Breast Cancer Basics

Understanding Signs, Symptoms and Risk Factors

by Tara M. Breslin, MD

October is Breast Cancer Awareness Month and a great time to spread the word about the importance of breast health all year long. Breast cancer is one of the most common forms of cancer diagnosed in the United States, typically in women, but it occurs in men as well. In 2020 alone, an estimated 276,000 women will be diagnosed with breast cancer. Most of these new cases will occur in women older than 50, but 10% will occur in women younger than 45. Recognizing the warning signs of breast cancer and early detection will mean more treatment options and a better chance of being cured.

Be aware of changes in your breasts

  • Lump in the breast or underarm
  • Bloody discharge from the nipple
  • Indentation or retraction of the nipple area
  • Change in breast size
  • Rippling (flattening or indentation) of the skin covering the breast
  • Crustiness or rash of the nipple or areola

What to you do if you notice a new symptom

Stay up-to-date with breast screenings

Regular screening for breast cancer is done before there are any signs or symptoms and is the best way to find cancer early when it’s easier to treat. The first step(s) of screening for breast cancer typically include mammogram and/or a patient’s awareness of changes in their breast.

  • Self-Awareness: Conduct regular and frequent self-exams of your breasts. Become familiar with your breasts, so you aware of, and able to, recognize changes right away.
  • Clinical Breast Exam: This exam is done in a clinical setting, by a physician who will use their hands to look for lumps or changes in your breasts.
  • Mammogram: An x-ray of the breast and the best way to detect cancer early. A screening mammogram is done for asymptomatic women, a diagnostic mammogram is done for women with a new symptom or mammographic abnormality.

A mammogram found something suspicious, now what?

If your doctor finds something concerning on your mammogram, the first step would be diagnostic imaging to further characterize the area.  This may include: diagnostic mammogram, ultrasound, MRI.

  • Biopsy: a small sample of cells or tissue is removed and reviewed under a microscope to determine if cancer is present. There are a variety of ways to perform a biopsy. Talk to your physician about the options available to you, if you require a biopsy.
  • Diagnostic Mammogram: an X-ray test used to diagnose unusual breast changes, such as a lump, pain, nipple discharge, change in breast size or shape or previous breast cancer. If your screening mammogram does show an abnormality, you may need additional imaging like a diagnostic mammogram.
  • Breast Ultrasound: Using sound waves to produce images of the internal structures of the breast, the breast ultrasound can help a physician determine if a mass an abnormality is more likely a solid mass or fluid-filled cyst.
  • MRI: The MRI uses magnets and radio waves to produce images of the breast. These images provide more information and details than other tests. Your physician may recommend a breast MRI for you if your biopsy results were positive for cancer or if you’re considered high risk for breast cancer. The breast MRI is intended to be used along with a mammogram, not as a replacement.

Who would be considered high risk for breast cancer?

As a person ages, their risk of being diagnosed with breast cancer increases, but there are a few other risk factors that you cannot change:

  • Age: Most breast cancers are diagnosed after age 50.
  • Genetics: Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
  • Dense Breasts: Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
  • Personal History of Breast Cancer: Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
  • Family History of Breast Cancer: A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

Understanding the signs and symptoms of breast cancer and your risk factors is important for every woman and man. If you have questions or concerns about your breast health, schedule an appointment with an IHA Breast Surgeon.

Busting Myths: Breastfeeding as a working mom

by Lisa A. Hammer, MD, IBCLC

You’ve heard about the benefits of breastfeeding your baby. You know breast milk is best for your baby (the antibodies!). But let’s face it, returning to work after weeks of cozy breastfeeding sessions creates a lot of anxiety and pressure (pun intended) for mom. There’s so much information out there online and from every woman you know that’s ever had a baby. We’re here to breakdown some of the most common concerns around returning to work and continuing to provide breastmilk for your baby. Read on to learn how some common myths around breastfeeding while working are, well, busted.

