Last week, Dr. Philippa Kaye, the author of an important new book, Breasts: An Owner’s Guide, on what to do about the many problems other than cancer affecting the breasts. This week, the GP looks at the top issues to watch out for in middle age and beyond…
My 55-year-old patient, let’s call her Nina, seemed puzzled. I had asked the question I ask many middle-aged women who come to my GP office: ‘Do you have any concerns about your breasts?’
She bluntly told me she doesn’t pay them much attention since they “moved south for the winter.” After stopping breastfeeding decades ago, she “couldn’t bear to look at her today.”
It’s a well-known story. While younger women seem conscious of their breast health, they reach a certain age and forget it exists. But it is at this point in life that they are most likely to cause health problems.
My 55-year-old patient, let’s call her Nina, seemed puzzled. I had asked the question I ask many middle-aged women who come to my GP office: ‘Do you have any concerns about your breasts?’
In Nina’s case, she had developed a small growth which she only noticed when she went home to examine her breasts that evening – on my advice. Luckily, it turned out to be a harmless cyst – but when she noticed it, she realized it was the soreness around her bra strap to blame.
And of course it could have been something much more serious.
Not only does the risk of breast cancer increase significantly between the ages of 40 and 51 – with eight out of 10 cases occurring in those over 50 – but falling sex hormone levels mean we are more susceptible to other breast problems as we age.
Last week, coinciding with the release of my book, Breasts: An Owner’s Guide, I outlined everything that could go wrong besides cancer—from rashes to pain, strains to jogger’s nipples.
This week, I take on the unnecessarily taboo subject of middle-aged breasts. It’s not often that we speak openly about the intimate parts of women of a certain age, but we should, especially since this is the time when talking about your breasts is most likely to save your life . From screening myths to life after cancer to avoiding sagging, here’s the ultimate guide to middle-aged breast care.
They can improve a sagging bust
A few weeks ago, Sarah, a 48-year-old teacher, came to me and complained that she had lost her libido. She thought it was due to the natural reduction in sex hormones as she approached menopause.
But as we chatted, it became clear that the problem had nothing to do with her hormones. Instead, she was wracked with worries about how her body looked naked.
Of particular concern were her breasts. “They’re limp,” she said. “I feel unattractive and the last thing I want is sex.”
Sarah is far from alone. In fact, I think we often underestimate the impact physical changes can have on our mental health.
Wearing the right sports bra can prevent the ligaments and skin from stretching, which can contribute to sagging.
Sagging – breast ptosis – affects all women, not just those with larger bust sizes, for a number of reasons.
First, declining estrogen levels. This hormone helps create the protein collagen, which keeps skin taut. Also, the glandular tissue involved in milk production begins to shrink, causing the breasts to become less dense and mostly composed of fatty tissue.
These changes can cause the breasts to appear smaller, lower, elongated, or flattened. You may notice that the nipples are pointing down instead of up and there may be more space between the breasts. In some women, hair also grows around the areola — the ring of pigmented skin that surrounds the nipple.
There are things you can do to fight gravity. First, don’t smoke. It weakens the blood vessels that carry oxygen to the skin and damages collagen. Exercises to strengthen the chest wall and shoulder muscles, such as lifting weights, can also help raise the breasts slightly. And wearing the right sports bra can prevent the ligaments and skin from stretching, which can contribute to sagging.
For Sarah, it has helped her address her insecurities, open up to her husband, and relieve some of the pressure.
Don’t be afraid of your mammogram
You’d be surprised how many women tell me they don’t attend their breast exams.
The scans, offered every three years to women ages 50 to 71, prevent about 1,300 breast cancer deaths each year. However, studies show that around a third of women in the UK do not show up. Why? There are a couple of reasons.
Take 68-year-old Sonal, for example, a patient who never went to any of her checkups because she fears it might hurt.
I explained to her that a mammogram involves taking an X-ray by placing the breast between two plates. This can cause a pinching sensation that can be painful.
For some women, the symptoms can last for a few days, but for most, it’s gone by the time the mammogram is finished, which only takes a few minutes. This seemed to reassure Sonal, although she was also troubled by stories that mammograms cause cancer.
She speaks of radiation exposure. But the amount used during mammography is vanishingly small. In fact, you would be exposed to the same amount for seven weeks just by living.
Meanwhile, another patient, Liz, 64, had been reading about overdiagnosis — when screening picks up cancers that turn out to be harmless. She didn’t want any treatment she didn’t need.
It’s true that some breast cancers are not life-threatening and, in fact, never cause any symptoms at all, but the risk of screening for this is small. About 3.7 percent of all breast cancers found are considered harmless.
And then there are those with what I call “afraid to find out” – scared of what might turn up.
I explain that if something shows up during a screening, most of the time it’s not cancer.
Of the four women in 100 who have requested follow-up after breast exams, three quarters will have no cause for concern.
Breast screening saves lives, especially in older women.
