Hereditary Cancer Awareness Risk: Why you should know your risk

This week marks Heriditary Cancer Week. If you’ve been following 40 Now What you will know that last year I discovered that I had the genetic mutation of the BRCA1 gene, which means that I have a high lifetime risk or developing breast and ovarian cancer.

The last year has not been easy and has involved a lot of research, medical appointments, discussions with my support network and soul searching.

The honest truth is that a year down the line beyond having a surgery scheduled to have my fallopian tubes removed and having a good old check down there for any signs of cancerous tissue I am still not certain of my course action or any precise timelines of action.

But what is certain that I know that I am at greater risk, I am in the system and being monitored by some of the best professionals in the world, and I am being checked routinely. And that in itself is worth its weight in gold. I know I am incredibly lucky to have that knowledge, and often think about all the people who might also have this mutation, but do not know. Especially as we are now in our 40s and before we know it we’ll be in the age bracket where general cancer incidence rates rise steeply (from around age 55-59).

The role of genes in cancer

According to Cancer Research UK, our genes play a big role in our risk of cancer. It’s estimated up to 10% of all cancers diagnosed are linked to a genetic fault that can be passed from one generation to the next. Ovarian, breast, prostate, pancreatic and bowel are some of the cancer types you’re more likely to get if you carry a BRCA mutation or Lynch syndrome.

But despite the hereditary cancer risks, according to Target Ovarian Cancer’s latest research 75% of the general public have never heard of BRCA and 84% of people have never heard of Lynch syndrome. What’s more many are unaware that a family history of cancer could put them at risk of these genetic faults. It’s time to change that.

What can you do

Use Target Ovarian’s risk tool

Knowledge is power, and using the tool will help you understand your risk and what to do next. So take a few minutes to complete it here. It could change your life and help you take control.

Be mindful if you’re of Ashkenazi Jewish heritage

People of Ashkenazi Jewish descent have a 1 in 40 chance of carrying a BRCA mutation, making them 10 times as likely to carry a BRCA mutation as someone in the general population. Whether you’re a man or a woman, if you have BRCA1/2 mutation then there is a 50% chance of passing the mutation on to your children, whether they are boys or girls.

Check out Target Ovarian’s newly launched hub to give anyone with Ashkenazi Jewish heritage all the information and support they need – stories from those who’ve had to make difficult choices, important information about your risk and what do next, and videos to help you understand more about your risk.

Spread the word about hereditary cancer

Awareness is key here. I know just how important it is to know your status, and then be in the system and be duly monitored. By sharing this article, raising awareness or mentioning this to somebody today, you could be making a life-changing difference.

Useful links about hereditary cancer

BRCA & Lynch syndrome FAQ

Facing Our Risk website

Inherited genes and cancer types

NHS guide to predictive genetic tests for cancer

Have you heard BRCA or Lynch syndrome? Or have you ever had genetic testing for hereditary cancer?

Diagnosed with terminal breast cancer: How to live when life hands you lemons

I didn’t expect to be diagnosed with terminal breast cancer at 47. Whilst I knew there was a small possibility, I didn’t really expect my cancer would return along with an incurable diagnosis. But here we are.

If we know anything, it’s that life often throws us curve balls, this one being the biggest, shittiest one you could ever imagine. Being diagnosed with terminal breast cancer is unimaginable and something I still struggle to believe, even though I know it’s very real. As I walked out the hospital I remember telling myself and those I loved that I would beat this, that if anyone can I would. That I would defy the odds and live with this for a long time. This became my mantra and one I still tell myself most days.

As hard as it is to imagine, life goes on. Living with cancer is far from easy, but this diagnosis has driven me to try and live more vividly and fully than I had before. I may be diagnosed with terminal breast cancer but right now I’m well and not ready to go anywhere.

It takes an army to live your best life when life gives you lemons. Here’s some of the ways I cope:

Choose life

I got busy living. Embracing life, enjoying the little things. I love my adventures and intend to live big.

Belief

This work is never ending. I believe I can do anything I set my mind to. It applies more now than ever before. Facing my fears, choosing my beliefs and letting go of those that don’t serve me. All of this work is central to my determination and belief that I can thrive with stage 4 cancer.

Be informed

Do your own research, read books. Make sense of your cancer and take control based on what works for you.

Be my best advocate

I have had to trust myself and the decisions I make. To take charge. It’s documented that patients who direct their own treatment fare better than those that don’t.

A strong reason for living

Focusing on all the reasons I want to keep living, rather than the fear of dying. Looking forward. To the experiences and adventures I’m yet to have. My husband. My family. My friends. My business. Early on, I was so terrified, I couldn’t imagine life six months out. Eventually once the dust settles I just started focusing on living instead.