Myth: Nursing less often will create more milk when I do nurse.
Actually, the more you nurse (or pump), the more milk you will produce. Your body is creating your milk supply based on demand. Feed your baby when they ask (in their own way), and your body will produce the milk they need. If you are returning to work, this will help in ensuring you are producing what your baby needs while pumping.

Myth: My baby won’t breastfeed once they get used to bottles.
You will always be your baby’s favorite way to get their milk. When your baby is with you, they will expect to be breastfeed. If your baby has a predictable feeding schedule, when you return to work ask your caregiver to hold-off on giving them a bottle close to your arrival, so you can breastfeed your baby when you return home. Also, be sure you drink plenty of fluids, avoiding caffeine and alcohol. Staying hydrated is important in general, but especially while breastfeeding.

Myth: I need a freezer full of milk to return to work.
Just when a new mom or dad feels like they are adjusting to life as parents, it’s typically time to return to work. For a mother who is breastfeeding, this transition can be especially difficult. A few weeks before your re-entry into the working world, start mixing some pumping and bottle feeding into your baby’s routine. This will help in two ways; your baby will get some practice with and be more willing to take a bottle and you will have some milk stored for backup. We recommend a minimum supply of two days’ worth of breastmilk for a smooth transition. As you pump at work, you will get into a rhythm of producing what your little one needs. You don’t need a freezer stocked full of milk in order to return to work.

Myth: I can’t breastfeed and pump at the same time.
There’s a balance between pumping and breastfeeding. Once you find it, your body will respond and produce the milk required. To start working pumping into your feeding schedule, pump between breastfeeding your baby. Pump about an hour AFTER you feed, and at least an hour BEFORE your baby’s next feeding. If you are returning to work, take note of when your baby typically eats, and pump based on that schedule. Continue to demand milk consistently and your body will get the signal to produce enough breast milk for your little one.

Myth: I will have to stop breastfeeding when I return to work.
Every mother has a legal right to take breaks from work to pump. That said, many women may still be anxious about taking this time. While you are pregnant and before you go on maternity leave, chat with your boss about a pumping schedule. That way, your boss will know what to expect upon your return and you will have some peace of mind knowing there is a plan in place to ensure you can continue to provide breast milk for your baby. Also, be sure to understand the accommodations available to you in the work place for pumping. Where is the room? Where will you store the milk you pump throughout the day? To get your questions answered, chat with a human resources rep or a colleague that recently transitioned from maternity leave and pumped at your office, to get your questions answered.

Myth: I won’t be successful at work if I have to stop and pump.
For a mother that wants to continue providing breast milk for her baby, taking the time to pump will create peace of mind, and allow you to be more focused when at your desk. You may even want to use the time you spend pumping to catch up on some emails, or read through an article or report that you can’t seem to work into your day while sitting at your desk. Some of your colleagues will understand when you excuse yourself a few times a day to pump, and others may not. The fact is, it’s your right to take time to pump during the work day, so try to focus on your baby and not the opinions of those around you. If you have concerns, talk to a manager or supervisor.

Breastfeeding is a wonderful way to take care of your baby, but it can be a struggle too. If you are feeling stressed about producing milk for your baby, make an appointment to chat with a provider. There is no “one size fits all” when it comes to breastfeeding, and they can provide the support you need as you work through challenges that come with being a new mom.

Originally Posted August 2019


Did you know IHA offers Breastfeeding Medicine? While breast milk is felt to be nature’s first food, breastfeeding does not always come naturally. Breastfeeding is a physiological process that involves both the mother and baby. We provide specialized breastfeeding care for both mother and baby. Learn more about IH Breastfeeding Medicine below.

Coping with Stress

Helpful reminders for when you feel stressed

Source: Centers for Disease Control and Prevention (CDC)

Even the most laid back, easy-going people feel stressed sometimes. And considering our current situation, a pandemic and all, stress pretty much goes with the territory. Luckily, the CDC has some important reminders to help manage stress and support yourself.

Take breaks from watching, reading or listening to the news.

