Author’s Note: The terms woman/women/female refer to a female sex assigned at birth and the terms man/men/male refer to a male sex assigned at birth.
Breast health is an extremely critical aspect of comprehensive healthcare. For women, the health and development of the breasts span through multiple reproductive stages, including puberty, pregnancy, lactation, and menopause. Breast tissue undergoes many changes through these stages and, under hormonal influence, can often evolve and present with certain abnormalities. Optimal breast health begins with awareness and education. Let’s explore some common changes and stages of development, and how to advocate for your care.
BREAST DEVELOPMENT
Breast development begins when a fetus is in the uterus; by the time a baby is delivered, they have already developed the nipple and milk-duct system. The next major stage of development occurs at puberty when the mammary glands develop. This stage of development is heavily influenced by sex hormones (specifically estrogen) that play vital roles in both the female and male reproductive systems. Anatomically speaking, breast development is often the first secondary sexual characteristic to appear in females, occurring between the ages of 8½–13½, on average. Due to the rise of testosterone, the male breast stops developing at puberty. With changes in relative hormonal levels, however, some males show signs of breast development beyond puberty, which is also known as gynecomastia. The breast undergoes more cellular and tissue changes in a female until the age of 18–20, when the adult nulliparous breast is completely developed. It’s not until pregnancy that the breast undergoes further tissue alterations to produce breastmilk. With age and through menopause and beyond, the breast undergoes multiple anatomical changes, increasing the risk of certain abnormalities.
BREAST PATHOLOGIES
According to the Canadian Cancer Society, breast cancer is the most common cancer among Canadian women over the age of 50, and it’s estimated that over 30,500 Canadian women will be diagnosed with breast cancer in 2024. It is important to note that while women account for most cases of breast cancer, it can also occur in males—but this is much less common. Breast cancer starts in the breast tissue and occurs when cells abnormally divide and form tumours
While breast cancer is the most common, other breast pathologies include cystic changes; mastitis (an infection of the ducts of the breast, often seen secondary to breastfeeding); and cyclical mastalgia (breast pain that is commonly hormone-mediated).
BREAST CANCER SCREENING
According to the province of Ontario’s Breast Screening Program, a woman between the ages of 50–74 years should get a mammogram every two years. A mammogram is a type of X-ray that can detect breast cancer. It does not require a referral from a doctor and is covered under OHIP. Ontario’s Breast Screening Program also offers guidelines for those who are at higher risk of breast cancer and may be eligible for a yearly mammogram and MRI. Fall 2024 will bring a new element to the Ontario Breast Screening Program guidelines, as you will now be able to self-refer for a mammogram starting at the age of 40. You can find an Ontario Breast Screening location at Ontario.ca. Breast cancer screening comes with benefits and risks, so it’s important to talk to your healthcare practitioners about your level of risk and what your preferences for screening are.
COMMON BREAST CHANGES
While there are breast pathologies and conditions that accompany risks to your health and warrant further discussion and workup, there are also breast changes that are normal and have no cause for concern. One major example is cyclic breast pain, also known as cyclic mastalgia. It’s one of the most common breast complaints among those of childbearing age (15–40). This often presents as a combination of tenderness, dull aching, burning pain, and swelling or engorgement as a female approaches menstruation. This pain is often localized to the upper-outer portion of each breast; however, it can often radiate into the armpit and other areas of the breast. While the cause of this pain is not definitively confirmed, it’s believed to be hormone-mediated. Other common changes include the development of stretch marks and changes in the shape of the breast with age. The breasts can also become elongated, the nipples begin to point downwards, and the space between the breasts often widens.
Even though these changes are considered normal, it’s still critical that you discuss any symptoms or changes you notice in your breasts with your doctor and/or healthcare team.
OPTIMISING BREAST HEALTH
There are specific interventions and alternative therapies that can be effective for certain breast conditions. Antibiotics, for example, are a first-line therapy for mastitis, and cold compresses are a common adjunct therapy for relieving pain and inflammation in this condition. But for general breast health and to reduce the risk of breast cancer, it is general health optimisation that’s the most protective. Getting adequate sleep, staying active, maintaining a healthy weight, avoiding smoking, and reducing your alcohol intake can reduce your risk of breast cancer while also improving overall health and well-being.
Most medical organisations advise against doing breast examinations on yourself due to the lack of evidence that it improves survival rates or breast cancer detection. While a self-exam for breast cancer screening is not recommended, it’s still important to be familiar with the texture and shape of your own breasts so you can take careful note of changes.
YOUR ROLE
It’s always a good idea to be your own health advocate, as you know your body best and will be able to spot changes more promptly than your healthcare team in some cases. It is critical to bring up any changes in your breast health to your practitioner right away to ensure you are acting proactively and finding trustworthy answers to your questions. Consulting the internet can lead to assumptions about one’s breast health and cause anxiety. Your healthcare team will have the appropriate resources to answer your questions and can obtain lab work assessments and diagnostic testing when necessary. Overall, being aware and educated on breast health, staying up to date with screening protocols, and consulting your healthcare team about any changes or questions you have will ensure you are receiving the best care possible.
