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Breast Health During Midlife: Common Myths, Concerns and Tips for Staying Healthy

Featured Speaker

Cecilia Stroede, MD

Cecilia Stroede, MD

About this Podcast

About This Podcast

Women’s bodies undergo many changes at midlife.

One of the most common areas women experience midlife health issues is with breast health.

Breast cancer is when a cancerous tumor occurs inside the breast.

Earlier detection, combined with improvements in therapy, has resulted in improved survival rates.

Clinical breast exams should be performed every 1 to 3 years up to the age of 40 and then annually after that.

Exercise alone reduces the risk of breast cancer by 25 to 30%, and the association seems strongest for those who engage in moderate rather than extreme forms of physical activity.

Cecilia Stroede, M.D., is here to talk about myths surrounding breast cancer. What are your risk factors? What is the importance of prevention and the elements of a good prevention plan? What are your common breast changes and concerns during midlife?

Dr. Stroede offers everyday living tips for maintaining your breast health and preventing disease.



Melanie Cole (Host):  Keeping your breasts healthy as you age is not a one size fits all proposition. Women's bodies undergo many changes at mid-life. One of the most common areas women experience mid-life health issues is with breast health. My guest today is Dr. Cecilia Stroede. She’s an Aspirus Network breast surgeon specialist. Welcome to the show, Dr. Stroede. What happens to women's breasts as we age?

Dr. Cecilia Stroede (Guest):  Well, the average age of menopause is around 51 and we define that as a 12-month period when you haven't had a period at all which can be difficult to determine if you've had a hysterectomy or not having a monthly cycle. So, during that time period leading up to menopause, there's a lot of hormonal fluctuation that’s going on, so you have a lot of estrogen and progesterone rising and falling. It can give rise to a lot of lumpiness in the breast, breast pain that you haven't had before, and also cysts that can pop out as really scary masses.

Melanie:  So, what do we women do? I'm 51 years old, Dr. Stroede, and just starting peri-menopause. What do you advise that we do to make sure that we're well aware of our bodies and these changes?

Dr. Stroede:  Well, for women of average breast cancer risk, which is going to be most women, you want to combine prevention with screening. So a good screening strategy is to do a monthly self-breast exam, have an annual exam by your provider, and then a yearly screening mammogram. And then, that is combined, then, with preventive strategies that we’ll talk in a minute but if you notice something to be different in the breast that you haven’t felt before then, it's important to kind of look at the area where you feel it, feel the corresponding area on the opposite breast to see if you feel the same thing and then, maybe give it the equivalent of one cycle if you are not regular. If it's still there, it needs to be checked out. So, you need to call your provider, have him or her look at it and then the usual approach, if it's concerning, is to go to a diagnostic mammogram with ultrasound at that point.

Melanie:  If we're giving ourselves self-exams, some women have trouble with this. We don't know what we're feeling. You mentioned if you feel it on the other side. Would that mean that it's something not quite to be as concerned about? What are we feeling for?

Dr. Stroede:  Yes. That's true. So, if you feel it on the opposite side, it's much more likely to be just part of your normal breast architecture. So, about 96% of the time, when women get breast cancer, it is in one breast and one breast only, and certainly would be very unusual to have breast cancer in both breasts and to have it be in the exact same location in both breasts. So, that’s an important starting point. What we're feeling for is texture differences. Certainly a mass--I think most people would pick up on that--but the more subtle finding is a texture difference, maybe it’s thickened. If that doesn’t disappear, it actually does need to be looked at. For women who go and see the doctor annually and have their screening mammograms, it's unlikely that between the time that you were last seen and your last mammogram that you're going to develop some really large cancer that’s going to have advanced signs of cancer that we really don’t see very often anymore. So, we're really looking for subtle things. Pain is not usually a sign of cancer. Pain is a lot more likely to be a sign of hormone fluctuation.

Melanie:  So then, we do these self-exams. We're feeling for the differences. What if you are somebody who has dense breasts? Is there something else you'd like us to know?

Dr. Stroede:  If you have dense breasts, then it's going to be harder for you. It's going to be harder for your doctor and it's going to be harder for your radiologist to screen your breasts. So, if you have a dense breast, one of the things that can really add to the diagnostic dilemma is ultrasound. That’s a very, very important part of a workup on something that is suspicious. But for women with dense breasts, the other thing that happens over time for most women is that a lot of that dense tissue, with age, will go away and will be replaced by fat. So, you will have a softer, less dense breast, probably a more saggy breast, but also a breast that’s more easy to examine and more easy to image for the radiologist.