The news is everywhere, it’s so hard to escape. If your stress levels are up, then an escape may be just what you need.  Hearing about the pandemic repeatedly can be upsetting.

Take care of your body.

When you feel like stress is taking over, take deep breaths, stretch or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.

Make time to unwind.

Make a list of the things you enjoy most. What can you do right now? What can you plan to do in the future, to help give you something to look forward to? If you’re a person that creates a daily schedule, include some time to do what makes you happy. You may also try setting an alarm or reminder on your digital calendar to stop and take a few minutes for yourself.

Connect with Others.

Consider who you trust in your life. Who do you think would best understand your current concerns? Seek out people in your life that can help you navigate stressful feelings and lighten your load. With social distancing rules currently in place, you may need to be creative in how you connect with others, phone and video calls work great!

Know when it’s time to seek medical care.

If your stress is keeping you from your daily activities or social interactions, reach out to your healthcare provider. They will be able to help you find a solution and get you feeling like yourself again!

Work + Life: The Juggle is Real

Finding a balance between work and life is one thing. Throw school in there, sports team practice, a science fair project, a growth spurt that requires new shoes that are only available at the store across town, and you have a perfect recipe for physical and mental burnout. Burnout can leave you feeling exhausted, drained, or even physically ill. You can’t always eliminate the stress from a busy schedule or workday, but you can learn to manage it.

Start by asking yourself: What needs to be done? Look at your task list and separate what truly must be done from less critical tasks. Things like work tasks, school events and appointments are not negotiable, while others may be. Sort through your to-do list and eliminate low-priority tasks where you can.

Create a shared family calendar. Whether you like a paper calendar stuck to the fridge, or you’re a digital family, there are templates and tools for everyone. Get upcoming events listed in one place, so everyone knows where they are supposed to be.


Wherever you are, be there. “Be present” is a trendy phrase that we hear a lot these days. But, it’s hard not to look at the 5 notifications that just popped up on your phone. When possible, set your device aside and focus your attention on what is happening around you. Maybe it’s dedicated time to play with your child or have a conversation with your spouse or a good friend. Making a conscious effort to focus on one task or person at a time will help clear the clouds of stress.


Make time for your family.
So many evenings are spent rushing to practices, classes or events, and dinners are consumed during the car ride. Try to find time each week to eat together as a family. Institute a family game night, a bike ride, or maybe a family meeting. Find ways that your family can be together enjoying each other without interruption or distraction (see point above). Ultimately those closest to you will be your front lines of support, so a weekly check-in will help catch when anyone is starting to succumb to stress.


Make time for yourself. The best way to work time for yourself into your schedule? Schedule it! Be creative (Paint! Garden! Journal!), eat a healthy diet avoiding sugar, caffeine, and carbs, have dinner with friends. Think about what truly brings joy into your life and make time for it.
Feel the burn! (Not the burnout). Exercise is one of the best ways to eliminate stress. That doesn’t mean you have to make it to a 5 AM barre class. A 10-minute walk can boost your mood and outlook for 2 hours! Find ways to work exercise into your daily routine, even if it means stretching on the sidelines at soccer practice.


Know when it’s time to ask for help. Burnout can happen at home or at work. Learn to recognize when stress is taking over, and you need help. Then ask for it. Burnout isn’t one size fits all. It can look and feel different for everyone. You may start to feel exhausted, moody or withdrawn. You may not remember what you had for lunch or where you are going when you leave the house. You may start to notice muscle pain from clenching or grinding your teeth.
If you are feeling the symptoms of burnout, seek support from those around you before you reach your breaking point. We’re here to help, too. Reach out to your primary care provider, they will help you extinguish burnout and feel like yourself again.

It’s easy to schedule an appointment with your primary care provider – simply visit our online appointment tool, scroll to find your provider, and click to schedule an appointment at a time that works for you!

