In the past 30 years, the mortality rate from breast cancer declined nearly 40%. Early detection and medical advances have contributed to that remarkable progress, but that doesn’t make a diagnosis any less earth-shattering.

When BlueCross BlueShield of Tennessee employee Constance Gaines (pictured above) noticed something different during a self-exam, she immediately made an appointment with her doctor. After an exam, her doctor ordered a diagnostic mammogram. That was life-saving in light of the cancer diagnosis that followed.

“It moved fast from there,” she says. With an aggressive form of breast cancer, she started chemotherapy to shrink the tumor prior to surgery. After the sixth treatment, she had a double mastectomy and radiation treatments.

Breast cancer is still the most common cancer among women in Tennessee, so screenings, self-exams and conversations with your doctor are crucial to getting treatment quickly and improving your chances of survival. Women must take control of their health by being aware of symptoms, knowing their family history and seeing a doctor when they are concerned.

Q&A with Dr. Phillip Burns

“At least once every six weeks I see an incidence of breast cancer that the patient found herself,” says Dr. Phillip Burns, breast cancer surgeon and founder of University Surgical Associates in Chattanooga. “Not everyone has the same risk of developing breast cancer — about 12% of women in the U.S. are at risk. But as I tell my patients: ‘Whatever happens to you is 100% for you.’”

With that in mind, Dr. Burns offers some thoughts about what women should know about breast cancer and addresses some of the questions he hears most often from his patients.

1. Self exams are more than just looking for lumps

There’s a common misconception that a woman performing a self-exam is looking for tumors that could be cancerous. Actually, the exam is a way for women to become more familiar with their bodies, so that they will be aware when something changes.

“Don’t worry about finding a lump,” says Dr. Burns. “Look for a change in your breast that persists. Do a self-exam regularly – it only takes about ten minutes. If you don’t do regular self-exams, you won’t notice changes.”

Look for:

• Increased density/heaviness of the breast
• A change in the shape of the breast
• Tenderness or pain
• Change in skin texture

These are not necessarily cancer symptoms. Breasts normally go through changes and noncancerous cysts that feel like lumps are fairly common. If the change persists or concerns you, make an appointment with a doctor for further evaluation.

2. The hand you use matters

“The most common mistake women make when doing a self-exam is they check the right breast with the right hand, the left breast with the left hand,” says Dr. Burns. “You need to use the opposite hand.”

Why? Doing the exam properly includes lifting the arm on the side that is being examined. This spreads the breast tissue and makes any lumps easier to detect.

3. Women with breast implants can still do self-exams and get screened for breast cancer

In fact, they will probably need to get additional mammogram images done so that the doctor gets a clear picture of their breast tissue. They actually may have something of an advantage in a self-exam, since the surgery lifts a small breast off of the chest wall, making it easier to examine. In addition, aftercare for breast implants includes regularly massaging them to keep them from hardening, so women with implants are usually very familiar with how their breasts feel normally and will notice any change.

4. Most women who develop breast cancer do NOT have a family history of the disease

For the past few years, many news stories put a spotlight on women who had a strong family history of breast cancer getting tested for inherited mutations of the BRCA1/BRCA2 gene, which are linked to breast cancer susceptibility. Almost always, the woman profiled has a heartbreaking story of watching many family members succumb to the disease.

“These women are at extreme risk,” says Dr. Burns, “but only about 5% of breast cancer patients have this mutation.”

• More than 80% of breast cancer patients do not have a close blood relative who had the disease. Their cancer occurs for nonhereditary reasons.
• Having a first-degree relative (mother, aunt, sibling) who developed breast cancer does increase the risk of developing the disease, but it is not an absolute prediction of your future. 

5. There is no such thing as breast cancer prevention

“Some women at high risk, those who carry the BRCA gene and have a family history of breast or ovarian cancer, choose to undergo a bilateral prophylactic mastectomy (removal of both breasts even when no cancer is detected),” says Dr. Burns. “But even that does not eliminate the risk completely.”

A physician can determine if genetic testing is warranted and, in case of a positive result, discuss options with the patient.

“There’s an implication that a woman who is concerned about developing breast cancer will go to a doctor to ask for this surgery and they just say, ‘sure,’” Dr. Burns says. “That doesn’t happen. Surgeons are not willing to do that unless the risk for the woman is extreme.”

6. Complete mastectomy is not the primary treatment

Most women who undergo surgery for breast cancer get a partial mastectomy, commonly known as a lumpectomy. In addition to a better cosmetic result, the surgery is less physically traumatic to the patient.

“This surgery, usually combined with radiation therapy or chemotherapy, leaves the breast relatively intact,” says Dr. Burns. “A surgeon removes the tumor, and to do that without leaving any microscopic margins positive is harder to do technically than a complete mastectomy.”

7. Physicians are less concerned with the size of a tumor than its aggressiveness

Most people know the progress of cancer described in terms of “stages,” which refers to the tumor size and the spread of cancer to the lymph nodes. For treatment purposes, doctors determine the “grade” of the tumor, which measures its growth rate. A lower grade tumor grows more slowly, while a high grade cancer will likely require more aggressive treatment.

If you have questions about breast cancer, talk to your doctor

“There’s a lot of debate now about mammogram frequency and whether a self-exam has any effect on breast cancer outcomes,” says Dr. Burns. “I still believe that we should be more aggressive rather than falling off the cliff the other way. When it comes to sorting out that debate, consult with your physician, who will know your risk factors and advise you based on your medical history.”

For more information about breast cancer, click here.

Get more information about specific health terms, topics and conditions to better manage your health on bcbst.com. BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also find tools and resources to help improve health and well-being by logging into BlueAccess and going to the Managing Your Health tab.