You will start to find mid-life lumps
If a lump or bump develops in your breast, harmless or not, it’s likely to happen in middle age. The type varies by age.
Women approaching menopause, in their 40s and 50s, are more likely to notice that their breasts are bumpy at certain times of the month. This is because ovulation is still happening, albeit irregularly, and the changing hormone levels can cause changes in the breasts.
Last week I mentioned something called fibrocystic breasts – clusters of small cysts and areas of fibrous thickening. It can feel like frozen peas in the chest, which can be uncomfortable, and is more common in women under 50. Single cysts are more common as women get older, but they can develop at any age.
If you notice a lump, see a doctor. As I said last week, we GPs don’t have x-ray goggles, so we might send you to a chest clinic for scans and other tests. This happens as part of a two-week cancer referral, but nine times out of ten the lumps are harmless.
Women approaching menopause, in their 40s and 50s, are more likely to notice that their breasts are bumpy at certain times of the month. This is because ovulation is still happening, albeit irregularly, and the changing hormone levels can cause changes in the breasts
Cysts are fluid-filled sacs and are smooth and firm to the touch. We don’t know exactly why they form. Having them doesn’t mean you’re more likely to get cancer.
A cyst usually doesn’t need treatment, but if it’s bothersome it may be possible to drain it surgically, although it can be refilled. This is done under local anesthetic – the skin is punctured with a tiny needle that allows the fluid to escape.
Other types of lumps include a fatty growth called a lipoma, which can be soft enough to bruise under the pressure of your palm, or fatty necrosis. The skin around a lump of necrosis may appear red or bruised and is more likely to occur in women with larger breasts.
Scar tissue can also cause a hard lump, as can an intraductal papilloma, which appears like a small wart near the areola. The latter can also lead to discharge from the nipple.
Unfortunately, these lumps must be treated as potential breast cancer until proven otherwise. GPs can’t tell which are harmless from the exam, so it’s likely you’ll be urgently referred to a breast clinic. Above all, try not to panic. That doesn’t mean you have breast cancer.
The side effects of cancer treatment
Thirty years later, women diagnosed with breast cancer would be lucky if they survived five years. Now 80 percent of those who develop the disease will live at least a decade – but the effects can outlast treatment.
Most of these women are discharged from specialist services and go to their GP for answers.
First, there are physical changes that can affect self-confidence — not just for those who’ve had a mastectomy — one breast removed. Radiation therapy can also cause one breast to become firmer and smaller than the other. Those who have had a lumpectomy (when the cancer is removed but the breast is preserved) may notice indentations over the scar or attachments of skin.
Scar physiotherapy – which uses stretching and massage to heal tissue – can reduce pain and improve appearance but is not usually offered by the NHS.
A common problem is lymphedema, which affects about one in five women after breast cancer surgery and can develop years later.
The condition is a buildup of fluid that causes swelling and a feeling of stiffness in the arm and hand on the affected side.
It develops when the lymphatic vessels — thin tubes that carry waste fluid and white blood cells around the body — become damaged during surgery. GPs can refer patients to specialist lymphedema nurses for treatments such as massage and pressure clothing. There are also things you can do to reduce the risk of developing it, such as upper body training and eating a balanced diet lower in salt.
Sunburn and skin infections increase your risk, so use sunscreen and wear gloves when doing things like gardening. If possible, use the other arm when you go for a blood test.
Women who have had breast cancer may be prescribed hormonal medications to block estrogen to prevent it from coming back. But the pills increase the risk of osteoporosis, in which bones become brittle and more likely to break.
Those taking certain types of hormonal medications should be offered regular bone density tests, and may benefit from vitamin D and calcium supplements to help strengthen their bones.
And don’t be afraid to ask your family doctor for psychological support if you are dealing with the consequences of cancer.
Women often suffer in silence, but talk therapy can help, as can support groups.
Breasts: An Owner’s Guide, by Dr. Philippa Kaye, (DK), is available now, RRP £15
My guide to the perfect sports bra
Exercise is important, but women are often put off by breast pain or discomfort.
This is thought to be caused by connective tissue stretching from repetitive movements of the breast. It can cause changes in the internal breast structure – so good support is key.
There are three main types of sports bras. Encapsulation bras look similar to everyday bras and support each breast within the cups. They have wide shoulder straps and are best suited for women with larger breasts and/or intense workouts.
dr Philippa Kaye: Change your sports bra every six to 12 months. Studies show that they lose their hold after about 25 washes
Compression bras are usually better for smaller breasts. They support by pressing the breasts against the chest. Combination bras combine elements of the two.
A few things to look out for: Choose a fastener that is covered by material to avoid chafing or skin damage.
Adjustable shoulder straps are a must. Two people can have the same breast size but different heights, so they don’t have the same distance between breasts and shoulders.
The side of the bra shouldn’t dig in, which can cause chafing, and high necklines often provide more support. Also, change your sports bra every six to 12 months. Studies show that they lose their hold after about 25 washes.