Avoid statistics

They are indicators not inevitabilities. There are exceptions to every rule. All we can do is walk our own journey, and be grateful and determined to defy the odds

Understand my disease

I spent a long time reading and researching different protocols so I kew my options. I have tried to understand what my body is trying to tell me. How to nourish myself, to appreciate, to let go. I try and take it as an opportunity to change the way I treat my body and the environment around me.

Focus on healing

I have also learnt that maybe this journey isn’t about finding a cure. A magic bullet. It’s about healing. The type of healing that never stops. Everything I do is about trying to heal my mind and body. There are so many options. The important thing is to trust the decisions you make and believe in yourself. My life has taken on a new normal, and whilst it doesn’t fit my old view of what my life would look like, it brings different joys and appreciations every day.

I’m only a year into my stage 4 diagnosis. As you can imagine, it’s been A LOT. It’s a process of continuous learning, about myself, my disease, my healing. My focus is on filling my life with love and adventures and creating something amazing as a legacy.

So when life gives you lemons, shake yourself off, take a deep breath and make shit happen.

Sara Cohen is founder of luxe sustainable womenswear brand www.hakinakina.com. Having already recovered from breast cancer once, she was in remission for several years, until last April when she found her cancer had returned and was by definition terminal. 5 years ago, having recently recovered from cancer she was looking for swimwear that suited her active lifestyle and offered the high level of protection she needed to cover up her radiation burns. She was left with minimal options; so when she moved to New Zealand she decided to take matters into her own hands.  Armed with a background in marketing and 5 years in women’s wear, she opened her own business and a line of swimwear to give women the freedom to play without compromising comfort, beauty or the environment. Find out more at hakinakina.com or connect on Instagram @hakinakina.active.

What happens when you have a mammogram

I won’t lie. The first time I had a mammogram, I really didn’t know what to expect. But being at high risk of developing breast cancer in my lifetime due to the fact I have BRCA1 gene mutation, then well let’s just say I am going to become very familiar with mammograms! But apart from the fact I expected it was some kind of scan, I had little idea about what happens when you have a mammogram.

Mammograms save lives

The bottom line is that mammograms save lives with breast screening saving around 1,300 lives each year in the UK. Finding cancer early can make it more likely that treatment will be successful.

Having said that, it doesn’t distract from the fact that having a mammogram is not exactly the most pleasant of experiences in my personal opinion just because it does tend to be pretty uncomfortable as your breast tissues gets pulled and manipulated into certain “flatter” positions before it gets positioned into place ready for the scan.

That said I would rather take a mammogram every day of my life rather than having a malignancy undetected in my breasts. The alternative – not knowing the status of your breast tissue and any potential changes and what they may mean, is unthinkable to me.

Do not put your mammogram off

Whatever the pain and discomfort you feel, I want to lay down now how important it is NOT to let this deter you from having your routine mammogram and attending breast cancer screening. All women are invited for a routine mammogram in the UK from age 50 up. If you have an increased risk of breast cancer due to hereditary factors then you should be having a routine mammogram annually from the age of 30 of 40.

Worries about the procedure, along with COVID disruption saw a 44 per cent fall in the number of women screened for the disease nationally in 2020-21 according to NHS England, but mammograms and early diagnosis of cancer can rapidly improve the long-term prognosis and chances of recovery. 

If you are worried about having a mammogram, not sure what a mammogram is, or yet to have your first mammogram, here Kate Whittaker, Superintendent Mammographer, at King Edward VII’s Hospital explains all.

when you have a mammogram

I’ve been invited to attend a mammogram. Should I go and what should I expect?

When women turn 50, they will be contacted by the NHS Breast Screening Programme  Unit, inviting them for a mammogram. All patients registered as female will be contacted every three years, until they turn 71.

Mammograms are a straightforward, non-invasive short procedure, but increasingly women are missing appointments, or declining to attend their screening. Worries about the procedure, along with COVID disruption, saw a 44 per cent fall in the number of women screened for nationally in 2020-21 according to NHS England. But mammograms and early diagnosis of cancer can greatly improve a patient’s long-term prognosis and chances of recovery – so why should women attend them, and how can they prepare?

Before the appointment

As mentioned above, breast screening can save lives. Identifying and intervening early can dramatically improve the outcomes for breast cancer, but attending a mammogram is obviously a personal choice.

If you do decide to attend and feel nervous about the procedure, try to book an appointment at a time when you’re not going to be rushing around. If you feel comfortable doing so, ask a friend or loved one to take you to the appointment for moral support, and have something nice planned for afterwards that you can look forward to and distract from any worries.

When you have a mammogram, you’ll be asked to undress from the waist up, so try to wear something comfortable that’s easy to take on and off. You’ll always be imaged by a female mammographer, but if you have any queries or concerns, including mobility issues or special requirements, it’s best to contact the screening unit before your appointment. That will allow them to make any necessary changes to your appointment, such as duration or location, as some sites are remote and may not be accessible to disabled service users.