Make An Appointment

Busting Myths: Breastfeeding as a working mom

You’ve heard about the benefits of breastfeeding your baby. You know breast milk is best for your baby (the antibodies!). But let’s face it, returning to work after weeks of cozy breastfeeding sessions creates a lot of anxiety and pressure (pun intended) for mom. There’s so much information out there online and from every woman you know that’s ever had a baby. We’re here to breakdown some of the most common concerns around returning to work and continuing to provide breastmilk for your baby. Read on to learn how some common myths around breastfeeding while working are, well, busted.


Myth: Nursing less often will create more milk when I do nurse.
Actually, the more you nurse (or pump), the more milk you will produce. Your body is creating your milk supply based on demand. Feed your baby when they ask (in their own way), and your body will produce the milk they need. If you are returning to work, this will help in ensuring you are producing what your baby needs while pumping.


Myth: My baby won’t breastfeed once they get used to bottles.
You will always be your baby’s favorite way to get their milk. When your baby is with you, they will expect to be breastfeed. If your baby has a predictable feeding schedule, when you return to work ask your caregiver to hold-off on giving them a bottle close to your arrival, so you can breastfeed your baby when you return home. Also, be sure you drink plenty of fluids, avoiding caffeine and alcohol. Staying hydrated is important in general, but especially while breastfeeding.


Myth: I need a freezer full of milk to return to work.
Just when a new mom or dad feels like they are adjusting to life as parents, it’s typically time to return to work. For a mother who is breastfeeding, this transition can be especially difficult. A few weeks before your re-entry into the working world, start mixing some pumping and bottle feeding into your baby’s routine. This will help in two ways; your baby will get some practice with and be more willing to take a bottle and you will have some milk stored for backup. We recommend a minimum supply of two days’ worth of breastmilk for a smooth transition. As you pump at work, you will get into a rhythm of producing what your little one needs. You don’t need a freezer stocked full of milk in order to return to work.

Myth: I can’t breastfeed and pump at the same time.
There’s a balance between pumping and breastfeeding. Once you find it, your body will respond and produce the milk required. To start working pumping into your feeding schedule, pump between breastfeeding your baby. Pump about an hour AFTER you feed, and at least an hour BEFORE your baby’s next feeding. If you are returning to work, take note of when your baby typically eats, and pump based on that schedule. Continue to demand milk consistently and your body will get the signal to produce enough breast milk for your little one.


Myth: I will have to stop breastfeeding when I return to work.
Every mother has a legal right to take breaks from work to pump. That said, many women may still be anxious about taking this time. While you are pregnant and before you go on maternity leave, chat with your boss about a pumping schedule. That way, your boss will know what to expect upon your return and you will have some peace of mind knowing there is a plan in place to ensure you can continue to provide breast milk for your baby. Also, be sure to understand the accommodations available to you in the work place for pumping. Where is the room? Where will you store the milk you pump throughout the day? To get your questions answered, chat with a human resources rep or a colleague that recently transitioned from maternity leave and pumped at your office, to get your questions answered.


Myth: I won’t be successful at work if I have to stop and pump.
For a mother that wants to continue providing breast milk for her baby, taking the time to pump will create peace of mind, and allow you to be more focused when at your desk. You may even want to use the time you spend pumping to catch up on some emails, or read through an article or report that you can’t seem to work into your day while sitting at your desk. Some of your colleagues will understand when you excuse yourself a few times a day to pump, and others may not. The fact is, it’s your right to take time to pump during the work day, so try to focus on your baby and not the opinions of those around you. If you have concerns, talk to a manager or supervisor.


Breastfeeding is a wonderful way to take care of your baby, but it can be a struggle too. If you are feeling stressed about producing milk for your baby, make an appointment to chat with a provider. There is no “one size fits all” when it comes to breastfeeding, and they can provide the support you need as you work through challenges that come with being a new mom.


It’s easy to schedule an appointment with your pediatric provider – simply visit our online appointment tool, scroll to find your provider, and click to schedule an appointment at a time that works for your family!

