shrestha, general consultant at Bir Hospital in Kathmandu, who specializes in Endocrine, GI, and Laparoscopic surgery, runs us through the basics of breast care in a conversation with ApEx.

What are the symptoms of breast health issues?

Usually, breast health issues come with the symptoms of breast pain, heaviness, and nipple discharge, whether bloody, watery, or black/blue. Also, you should pay attention to changes in your breasts, like lumps, changes in size or shape, persistent pain, tenderness, and skin texture. One should be mindful of changes in breast temperature as well, as heat could be indicative of some problems. To avoid risks, it’s better to do routine self-checks and seek medical help if you notice any unusual signs.

How do you differentiate between a normal breast and an abnormal one?

During puberty, girls typically experience natural breast growth and some women may feel like their breasts are getting heavier before, during, or after their menstrual period. These are normal. However, unusual discharges (bloody or greenish), the presence of breast lumps, tenderness, hot areas (with or without fever), and uneven nipple position or size (either up and down or the nipple turning inward or to the side) can indicate some abnormality within the breast tissues.

What are some of the common breast health issues?

Some women have breast abscesses. These are usually common in lactating mothers. Fibroadenoma are little lumps which are also called ‘breast mice’ and they are usually found in women aged 15 to 35. It’s important to take notice of these issues and consult a doctor. A retracted nipple, where your nipple dips into the areola and doesn’t stick out as it should, can be a cause for concern. Breast eczema may cause itchy and scaly areas around the nipple. Uneven breast size can be considered normal unless there are other signs and symptoms or it’s congenital. Ductal ectasia, causing discharge from some nipple ducts, is another issue you should be aware of. If you’re facing any of these problems, it’s very crucial to seek medical help as soon as possible.

What are the main risk factors for breast cancer?

It’s important to know if breast cancer runs in your family. If you haven’t had children, you should pay extra attention to your breast health as nulliparity comes with a higher breast cancer risk. If you have been exposed to radiation, whether for medical reasons or at work, that’s something to think about too. 

As we get older, the chances of breast cancer increases. Carrying heavy loads can also increase your risk. Drinking alcohol and smoking are also risk factors. The onset of menstruation before the early age of 12 or experiencing menopause after 55 can also impact breast cancer risk. It also depends on ethnicity, with white women at higher risk. 

Do the menstrual cycle and contraceptives affect breast health?

The menstrual cycle and the use of contraceptives impact a woman’s breasts in different ways. During menopause, the decline in estrogen and progesterone levels may affect breast tissue, while the reduction in breast density can result in abnormalities later. Throughout the menstrual cycle, hormonal fluctuations can alter breast tissue density and sensitivity, causing breast tenderness in some women. While modern contraceptives with low estrogen are safe and don’t increase the risk like some pills do, it’s important to consult a doctor before taking anything. Also, be careful with other hormone treatments and try to avoid radiation exposure. 

What can be done to prevent breast health issues?

To keep your breasts healthy and lower the chance of getting breast cancer, you can do a few things. First, make sure to go for regular check-ups, like mammograms, which are x-ray checks for breast health. Catching problems early can help fix them with minimal hassle. Also, check your breasts yourself each month and look for any changes. Eating good, nutritious food, not smoking or drinking too much alcohol, and staying active by exercising can also go a long way. 

How can we self-check for problems and what’s the right age to start regular mammogram screenings?

It’s a good idea for women in their reproductive years to check their breasts for any changes every month. For that, stand in front of a mirror and look at your breasts. Check if they look different in size, shape, or skin texture. Lift your arms and use your fingers to feel your breasts for lumps or anything unusual. You can start with mammograms after you turn 40, and I recommend the test every couple of years.