During the mammogram

When you’re ready, you’ll be invited into an x-ray room by the mammographer, who will explain the procedure and answer any questions. Your breast is imaged by gently placing it onto the x-ray machine and applying some compression. This only lasts a few seconds and releases the moment the x-ray has been taken. You’ll have four images taken in total, two on each breast. All you’ll need to do is take a few small steps in front of the machine and raise your arms when asked, to help with the breast positioning in the side images. The whole process is over very quickly, in around five minutes, but keeping still is really important to get an accurate x-ray.

Breast screening can be uncomfortable, or occasionally a little painful for some people, so talking through any concerns with the mammographer can be very useful, you can also tell them to stop at any point if you’re feeling discomfort.

Getting your results

Results will be sent to you by post and they generally take between two and four weeks. A copy will also be sent to your GP for your medical records.

Your results will either say ‘No sign of breast cancer’ or ‘Need further tests’. If you have no sign of breast cancer, you can wait for your next mammogram in three years time, unless you notice any breast changes, including any lumps in your chest or armpit, discharge from your nipple, or an unusual texture on the skin of your breast. Do a check once or twice a month, and contact your GP if you notice any changes or have any concerns about your breasts.

when you have a mammogram

If you need further imaging, don’t panic. Most people who need further tests will not be diagnosed with breast cancer. But if you are worried, you can discuss the appointment with a breast care nurse, who will be able to explain to you the result, and what next steps will be taken.

You’ll be offered an appointment in a screening assessment clinic where you’ll be offered an examination of your breast and sometimes more mammograms, an ultrasound, or sometimes a needle test. Results from these tests normally take around a week. All of this will help the Breast Unit team and your GP to best support you and offer any further investigations and treatment you may require, which, in some cases, can limit the need for invasive treatment, or surgery. So when you receive your next invitation, I’d urge you to come forward and attend your  mammogram, or if you notice any breast changes or symptoms in the meantime, speak to your GP to access support as early as possible, which may save.

We hope the above helps you overcome any fears you may have about attending a mammogram screening. Focus on the end game in that when you attend a mammogram, you are doing something amazing for your body and yourself, and empowering yourself with the knowledge you need about any risk factors, warning signs and potential treatment down the line. To find out more about assessing your breast cancer risk see this useful guide over at our friends Breast Cancer Now or speak to your GP.

Photos by cottonbro and Tara Winstead via pexels and National Cancer Institute on Unsplash

Living with BRCA1: From ticking time bomb to taking action

It’s been almost 6 months since I tested positive for the BRCA1 gene mutation. That means six excruciating months of living with BRCA1 feeling like a ticking time bomb and being at worryingly high risk of developing breast or ovarian cancer – may be both – over my lifetime, maybe over the next couple of years. Who knows? I don’t have enough women in my family to know how this could play out for me.

After spending a couple of months in denial, I went into a total research frenzy. I became obsessed with finding out the answer to everything about my new mind-bending prognosis to make sense of this crazy world of living with BRCA1. I had so many questions and thoughts on repeat in my brain it was utterly exhausting and overwhelming. Every spare minute I had I was lurking around in BRCA Facebook support groups and BRCA threads in cancer charity forums, feverishly devouring other women’s stories of their BRCA journey and their version of living with BRCA1 – the good, the bad and the ugly.

With every story, I anxiously weighed up my options, which I began to realise were not as many as I had hoped for a woman in her 40s in this day and age.

As I write this, I already have a 1 in 100 chance of developing breast cancer anytime now and that gives me the cold sweats just thinking about it. I know I need to trust myself, have courage, and blow this baby wide open.

Living with BRCA1

Living with BRCA1: No easy magic bullet

After countless conversations, I began to realise there is no magic bullet here other than to have preventative surgery. At my appointment with the Genetics team at The Royal Marsden to which I turned up still clutching at the hope that I wouldn’t have to have my ovaries and breasts removed dissolved quickly. The brutal reality of what I was dealing with smacked me right in the face.

Any noninvasive treatment using PARP inhibitor drugs in a preventative manner that might suppress the faulty gene expression instead of ops was at the very least five years away. At the moment they are only used for actual cancer treatment and are at the time of writing not even in the early trial phase for preventative treatment. Even if I got onto a trial, there is no guarantee that I would then be given a placebo. And of course then I would also have to sit and twiddle my thumbs for a number of years, by which time I could have already developed cancer. And that is not a chance I’m willing to take. Ultimately I began to realise my options were:

  1. Go through the excrutiating pain of taking a wait and see approach of being monitored for breast cancer through regular MRIs, mammograms and freaking out every time I thought I found a lump in one of my breasts. Note, there is no effective screening process for ovarian cancer. So that basically means just waiting to see if and when the cancer shows up and then having to deal with it and the potentially horrific treatment that fighting cancer involves. Thanks but no thanks.
  2. Taking place in The Protector Study to have just my fallopian tubes removed because it’s estimated that around 70% of ovarian cancers start there. I was seriously tempted by this but at already 41 years of age and most ovarian cancer risk presenting itself from age 45, I felt I didn’t really have the time to be messing around with this one. Ultimately I would need to have my ovaries removed in the end anyway and this felt like simply delaying the inevitable….
  3. Having my ovaries removed, my breasts removed and the reconconstructed. The full shebang. Jesus.
  4. Put my faith in alternative approach mainly through lifestyle, diet and herbs and supplements known to have cancer suppressing properties. Ultimately I was just not willing to put my eggs in that basket – as big an advocate I usually am of the natural approach – when essentially my life was on the line.
Living with BRCA1

Step up number three

I knew that whichever way I sliced it, the only option to help keep me cancer-free, alive and well would be number three.

So now I spend my free time looking at pictures of reconstructed boobs convincing myself that I will be ok with my future double mastectomy and reconstruction, that the scars will not be too bad and if they are, that I will try to turn them into something positive by having an artistic tattoo inked over them.

I am also shit scared of the hormonal mess that may ensue from having my ovaries removed – even with HRT which doesn’t mean it will all be rosy. I’ve been there before when I had a total thyroidectomy due to precancerous cells in my thyroid and it was not pretty let me tell you. So I’ve booked an appointment with hormone specialists at The Marion Gluck Clinic to start that conversation and get the best advice I can get.

I’ve also been really lucky to find a couple of amazing BRCA positive role models in my personal network who have been there done that and are helping me to deal with all the things I am so scared of. Questions like will I still be the same person? Will I still like myself? Will it affect my confidence? Wow about my libido and sex?

In the final analysis, it is a big thing having two things massively associated with your womanhood removed, and it is that at the moment that I’m finding the hardest to come to terms with. But then when you stack that up against cancer….well, how could I be so vain? But there it is.

Living with BRCA1: So what’s my game plan?

Right now, I’m waiting for my breast MRI results, hoping that there isn’t something lurking there already. And my rebooked mammogram- because I bloody well got pinged and had to go and take a PCR test which scuppered my previous appointment – is now ticked off. And so I wait.

Once I’ve had those results and know what I’m dealing with, I’ll be able to move forward. My plan is to immerse myself in the Christmas festivities and live life to the max with as much joy as I can possibly cram into it, then come January it’s time for shit to get real. I need to push the button and say I want to move forward with the procedures and stop cowering behind the sofa, starting with the oophorectomy (that’s ovaries removed to you and me love). I know I can do this, I’ve got to be fierce, a previvor, and do it for all those women who never got a chance to do so. I’m doing it for me, my daughter, my family, and for every woman who never made it this far.

Woman photo , People photo created by wayhomestudio, Ribbon photo created by rawpixel.com – www.freepik.com

How to check your breasts for lumps

Righto ladies, today in this second part of our Breast Cancer Awareness month series we are going to talk boobs – specifically, how to check your breasts for lumps. Sadly, in this country we are woefully behind on understanding how, when, why and where we should be copping a feel of our jugs so that we can check your breasts for lumps.

I became painfully aware of this when I recently tested positive for the BRCA1 gene mutation responsible for hereditary breast cancer in my family. Embarassed to realise that I probably hadn’t checked my boobs since life before the ‘vid, I got a rude awakening when I realised I had absolutely no idea what I was doing on the breast feeling front.

So with that said, this Breast Cancer Awareness Month, we have together this in depth guide on how to check your breasts for lumps with Dr Deborah Lee of Dr Fox Online Pharmacy. Remember ladies, knowledge is power and our breasts deserve more than just the occassional squeeze during a mid life romp.

And if you missed it don’t forget to catch on part one of our breast cancer series where we clear up all the things you wanted to know about breast cancer but never dared ask as well as common breast cancer misconceptions.

check your breasts for lumps

The 40 Now What guide on how to check your breasts for lumps

The best time to check your breasts

Breastcancer.org recommends you check your breasts once a month, a few days after your period has come to an end. This means that any premenstrual breast pain and tenderness should have settled. If you are not having periods, which could be for many reasons, choose a day – say the 1st day of each calendar month – to do this.

The best place to check your breasts

The best place to carry out your breast examination is in your bedroom or bathroom, where it is warm and private, and you have a mirror in which you can see your whole upper body, and a good light. You need to feel relaxed, confident and unhurried, and be able to get a good view of both breasts. You also need to be near your bed so you can examine your breasts sitting up and lying down.

How to check your breasts step by step

Undress completely to the waist, and stand in front of the mirror, so you can see your whole chest and both breasts. Stand square in front of the mirror and look at your breasts. It is normal for one to be slightly larger than the other.