Make An Appointment

Cervical Health Awareness

Cervical Health Awareness Image

 

MAINTAINING YOUR CERVICAL HEALTH IS IMPORTANT FOR WOMEN OF ALL AGES

Did you know that nearly 13,000 women are diagnosed with Cervical Cancer each year in the United States alone? January is Cervical Health Awareness Month, a time to take the opportunity to learn how to monitor your own cervical health for early detection of cervical cancer and human papillomavirus (HPV) related issues. It is important to stay up-to-date with cervical cancer screening recommended by your OB-GYN provider based on your age. Stay in touch with your body – here are common recommendations for women of all ages:

AGES 9-26

It’s time to get your Gardasil Immunization to prevent infection and transmission of the most common strains of HPV (Human Papilloma Virus, the most common cause of cervical dysplasias and cervical cancers). No cervical screening is recommended for young women before age 21.

AGES 21-29

When you turn 21, it’s time to start with regular cervical cytology – commonly known as the Pap test or Pap smear – every three years. If your results are ASCUS (borderline between normal and abnormal), your doctor may recommend HPV triage, which is done using the same cells taken at your screening and will look for any high-risk HPV infections. This approach may be taken between ages 21 and 24 and it is preferable between ages 25 and 29.

AGES 30-65

At age 30 it is recommended to maintain cervical cytology alone every three years, or to get co-testing, cytology and viral culture, every five years.

AGES 65 AND BEYOND

Once you reach age 65, no cervical screening is needed if prior testing has been normal. 

 

Of course, your gynecologist will chart your plan of care based on your personal screening history – it can vary, but annual care is most important!

 

Learn more about cervical health and cancer warning signs from the CDC. 

Learn more about HPV screening and safety from the CDC. 

Break Free from Pelvic Floor Disorders

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Did you know that 1 in 3 women suffer from or will develop a pelvic floor disorder during their lifetime?

Pelvic floor disorders are problems related to bladder, bowel and sexual function. They include different types of urine leakage (incontinence) or bladder control problems like going frequently, getting up at night to urinate, or getting strong, uncontrollable urges to urinate. Pelvic floor disorders also include problems related to the bowels such as accidental loss of gas or stool. Finally, a condition known as prolapse, which is a feeling that the pelvic organs (bladder, uterus, vagina or rectum) are bulging or falling out, is also a pelvic floor disorder.

The risk for pelvic floor disorders increases with age. While these conditions are often linked to having children, there are other reasons they can develop. There are also many conditions that make pelvic floor disorders worse that can be managed with relative ease. Many women suffer silently from these conditions. They assume that these conditions are a normal part of the aging process. They also assume that because their mother or sister had it, then they are destined to get it too.

Fortunately pelvic floor disorder are not life threatening. They primarily affect a woman’s quality of life. That means that they do not have to be treated right away. Depending on how bothersome the condition is, a watch and wait approach is often acceptable. However, a thorough evaluation is needed first to ensure it is safe to wait.

Once a pelvic floor disorder affects a woman’s quality of life, there are a number of treatment options available. Many of these options are conservative and non-invasive like lifestyle, behavior, or diet changes. Other treatments include medications, physical therapy and surgery in some cases. Each woman is different; therefore each woman’s treatment plan will be different.

Be open with your doctor about your symptoms and ask about treatment options. You can also ask about seeing a specialist and request a referral if needed. There are qualified specialists in your area that are willing to help you break free from pelvic floor disorders.

This article was originally published on October 20, 2014, and was updated on March 30, 2017.

All about menstrual cups

For years, women have relied on pads or tampons during their period. But, recently menstrual cups have become more popular and more widely available.
A menstrual cup is a flexible cup that is designed for use inside the vagina during your period to collect the menstrual blood. Menstrual cups are usually made of medical grade silicone, but some can be made from latex.

You can use a cup throughout your entire cycle, some users only need to empty it once every 12 hours, and some empty it more often on their heavier days.

A menstrual cup is a more expensive up-front purchase than a box of tampons or pads, however it can last for up to ten years, providing you with a significant cost-savings, and less waste. You also get more time between changes.

