Q: What are the most common misconceptions you hear in your practice about breast cancer?
Many women are attuned to their breast health, which is a good thing, but rumours and misinformation can circulate quickly. Some come out of nowhere, like the myth that antiperspirant causes breast cancer. Not true!
One very common misconception is that breast lumps that are painful to the touch are scary. I see this a lot in younger women, in their teens, 20s and 30s. Breast soreness is common in the premenstrual phase of women’s cycles, and many women get tender lumps prior to their periods — these are almost always cysts.
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Cysts feel soft, are tender to the touch and you can often move them around under your fingertips. More rubbery lumps are often fibroadenoma or intramammary nodes — both benign changes that occur in breast tissue. Lumps caused by cancer are often painless, hard and may be fixed in one position. Of course, if you find a lump in your breast, you should go see your doctor. But before you panic, it’s important to realize that a lump does not automatically equal cancer.
Another is the assumption that since the current guidelines recommend mammograms at 50, mammograms at 35 must be even better. I understand the “better safe than sorry” rationale, but we don’t recommend early mammograms in most cases. The risk of false positives in younger women is very high, and the likelihood of getting cancer young is low. (Though it does happen, particularly in women who carry a genetic mutation.) On balance, for women who are under 40 without a family history, the risks of early mammography outweigh the benefits. When it comes to medical tests, more is not always better.
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One final misconception relates to how we think about breast cancer more broadly, and our understanding of how cancer works in the human body. It’s my impression that many people believe that the difference between a “successful” treatment (a case of cancer that is cured) and an “unsuccessful” one (that ends in a death) is how quickly the cancer was detected. There’s this idea that “if only they found it sooner” it could be treated more effectively in the so-called “early stages.”
But research is showing us that there’s no such thing as a single kind of breast cancer. Some are slow growing, and responsive to treatment, and it might not matter much at all when they are discovered. Other cancers are extremely aggressive – and in some instances, it’s questionable whether treatment, at virtually at any stage, will make much of a difference in a person’s outcome from treatment.
So the big challenge for medical science is: How do we identify the cancers that will respond to treatment, find them at the right stage (not too early and not too late), treat them, and not cause harm to people whose outcomes are not going to change, for good or for bad? For women, it’s important to be aware of this and to talk with their health care provider about their own preferences and values.