Look at the shape and contours of both breasts. Look at the nipples. Is there any irregularity in the outline of the breasts, or any unusual dimpling or puckering of the skin, especially around the nipple area? Are there any red areas, swelling or rashes?

Next, slowly raise both arms above your head and hold them there, as you continue watching carefully in the mirror. The breasts should change shape in a symmetrical fashion. Again, can you see any changes in the breast as described above? Look under the armpits too. Now lower your arms to the resting position. Have you noticed any discharge from either nipple – this could be clear, milky, or blood-stained?

Your next step is to lie on the bed and put one hand behind your head and with the other, use the flat of your fingers to examine each breast. Feel round all four quarters of the breast rolling the tissue gently under your fingers against your ribs. Be careful around and under the nipple area, and make sure you feel right round under the arm into your armpit, and across the entire chest wall from the upper abdomen to the collarbone. You need to use a medium to firm pressure, but it should not be painful. Then change hands and examine the other breast.

Next, sit on the edge of the bed. Keep your arms by your side. Feel right around each breast carefully, including behind the nipple, into the armpit and up into the collarbone.

What to look out for

By doing self-breast examination, you will get to know what your breasts normally feel like, and this will hopefully mean you can notice quickly if anything changes.

You need to look out for any changes in the shape or contour of the breast, along with any puckering or dimpling of the skin, especially around the nipple. If you find a breast lump, try not to panic. Breasts can feel lumpy especially before a period. Benign breasts lumps such as breast cysts are very common. Check for any nipple discharge. Always remember to feel right round and into the armpit.

The average breast cancer is around 1 cm in diameter when it is felt in the breast – about the size of a kidney bean. However, the size of breast tumours does vary from smaller, to much larger. They can also increase in size quite quickly. They are usually mobile and not fixed in one place unless the disease has become advanced. Most breast cancers are painless.

check your breasts for lumps
Check4Cancer is available via myGP, the UK’s largest independent healthcare management app

Don’t panic

If you find a breast lump, try not to panic. Around 80% of breast lumps are benign (noncancerous) – however, anything that is not normal for you, should be reported promptly to your GP.

Common benign lumps include –

  • Breast cysts – the breast is a gland- the mammary gland – consisting of lobules that can fill with fluid to form a cyst. The cysts will feel a bit like a squashy balloon. These can be aspirated with a needle and a syringe.
  • Fibroadenoma – These are benign tumours made of glandular and connective tissue, that often feel hard and gritty. They tend to be near the surface of the breast. They are often removed with a lumpectomy – usually to check the pathology and ensure they are benign.
  • Fibroadenosis – this is just a general lumpiness you can often feel in the breast, which is sometimes a bit tender and often worse before a period. Sometimes on a mammogram the are contains calcification.
  • Mastitis – this is a painful infection in the breast. It is often related to breastfeeding. Although generally benign, it does need to be distinguished from an inflammatory breast cancer.
  • Sclerosing adenosis – a small painful lump that develops due to overgrowth of breast lobules.
  • Duct ectasia – this is common in the premenopausal and menopausal period, when the milk ducts around the nipple become clogged and the tissue shrinks. The nipples can be retracted inwards.
  • Fat necrosis – this can occur usually as a result of surgery when scar tissue causes a hard lump that may be associated with a nipple discharge.

There are some other benign conditions that can occur in the breasts such as lipomas (fatty lumps), and haematomas (bruises – a collection of blood under the skin).

There are also a range of premalignant conditions which need to be picked up and removed before they become malignant. Examples include intraductal papillomas, ductal hyperplasia and ductal carcinoma in situ.

Unfortunately, having benign breast disease does increase our lifetime risk of breast cancer. It is imperative you continue to check your breasts regularly throughout your lifetime and attend regularly for breast cancer screening when you are invited.

Getting to know your breasts

Breastcancer.org suggests you need to get to know ‘the different neighbourhoods of the breast.’ They say the upper outer portion of the breast is the area likely to be the easiest to feel, in terms of lumps and bumps. They describe the lower half of the breast feels like a sandy or pebbly beach, and that the area under the nipple feels like a collection of large grains. Other parts of the breast, they say, may feel like lumpy oatmeal. Having examined many breasts in my working lifetime, I really like these analogies.

The idea here is not to be afraid of your body. You need to love and respect it and know every nook and cranny. You are the best person to notice if something is wrong. Don’t be fearful of checking your breasts. If there is any abnormality, the sooner you get this checked out at the GP surgery, the quicker you can get on and have treatment.

check your breasts for lumps

What else you need to know

Caring for yourself is vitally important. When you reach the age of 50, please go and have your breast screening mammograms. Breast cancer screening saves 1 life for every 200 women screened. This means the programme saves 1300 lives every year.

Breast cancer screening has the advantage of detecting cancers early, meaning they can often be treated with  minimal surgery. 80% of women whose cancers are picked up with screening mammograms, have lumpectomy and if needed, radiotherapy, meaning they do not need to undergo a full mastectomy.