It’s also surprisingly easy to use. If you currently use tampons, or have used a diaphragm, you should have little trouble learning to use a cup. It folds up to a size similar to a tampon for insertion. When properly inserted, the wearer shouldn’t feel it at all, much like using a tampon.

There are some potential drawbacks to using a cup. Some women aren’t comfortable inserting them or have fit problems. That’s OK! A menstrual cup isn’t for everyone, but it’s an alternative for women looking for something different.

If you have any questions about a menstrual cup, ask during your next routine gynecological exam. Your provider can help you determine if you should give a menstrual cup a try and can help alleviate any concerns you may have.

Cervical Cancer Screening Guidelines

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In 2012, the way we screen for cervical cancer changed. There were new guidelines for PAP smear testing based on medical evidence, supported by the American College of Obstetrics and Gynecology.

The new recommendations, which IHA providers agree with and follow, start with a PAP test at age 21, followed by PAP testing every three years between 21 and 30 (if you’re low-risk). Once you reach age 30, you’ll be tested every five years with a PAP test and high-risk Human Papillomavirus (HPV) test. As long as you’re low-risk, and the tests are normal, you’ll remain at the five-year interval for testing.

If you are high-risk (you have a history of abnormal PAP tests or have had prior cervical procedures), you may not fit in these recommendations. Your provider will discuss what the best screening frequency is for you based on your history.

In certain situations, a woman may no longer need PAP testing. Generally, if you’re over 65 and have had normal tests previously, you may no longer need PAP tests. You may also be exempt from PAP testing if you have had a certain kind of hysterectomy. You and your provider can discuss and decide if that is best for you based on your risk factors.

A PAP test is a safe way to screen for cervical cancer, with little to minor discomfort. Your provider will use a speculum and a soft brush to take a sample of your cervical cells. If your PAP test is abnormal, your provider will request you come back for additional testing.

If you have additional questions about what to expect, please talk to your provider.

Benefits of Nurse-Midwifery

When you find out you’re “expecting” there are so many decisions to make. Will you find out the gender before birth? What names do you like? What items do you have and what items do you need? And, perhaps most importantly, who will deliver the baby? For most women, this means choosing between an obstetrician-gynecologist and a midwife.

There’s no right or wrong answer. Every pregnancy is different, every woman is different and every woman has a different idea about their ideal birth experience and needs to make the decision that’s right for them.

An obstetrician-gynecologist (OBGYN) manages medical complications throughout pregnancy and birth. If you have certain complications that make your pregnancy high-risk, an OBGYN will be equipped to guide you through the pregnancy and delivery, and will be able to perform a cesarean section, if needed. IHA has many trusted OBGYNs in the greater Ann Arbor area.

An OBGYN isn’t your only option, though. A certified nurse midwife (CNM) is a registered nurse who has graduate-level training in midwifery and is certified by the American College of Nurse-Midwives. IHA Nurse Midwives, who have office hours at the new Domino’s Farms building and attend births at St. Joseph Mercy Hospital in Ann Arbor, are trained to handle all aspects of prenatal care, labor and delivery for low-risk pregnancies. CNMs are trained to recognize potential complications during pregnancy and birth, like the need for a cesarean section, for example. In this case, your CNM will consult with the IHA obstetrician that is readily available on the Labor and Delivery unit.

Additionally, CNMs provide care for the well-woman including family planning, contraception, annual exams and problem gynecological visits. CNMs favor a holistic, family-centered approach to pregnancy and birth with a focus on education, support and intervening in the process only when necessary.

While you’re interviewing and considering practitioners, don’t hesitate to ask specific questions about their approach to prenatal care, labor and birth, protocols for complications and anything else that may help you make your decision. The more information you gather, the better you’ll be able to choose the right provider for you and your family.

If you’re interested in learning more about IHA Nurse Midwives, please join us for a midwife-guided tour of the hospital birthing center on October 16, 2014 from 6:00-7:00pm at St. Joseph Mercy- Ann Arbor, 5301 McAuley Drive (the first floor lobby of the birthing center).