Melanie:  Of course, it will. That’s what we women go through.

Dr. Stroede:   Yes.

Melanie:   We go through so many changes, Dr. Stroede. What would you like us to know about keeping healthy? Prevention? Things that we can do in lifestyle behavior modifications that we can do that could give us a better outcome.

Dr. Stroede:   So, there's some pretty basic simple things that I think most people are well aware of. Exercise, of course, is good and we know that for women who exercise, I think the number that they've come up to now is at least 4 hours a week of some moderate to better than moderate exercise is going to result in a risk reduction when it comes to breast cancer in about 12%. So, that’s a pretty big deal. Even for women who are obese, exercise will result in breast cancer risk reduction. So, exercise is one and I think that's something that we need to incorporate in our lives pretty much like brushing teeth. It just needs to be a part of it. Keeping a healthy diet is very important as well and I think that staying away from processed foods is a very big first step. If you can’t spell it, don’t eat it. Then, gravitating towards a more plant-based diet and eating meat in moderation and when eating meat make it count. Make it good. Try to make it grass-fed, antibiotic-free and hormone-free, if possible.

Melanie:  What are some of the most common questions, Dr. Stroede, that you get from patients? Some myths or concerns? What do people ask you every single day?

Dr. Stroede:  I think one of the more concerning myths that is part of what people pick up from media, I think, is that family history is really, really a big deal in breast cancer and it is, but it's important to note that only about 5% to 10% of breast cancers that we diagnose are felt to be truly hereditary. So, it's really the minority of people that actually have a true family history and perhaps a genetic mutation as the basis for their cancer. For most people, it is something else--primarily something environmental. We haven’t figured it out yet but I have women that come in with cancers who opted to not have mammograms because they have no family history and, therefore, they didn't feel themselves to be at risk. Breast cancer is a common cancer. Twelve percent of all women in American are going to get breast cancer and that’s second only to skin cancer. So, even a woman at average risk is at high risk.

Melanie:  As our hormones change, as we get older, do you recommend to your patients to use hormone replacement? And do they ask you if hormone replacement therapy contributes to breast cancer?

Dr. Stroede:  Yes, I get that question a lot and I don’t think it’s an easy question to answer because you have to really dig into to what is that individual women's risk. So, if she's had a breast cancer diagnosis the answer is going to be “no.” It will increase the risk of recurrence and it is definitely not going to be a good idea. If this is a women who is at higher risk because of either an identified genetic predisposition which, again, are rare or maybe something abnormal that she's had on a biopsy before or other risk factors that are out there, then the risk is probably not going to be worth it. For most women, to do it at a smaller dose for short period of time is considered to be safe and we're talking about a period of between two and five years at the time of peri-menopause. But, again, it will have changes in the breast and it will--especially if it is a combination hormone product--it will increase the breast cancer risk during the period of time that the woman is taking it.

Melanie:  In just the last few minutes, Dr. Stroede--you've given us such great information about the hormone changes women go through and breast health and self-exams and yearly exams-- please give us your best advice for the listeners and why they should came to Aspirus for their care?

Dr. Stroede:  So, I think every women needs to partner with her provider and when there isn’t a problem, then prevention is the answer. When a problem has been identified, then you need a team of fully trained providers that work together in a multidisciplinary approach to provide all of the cancer cure that we have out there at this point in time. But, since most women aren’t going to get breast cancer, I think the best approach is to keep up with screening, annual mammograms for women at average risk, do the exercise, do your best at keeping your weight under a BMI of 25, limit your alcohol intake. We know that women who drink 3 drinks or more a week increase their breast cancer risk significantly. Don’t smoke and avoid secondhand smoke. And also, when you choose what you eat, be mindful of what you choose and steer yourself towards a more plant-based diet and make your selections heard. Demand when you eat in restaurants and when you buy food at the grocery store that we are provided with better choices, more healthy choices, and don’t buy the stuff that’s mysterious looking.

Melanie:  It's great information. Thank you so much. You’re listening to Aspirus Health Talk. For more information you can go to aspirus.org. That's aspirus.org. Thank you so much for listening. This is Melanie Cole. Have a great day.