At the moment, breast cancer screening in the UK starts at 47, meaning all women should get their first invitation before the age of 50, and continues every 3 years, until the age of 70 years. Over the age of 70 women can still request a 3 yearly mammogram – they just don’t get an automatic invitation. However, Breastcancer.org has always recommended breast cancer screening should start at age 40.

Unfortunately, screening mammograms are not 100% accurate and can result in overdiagnosis of breast cancer, resulting in unnecessary investigations and sometimes surgery. So, it’s not as simple as just a blanket recommendation to screen women at younger and younger ages. Also, breast cancers can occur during the 3 year screening interval, which is why continuing to examine your breasts regularly is so important.

For the best outcome, women need to be familiar with their own breasts and be able to spot quickly if something has changed or is not quite right. Once this has been reported to the GP, they can be fast-tracked if needed to the Breast Clinic for further investigation and treatment.

How to check your breasts for lumps

For more information

So go on, cop a feel….it could just save your life.

Picture credits: Photos by Jan Kopřiva , Olya Kobruseva & Anna Tarazevich from Pexels

Breast cancer: what you’ve always wanted to know + misconceptions to avoid

Breast cancer has been a hot topic in our household since I recently tested positive for the BRCA1 gene mutation responsible for hereditary breast cancer in our family. And as I started having more and more conversations around breast cancer, I realised just how many breast cancer misconceptions many of us had been duped by somewhere along the line. Well, it is no wonder seeing as we live in an era of fake news is it really?

But that stops here because this Breast Cancer Awareness month, the team at 40 Now What decided that it’s time to set the record straight in our two part series on breast cancer.

In part one we’ll be taking a sledgehammer to all those breast cancer misconceptions with insights from Daniel Leff, Consultant in Oncoplastic Breast Surgery at King Edward VII’s Hospital and Dr Petra Simic, Medical Director at Bupa UK Insurance. In part two, we’ll be getting underneath the hood so to speak with a detailed guide on how to check your breasts and everything you need to know in order to become your boobs’ best friend and safeguarder with Dr Deborah Lee of the Dr Fox Online Pharmacy.

The things you wanted to know about breast cancer but never dared ask

Here, Mr Daniel Leff, Consultant in Oncoplastic Breast Surgery at King Edward VII’s Hospital in London takes us through all the things you always wanted to know about breast cancer but were too scared to ask.

He says: “In my practice I see a lot of patients who have been holding off from asking questions because they’re embarrassed or are worried about what I’ll think.

“But I always encourage my patients to come forward with whatever’s on their mind, rather than holding the question in or trying to search the internet for the answer. There’s plenty of misinformation out there and often you’ll come across myths that might make you feel worse, or worry unnecessarily, so it’s always best to speak to a medical professional if you have any concerns.”

If a family member has had breast cancer, will I get it too?

There are lots of different risk factors for breast cancer. Some of these factors are genetic and some are environmental, so often it’s hard to say exactly why someone has developed a cancer – it could be due to multiple factors.

There are some genetic factors that we do know about – for example some families carry the BRCA 1 or 2 genes which raise the risk of some cancers, including breast and ovarian cancer in women and male breast cancer and prostate cancer in men.

If you have potential breast cancer symptoms and there is a history of breast, ovarian, prostate or pancreatic cancer in your family, it’s definitely worth seeking medical advice.

I’ve heard that being on the contraceptive pill (or taking HRT) could give you breast cancer?

There is some scientific research showing that people who take the contraceptive pill have a slightly higher chance of being diagnosed with breast cancer than people who have never taken it. But there are lots of other factors involved, including your family history as well as lifestyle factors such as the amount of alcohol you drink, being overweight, or previously having had radiation therapy.

There are some studies that show a link between taking HRT and a slightly increased risk of developing breast cancer in post-menopausal women – but only if you have taken it for longer than a year. And this risk starts to decrease when you stop taking it.

Should people who have had breast augmentation surgery be more worried?

There’s not enough evidence to know whether breast implants are a risk factor in breast cancer.

But a myth that I often hear is that breast implants make it impossible to detect or diagnose breast cancer. Happily, this is completely untrue. When it comes to self-examinations though, there are some different techniques to use. For example, people who have breast implants may want to lie down and feel for the implant, then feel carefully and gently for their ribs underneath to check for lumps.

When standing, it’s important to check for changes to the appearance of the breasts such as swelling, colour changes, rashes or puckering, by looking in the mirror. Try this both with arms raised and arms by the sides to help check for changes.

Are mammograms painful?

Everyone’s perception of pain is different. However, is it is true that some people find having a mammograms uncomfortable, but few find it very painful. We try to make the process as pain-free as possible, and depending on what exactly is needed to help with a diagnosis, we can numb the area too.

