The most effective way to fight breast cancer is to detect it early.  Self-exams?  Good!  But the most effective detection is a mammogram. Have you scheduled yours this year? We like to encourage our members to have their well-women checkup and mammogram during their birthday month as an easy way to remember.

While  our genes can work against us,  there are ways to lower our risk. Here are 7 ways to lower your breast cancer risk.

1.       Exercise.

Scheduled exercise more than three times a week can reduce your risk of breast cancer by 30%-50%.

2.       Control your weight and maintain a healthy body weight (BMI).

Women who are 25 pounds or more overweight seem to get breast cancer more than twice as often as those who are not overweight.

3.       Stop smoking.

 There is no need to explain this one. Smoking adds many risks to our health. Stop.

 4.       Minimize or avoid alcohol.

 The Harvard Nurses' Health study, along with several other studies, has shown that consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.

 5.       Consume as many raw fruits and vegetables as possible.

 Eating seven or more servings per day is ideal.

 6.       Minimize the wrong fats.

 The type of fat you eat can affect your risk. Avoid Omega-6 fats and maximize Omega-3 fats. This can include taking Omega-3 supplements.

 7.        Maintain a healthy lifestyle. Make arrangements to sleep 7-8 hours each night.

 And be sure and check out the Breast Health forum at HysterSisters.com to find woman-to-woman support for your breast health questions.

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Breast Self-Exams

The first step in your self-examination is to be familiar with your own breasts. That will help you recognize when any changes occur. Ask your doctor to show you how to do a breast self-exam. The American Cancer Society recommends that doctors inform women about the benefits and limitations of breast exams when they reach the age of 20.

Tips for your breast self-exam:

Be thoughtful with the timing: Choose the time during the month when your breasts are less tender. If you have ovaries, your hormone levels fluctuate each month, causing changes in your breast tissue. If you do not have ovaries or do not menstruate because of a hysterectomy, pick a certain day of the month.

Make notes: Keep a notebook handy to record anything you may notice with your breasts. Draw a map of the breast to note any thick tissue areas. Generally, the breast can be divided by quadrants or like a clock, which may help you when mapping changes in your notebook. Be sure and write the date with your map of changes.

Contact your doctor if you notice:

• A hard lump or knot near your underarm.
• Changes in the way your breasts look or feel, including thickening from surrounding tissue.
• Changes in color, size, texture or shape.
• Dimples, puckers, or bulges on the skin of your breast.
• A nipple that is pushed in (inverted) instead of sticking out.
• Redness, warmth, swelling, or pain.
• Itching, scales, sores, or rashes.
• Bloody nipple discharge.

Your doctor may follow up with a breast exam, mammogram and ultrasound.

Because each woman is different, there's no one-size-fits-all estrogen therapy. From creams to gels to pills to patches, there are several types of estrogen therapy. Choosing the type of treatment that's right for you starts with knowing your options, understanding your unique set of needs and personal preferences, and discussing these questions with your doctor: How severe are your symptoms? Is there a convenient option that will work best with your active lifestyle? Do you prefer an estrogen therapy derived from a plant or an animal source? What exactly is bioidentical hormone therapy?

The most commonly used forms of estrogen therapy are daily pills and transdermal patches you change once or twice a week. One of the major differences is how they deliver estrogen to your body. In order for your body to receive enough estrogen, the dose in an oral pill has to be higher than the dose used in a transdermal patch. That's because when taken orally, estrogen has to pass through the stomach and then be metabolized by the liver before reaching estrogen-receptive tissue. During this process, a lot of estrogen is broken down and destroyed.

Another major difference between pills and a transdermal patch is dosing schedule. Pills have to be taken on a daily schedule. The patch only needs to be applied twice a week. That means there's less to remember with a patch, fewer interruptions in your schedule, and more flexibility.

The dose and length of estrogen therapy is based on your individual symptoms, health risks, and treatment goals. It's important to schedule follow-up visits with your doctor every 3 to 6 months to discuss your progress.

Cancer is a common disease, and most families have members who have had some kind of cancer. This, however, does not mean that the cancer is necessarily genetic. Cancers that are not genetically based are considered "sporadic" and  account for 90% of all cancers. Experts believe that only 10% of all cancers are inherited.

The medical community uses the term "genetic susceptibility" to describe the high risk for cancer in people with an inherited mutation.

According to FORCE (Facing Our Risk of Cancer Empowered at www.facingourrisk.org), there are some signs of a hereditary breast-ovarian cancer syndrome in a family.

Any family member with:

• Ovarian or fallopian tube cancer at any age
• Breast cancer at age 50 or younger
• Breast cancer in both breasts at any age
• Both breast and ovarian cancer
• Male breast cancer
• Ashkenazi Jewish heritage and breast cancer before age 60

More than one relative on the same side of the family with any of these cancers:

• Breast cancer
• Ovarian or fallopian tube cancer
• Prostate cancer
• Pancreatic cancer
• Melanoma

Several different cancer syndromes have been identified, each with a particular set of signs. If the cancer in your family may be hereditary, it is important to consult with a genetics expert.

For those who are concerned about the Breast Cancer and Ovarian Cancer genetics, discuss your family history with a genetics specialist. The test for BrCa1 and BrCa2 requires a sample blood test, cheek swab, or tissue test and may be covered under your health insurance. The decision to undergo testing for the breast cancer gene is a personal one, with different benefits and limitations depending on your circumstances. Additionally, the test results are often not straight-forward; they require a medical professional with a genetics background to explain the results and help you determine your future options.

Consider seeking medical help from a genetics specialist. For more information, please visit Facing Our Risk for Cancer Empowered: http://www.facingourrisk.org.

