Breast Health in Your 40s

Keeping your breasts healthy as you age is not a one-size-fits-all proposition. "The general principles are the same whether you're in your 40s, 50s, or 60s," says Larry Norton, MD, deputy physician-in-chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center, in New York City. "But how you apply them shifts over time." That's because the changes and options you face in your 40s are different from those you confront in your 50s or 60s. Here's a decade-by-decade guide to your breast health, including the best choices to make concerning everything from your diet to your bra size.

Breast Health in Your 40s

As you head toward menopause, your body starts a new phase of change. One result: 95 percent of all new breast cancers and 97 percent of all deaths from the disease occur in women over 40 (though both are more likely to happen at older ages). So if you haven't paid much attention to breast health before, now is the time to start.

Expect Your Breasts to Feel Different Each Month

In this decade, women often have their first experiences with breast lumpiness, tenderness, and cysts.

"The hormone levels in your body are starting to fluctuate, and your breasts are responding to that," says breast surgeon Shawna Willey, MD, of the Lombardi Comprehensive Cancer Center, at Georgetown University. So from the time you ovulate until you menstruate, you may encounter lumps, bumps, and thickening. Report any new change to your doctor. The presence of cysts or lumps may lead to biopsies, but according to the American Cancer Society, the results of most biopsies (80 percent) are benign. "Seventy percent of women have fibrocystic changes in the breasts over time, and these will become more exaggerated in this decade," Willey says. "But they will diminish after menopause."

Keep Up Self-Exams

Although not many cancers are discovered by this method, of those that are, most are found by the women themselves. Self-exams are still a useful tool, says Jennifer Eng-Wong, MD, a medical oncologist at the Lombardi Comprehensive Cancer Center. Performing exams will keep you familiar with how your breasts feel, she says, which means you'll be alert to any changes that do occur. Which changes should you investigate? "The ones that come and don't go away," says Banu K. Arun, MD, associate professor of breast medical oncology at the M.D. Anderson Cancer Center, at the University of Texas. Schedule a visit to the doctor if you notice changes that linger after your period has ended. If your menstrual cycle is erratic and you experience something unusual, play it safe and talk about it with your physician.

Watch the Calendar

Systematic screening is crucial in your 40s: monthly self-checks, annual ob-gyn checkups, and yearly mammograms. On the one hand, your risk for cancer is lower than it will be in the next two decades. (According to the ACS, a 40-year-old woman has only a 1.43 percent chance of developing breast cancer over the next 10 years.) On the other hand, the tumors that do show up tend to be more aggressive, and less responsive to treatment, than those that appear later. That's why, even though it's unlikely you will develop a problem, you need to start annual screening once you hit 40, says Debbie Saslow, PhD, director of breast and gynecologic cancer at the ACS. Regularity is key: The more time that passes between screening tests, the longer cells can grow unchecked.

Keep Your Weight Steady

Women who get significantly heavier in midlife are more likely to develop breast cancer after menopause than those whose weight remains roughly the same, according to a study in the Archives of Internal Medicine last fall. "Those who gained 40 to 60 pounds between the ages of 35 and 50 had a 40 percent increase in risk compared with women who maintained their weight," says the study's lead author, Jiyoung Ahn, PhD, research fellow at the National Cancer Institute. Over time, even a few extra pounds a year ups your odds of developing breast cancer, as well as a host of other chronic, even deadly, diseases. That's why Ahn calls maintaining a healthy weight the key to cancer prevention.

Meet Your Calcium Quota

In May 2007, a study of 10,000 premenopausal women found that those who consumed 1,370 milligrams of calcium or more a day had a 40 percent lower risk for breast cancer than those who ingested 620 milligrams or less. And those who consumed a daily dose of at least 550 IU of vitamin D (which helps the body absorb calcium) had a 35 percent lower risk than those who consumed 160 IU. The vitamin intakes in the study were higher than current USDA recommended daily amounts (1,000 milligrams and 400 IU, respectively), so which number is right? "We will need to do a clinical trial to determine the optimum amount for breast health," says study author Jennifer Lin, PhD, assistant professor of medicine at Harvard Medical School. For now, hit the USDA quota, adding supplements if you can't get it all from food. Even if it turns out that calcium doesn't affect your breast cancer risk, you'll make your bones stronger.

Choose the Right Technology

Typically, the breast tissue of premenopausal women is denser than younger women's, which can make it more difficult to get a clear mammography image. "Because of that, there may be a small advantage for women at this age to get a digital mammogram rather than the traditional type," Saslow says. If your ob-gyn says you would benefit from this technology, the next step is to find a nearby center with the right equipment. This may be easy in urban areas and near teaching hospitals but harder in small cities and rural areas. One way to find locations is to check the equipment manufacturers' Web sites: GE Healthcare (gehealthcare.com), Hologic (hologic.com), Siemens AG Medical Solutions (medical.siemens.com) and Fujifilm Medical Systems (fujimed.com). "If you don't have access to a digital machine or if your insurance won't cover it, you should still get an annual screening with a traditional machine," Saslow says. Pairing an ultrasound exam with a conventional mammogram is another option. Having both tests increased the number of tumor findings in women with dense breasts, according to a May 2008 study in the Journal of the American Medical Association. The downside: It also substantially upped the number of false positives (findings of something suspicious that later turned out to be normal).

Keep Hormones in Check

The more estrogen and progesterone your body is exposed to over your lifetime, the greater your risk for breast cancer. Hormone therapy and excess weight may increase your risk; breastfeeding, on the other hand, reduces it. But even if you take hormones and didn't breastfeed (or never had children), there is still much that you can do to mitigate your risk. "Keep your weight steady, and get regular physical activity," advises Giske Ursin, MD, PhD, associate professor of preventive medicine at the University of Southern California. "Both have been shown to reduce hormone levels."

Fill in Your Family Health History

If you haven't done so already, collect as much information as possible from relatives on both sides. "Go back several generations, if you can," Norton says. "It's especially important to know if your mother or father carries cancer-predisposing gene mutations, including BRCA-1 or BRCA-2. So if your parents are alive, you might ask them to consider genetic testing." Even if there's no breast cancer in your immediate family, you may still be at risk if you have first-degree relatives with other hormonally driven cancers, such as prostate and ovarian cancers, which are also linked to the BRCA-1 and -2 genes. "If you have a strong family history of breast or ovarian cancer, or any cancer in a parent or a sibling, it's worth a trip to a genetic counselor to assess your personal risk," Norton says. Afterward, you may be advised to seek genetic testing. The process is simple (your doctor takes a regular blood sample and sends it to a special lab); the cost ranges from $300 to $3,000, depending on the test ordered, and many insurers will cover it. If privacy concerns have stopped you from considering such tests in the past, be aware that Congress recently passed the Genetic Information Non-Discrimination Act, which forbids employers and insurers to use DNA test results to deny coverage.

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