What I would say is that techniques are improving all the time, so I’d try not to let preconceptions or other people’s experiences put you off. If there’s something that you’re worried about it’s always important to get checked rather than delaying seeking help, as this could mean less invasive treatment later down the line.

Is it true that mammograms don’t work on younger people?

Breast cancer mainly occurs in people over 50, and it’s rare in people in their 20s and 30s, but that doesn’t mean that younger people shouldn’t be vigilant. The majority of lumps in younger people are totally benign lumps called fibroadenomas – which may feel hard and rubbery – but your GP may refer you to a breast clinic for a scan or biopsy to make sure.

It is true that mammograms are used more to diagnose breast cancer in older patients – because the breast tissue tends to be less dense, making it easier to detect on the mammogram. But we have lots of other very successful techniques to diagnose breast cancer in younger patients, such as ultrasound examinations.

Does nipple discharge indicate cancer?

In most cases, nipple discharge that comes only from pressure or massage from multiple points on the nipple from  both sides of the breast is normal, and  this type of discharge on its own isn’t usually a sign of breast cancer. It might just be something that happens from time to time, especially after giving birth or while breastfeeding, or it might be caused by widening of the ducts  or a benign lump, or as a side effect of a medication. 

But there are some signs that there may be something more serious going on. If fluid leaks out regularly, or spontaneously (without you pressing or squeezing the nipple) or is blood stained, then that can be a warning sign. And if you’re over 50 and / or have other symptoms like a lump, pain, swelling or a non-itchy rash on one breast, you should seek medical help.

It’s important to note that nipple discharge in men isn’t normal, so men who notice fluid coming from their nipples should make an appointment with their GP. And the main point I’d make here is that if something is worrying you, get it checked out.

Is it still possible to get breast cancer treatment during COVID?

If you have symptoms that you’re worried about, it’s important to still seek help. Lots of doctors are now conducting appointments over the phone or over video call, so it might be possible to reassure you without having to go to a GP surgery or hospital in person.

If a physical examination is necessary, medical staff have taken every precaution to keep patients safe. There might be some new rules to follow when you attend your appointment, so make sure you read any letters or correspondence carefully.

7 breast cancer misconceptions to avoid

Misinformation about breast cancer floods the internet and social media. Here, Dr Petra Simic, Medical Director at Bupa UK Insurance sets the record straight by separating fact from fiction.

Myth 1: Finding a lump in your breast is always cancerous

If you notice a lump in your breast, it’s very important to get this checked by your doctor; a lump or change to the feel or appearance of your breasts should never be ignored. However, not all lumps are cancer – but they do need to be checked out.

It can be difficult opening up about your breast health; perhaps you’re worried about wasting your doctor’s time, or you may be nervous or embarrassed to tell them about how you’re feeling.

However, it’s always best to reach out to your doctor for anything unusual. Your healthcare professional will want to hear about any changes you are concerned about.

Myth 2: I should check my breasts on the same day of every month

You should check your breasts whenever it’s convenient for you. It’s important to get to know what is normal for you to help notice any changes. A good time to check your breasts can be when you’re in the shower or bath. You should speak to your GP about any changes to how your breasts feel or look.

Myth 3: If I check my breasts regularly, I don’t need a mammogram

It’s important that you check your breasts regularly and attend your female health appointments. A mammogram is a type of X-ray that can help find breast cancer at an early stage when treatment is most successful.

Anyone registered with a GP as female will be invited for NHS breast screening every three years between the ages of 50 and 71. Cancers found during a mammogram may have been too small to see or be difficult to feel, meaning you may not have noticed a change in appearance or touch.

Myth 4: Wearing a bra can cause cancer

There is no evidence that wearing a bra causes breast cancer. The theory behind this misconception focuses on wearing an underwired bra, and a theory that the wiring restricts the flow of lymph fluid out of the breast. There is no scientific evidence to support this theory.

However, it is important that you wear a correctly fitting bra as not wearing the right sized or supportive bra can lead to breast pain.

Myth 5: Breast cancer is only a problem which affects women

This isn’t true: whilst each year in the UK, 55,000 women are diagnosed with breast cancer, 350 men are also diagnosed each year. Although this is a much smaller number in comparison to women, it’s still important for men to report any changes to their doctor.  

Having a close male family member (brother or father) with a history of breast cancer can mean you have a higher risk of having breast cancer, so make sure this information is shared with family members, or any medical professional if you are having breast issues. 

Myth 6: I don’t have any symptoms, so I don’t need to attend screening appointments or health check ups

Female health checks and cancer screening across all ages are there to detect any early signs of abnormalities and cancer. It’s important to attend all your female health checks and to know how to identify important changes in your own body.

Even if you’re showing no unusual symptoms, you should attend your checks and screening appointments as these can detect abnormalities before you start showing any symptoms. Early detection is key to effectively treating cancers; attending all appointments – even if you’re feeling well – is vital.