Surferbabe, a HysterSisters hostess, has had to learn a great deal about breast health since her hysterectomy.  She shares her story with us here.

What brought you to HysterSisters?

I found Hystersisters by doing a google search for information on prolapse while I was home recovering from my hysterectomy in 2002.  I had searched once before, when I was diagnosed, and had found a couple of pelvic floor sites, but since I really didn't have any choice about the surgery I didn't really pursue the search - I only had ten days to prepare myself and my kids and was pretty busy running around getting things ready in terms of the house, child care, transportation, meals etc.  Once I was home recovering, I slowed down, took a deep breath and started reading.  I found Hystersisters right away, and joined at ten days post op on Valentine's Day, 2002.  I'd had to go home with a catheter (my DR had warned me it might happen) so I felt that maybe I could share my experience there with others who were afraid of the catheter.

What can you tell us about your experiences with breast health?  

I had had my first mammogram, a baseline, at age 39, and had been having them annually, including the year I had the hysterectomy (I was 45 then).  All had been clear.  At age 47, two years post hysterectomy, I was called back for "additional views".  That then turned into a recommendation that I have a stereotactic biopsy to investigate suspicious-looking microcalcifications in my right breast.  The radiologist who recommended the biopsy told me that, at that particular facility, about 20% of women are called back for additional views after a routine mammogram, that about 20% of those women end up having a biopsy and, of those biopsied, only about 15-20% turn out not to be benign, so I was hopeful.

Can you tell us about your cancer diagnosis?

Well, when I met with the surgeon, even before the biopsy, he told me that based on the configuration of the calcifications, he was 99% sure they were not benign, and he turned out to be correct.  I was diagnosed with ADH (atypical ductal hyperplasia), ALH (atypical lobular hyperplasia), LCIS (lobular carcinoma in situ) and "borderline DCIS" (ductal carcinoma in situ).  Since the area was very small, and it was obviously very early, my doctors recommended just doing a lumpectomy and watching carefully after that, and possibly taking Tamoxifen, so that's what we decided to do.  However, I could not tolerate the side effects of the Tamoxifen and had to discontinue it after only six days.

How was your cancer treated, and how are you doing now?

I was then put on a schedule of mammograms every six months for two years.  For those two years, the first three mammograms were fine, but the last one was not - I was diagnosed with DCIS in the right breast again, in a small area near where the initial microcalcifications had been.  The doctors believe it was a spot that had been present but too small to show up in the mammograms two years earlier, rather than a new development, but in any case, I was faced with a decision on how to proceed.  My doctors recommended breast-conserving therapy as the standard of care for DCIS and I agreed, though some women who have LCIS elect prophylactic double mastectomies because, while it's not actually cancer, LCIS is a risk factor that increases a woman's likelihood of recurrence in either breast.

I had a much larger lumpectomy the second time, and at the time of surgery the surgeon created a large empty cavity in the incision site where a catheter could later be inflated so that I could have Mammosite radiation - internal brachytherapy delivered by a robotic catheter system.  I had complications from surgery in that I developed two hematomas, which later became seromas and which both delayed the radiation and made the placement of the catheter extremely painful, but I proceeded with the plan anyway.  It ultimately went very well and I'm glad I elected Mammosite -- it's very concentrated, but minimizes potential side effects that can result from radiation being scattered to the heart and lungs.

How has your life changed (or not)  as a result of having breast cancer?

After the radiation, I was once again put on a schedule of mammograms every six months for two years, transitioning to once a year after that.  It's now been four years, and so far (knock on wood) I have been cancer-free.  However, never does a day go by that I don't think about the fact that I've been diagnosed twice already and wonder when the third time will come.  It's not something that, at least in my experience, ever goes away completely.

What is next in your life?

In between my hysterectomy and the two experiences with breast cancer, I also had a colectomy because of recurring diverticulitis which had also caused a perforation of the colon and abscess.  That surgery has physically been difficult to deal with, as opposed to the breast cancer, which has been much easier physically but tougher emotionally.  The result of all that has been that it's taken me quite a while to pick up the pieces and try to move on, but it's finally happening.  I've just gone back to school full time in preparation for a career change and am, for the first time in a looooong time, hopeful for the future. :)

Based on your experience, what advice do you have for other women when it comes to breast health?

My #1 recommendation for women regarding breast health is, get those mammograms.  Don't be afraid - the technology has improved, and it really isn't as painful as it used to be.  In fact, in my breast which hasn't had surgery, it's not painful at all; it only hurts in the one which had surgery, because I have scar tissue there from the two lumpectomies.  Don't assume that because you don't feel a lump, you're fine - I never had any lump or pain either time, and many women who are diagnosed with early breast cancer do not feel a thing.  Conversely, don't panic if you do feel a lump or have pain - there are plenty of benign conditions that can cause pain and lumps, and the odds are that you'll find out you are OK, but don't assume anything - get it checked out.

If you can't afford a mammogram, consider how you'd pay for treatment in the unlikely event that you do have breast cancer and it's diagnosed later, as opposed to earlier, because you didn't go for the mammogram.  There are affordable programs, even free ones, out there -- look into it.  I feel lucky that in both cases, mine was caught so early that I had treatment options to consider and the odds of survival were excellent.

I am just wondering if there is anybody here with BRCA1+ ? I am planning on doing hysterectomy soon and straggling to decide if I should keep my cervix or not. Would love to hear other woman opinions and any advice is welcome.

Also , I hope I am not doing the surgery too soon ( I am 34 and not planning to have more children) . My Dr recommends waiting until 40, but I am scared and feel like I am playing with fire keeping my ovaries.

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New lady in waiting with concerns about tender breasts

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