Myth 7: I have a breast lump and I am due my routine screening mammogram, so I don’t need to see a doctor

Not all breast cancers are apparent on mammogram. If you’ve found a breast abnormality you need to see your doctor, as you may need other tests in addition to a mammogram to rule out breast cancer.

Mammograms are designed for women without any symptoms and will pick up around 4 in 5 breast cancers.  They aren’t 100% accurate in showing if a person has breast cancer, so it shouldn’t replace seeing your GP if you have new symptoms.

If you’ve had a normal mammogram and subsequently find a lump or a change, it’s important you also see your GP just as urgently, as you may need an ultrasound scan or other tests to rule out breast cancer. 

Breast cancer is not an easy topic to talk about, but it is important to guard against fake, misleading and ill-informed medical information that potentially poses significant risks. Help us fight back against misinformation by sharing this article with your friends and family today and connect with us on Instagram here where we’ll be continuining the conversation on all things breast cancer this month.

Photos by Klaus Nielsen & Olya Kobruseva from Pexels

I tested positive for the BRCA1 gene mutation and here’s how I felt

From a young an age as I can remember, I was always aware that my family was riddled with cancer. Practically every other person in my dad’s family had been marred by it, and both my paternal grandparents had died of it. But until I hit my 4th decade, all of this seemed like something fuzzy and distant that didn’t really apply to me. I didn’t even know what the hell the BRCA1 gene (otherwise known as a tumour suppressor gene), so why should I care.

Oh my dear father

Then last year, due to the fact that my dad had to have a couple of melanomas removed, pieces were starting to be put together. Despite the BRCA1 gene not being linked to melanoma, the medics started paying attention to our family history of cancer, and so did I.

My father was sent for genetic testing. For some reason I still felt a bit detached from what was going on. Even as he told me that he had tested positive for the BRCA1 gene mutation, I still felt pretty nonchalent about the whole thing. After all, about 1% or 1 in 100 men who carry BRCA1 develop breast cancer. Some studies suggest there may be a slight increase in the risk of prostate cancer, but this is not conclusive.

But then the penny dropped

…as I realised that I would have a 50% chance of having the BRCA1 gene mutation, and so at a flip of a coin, my breast and ovarian cancer skyrocketed. Women with the faulty BRCA1 gene, for example, have a 65 to 79% lifetime risk of breast cancer and a 36 to 63% risk of ovarian cancer before the age of 80.

In the back of my mind, I guess I already knew I would have the mutation. I had my thyroid removed due to the discovery of pre-cancerous cells around ten years ago (there is evidence to show a link between thyroid cancer and the gene mutation). But still I remained calm, until I had my pre-test consultation where the harsh reality of a worst case scenarios double mascetomy and having my ovaries ripped out came and smacked my full throttle in the face. But what really got me? That if I did test positive, my daughter would then also have a 50% chance of having the mutation that would then also put her at risk. That’s when the tears started pouring.

Fast forward on a couple of weeks

I saw the letter from The Royal Marsden on my door matt. I wasn’t ready for the results yet. I left it on the stairs for another week. My sister got in touch to tell me she was negative, and right then I knew – I would be that other flip of the coin, the loser in this game of genetic russian roulette.

I prepared myself mentally. I opened the letter, and there it was. As I had suspected all along, I was positive.

I slid into a dark mood

For a few days, I needed to wallow. I didn’t really want to talk to anybody about it. I just needed to process everything. Although I knew I was priviliged to have this information because I would now be on watch and routinely screened, I reeled from the injustice of it all. Hadn’t I had enough shit with my existing health conditions? The total thyroidectomy and the hormonal calamity it unleashed on my body for years after? The metabolic carnage I experienced as my system reeled from a rare condition usually found in diabetics (of which I am not) called reactive hypoglycemia? And now this shadow hanging over me.

And then there was my daughter. Already the letter was urging me to have her tested, at eight years old. I just couldn’t fathom telling her, of passing on this burden to her, and why should I at some a young and beautifully innocent age?

Then a chance to rewrite the script

And then I realised. This thing has been in me all along. And this is my chance to rewrite the script. To get tested, to live life to the fullest because who knows what might happen when. To break out of this dumbed down and restricted Covid sleepwalking state we have all been stuck in for far too long. To cut out meat and dairy from my diet as I had increasingly been trying to do. To stay fit and healthy. And to not let other people’s shit stress me out. All lifestyle factors which can play into the hands of the risk lying within.

I can’t change things the results, but I can change what I do with them and how I approach it all. I either let this weigh me down like an Albatross round my neck, or I use it as a force for good, and remember that I am one of the privilged few to have this information. Because after all knowledge is power, power is wisdom, and I’m going to use that wisdom to change my life for the better.

Photo by Anna Shvets from Pexels, Brett Sayles from Pexels