Cancer is personal to us here at The Lily. The mother of Editor and Creative Director Amy King is an ovarian cancer survivor, and her sister is BRCA2 positive. My own mother had breast cancer 10 years ago, after watching her brother’s wife lose her life to it.
September is National Ovarian Cancer Awareness Month. And next month is Breast Cancer Awareness Month. So we’ve partnered with Bright Pink, an organization that empowers young women with knowledge about breast and ovarian cancer. Its mission is to “inspire women to practice prevention.”
We spoke with Deborah Lindner, an obstetrician-gynecologist and Bright Pink’s chief medical officer, about the best ways to approach your doctor, reduce your risk and take care of your body. With her tips, we’ve created this guide for being proactive about your health.
As Lindner knows from personal experience, finding the right medical professional can be challenging.
Around 2006, she was an obstetrics and gynecology resident when she tested positive for the genetic mutation BRCA1, which raised her risk of developing breast cancer and led her to see a string of doctors and surgeons.
Lindner knows what it’s like to be a patient, and this informs the advice she gives to women like her today. She says you can start by looking for these traits:
- “You need to find somebody you can trust. Implicit in that is somebody who actually listens to you and doesn’t brush off your concerns but addresses them.”
- Your doctor will implement shared decision-making into his or her practice, where the physician helps you see the decision clearly, weighs the pros and cons, and allows you to make the final call.
- At the end of your visit, did you leave feeling educated, or did your doctor take a more paternalistic approach?
Typically, you’re not going to have a lot of time with your provider. You can be your own advocate by preparing for your appointment ahead of time with a list of questions and concerns.
A few points you could bring up:
- Ask when you should start getting mammograms, based on your level of risk. Women typically get their first mammogram in their late 40s or early 50s, but if you have a family history of cancer, it’s advised to get one earlier. (Bright Pink recommends scheduling your first mammogram 10 years younger than the age your relative was diagnosed with breast cancer.)
- If your doctor doesn’t offer a clinical breast exam, ask for one.
Lindner can’t stress this enough. To figure out your risk level for ovarian and breast cancer, it’s important to understand your family history with these diseases.
You can start by printing out Bright Pink’s "My Health History” form. Go through the list with your loved ones, and write down the age of each relative at the time of their diagnosis.
“The concept of personalized medicine is that it’s not a one-size-fits-all-approach. Everyone does not have the same risk, so physicians should not be treating everyone the same,” says Lindner.
Bright Pink recommends taking this online risk assessment for breast and ovarian cancer. Save the results by sending it to your email, and bring a copy to your next doctor’s appointment.
If you’re at high risk for developing cancer, you can speak with your doctor about risk-reduction tactics, such as chemoprevention (using medication to prevent cancer) and risk-reducing surgeries.
If you’re at increased or high risk for breast or ovarian cancer, you should speak with your doctor or a genetic counselor about genetic testing.
Not every city has genetic counselors you can meet with face-to-face. To find one in-person or online, visit the Find a Genetic Counselor directory.
- Having an inherited genetic mutation in breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2) increases your risk for breast and ovarian cancer. When genetically mutated, these genes aren’t able to correctly produce tumor-suppressing proteins to repair damaged DNA. The Ovarian Cancer Research Fund Alliance says the genes are “responsible for about 10 to 15 percent of all ovarian cancers.”
- “The more you ovulate, the higher your risk [of breast and ovarian cancer],” says Lindner. Did you get your period before the age of 12 (slightly higher risk) or after 12 (slightly lower risk)?
- Pregnancy also decreases your risk of breast and ovarian cancer in two ways. It stabilizes cells in your breast and eliminates “some ovulatory cycles and therefore the number of chances for ovarian cells to ‘go rogue’ during cell division,” says Bright Pink.
- According to the American Cancer Society, “A family history of some other types of cancer such as colorectal and breast cancer is linked to an increased risk of ovarian cancer.”
“If you’re a woman with average risk for breast or ovarian cancer, there are a lot of lifestyle changes that could be made to help reduce the risk,” says Lindner. “It’s really important to talk about them.”
- Breast-feeding: If you have a baby, breast-feeding for at least a year, if possible, reduces your risk for both breast and ovarian cancer.
- Exercise: Maintaining a healthy weight helps lower your risk. “There is a clear link between obesity and breast cancer because of the excess estrogen produced by excess fatty tissue,” according to Bright Pink.
- Alcohol:Drinking also plays a role in breast cancer risk. There’s a “7 to 10 percent increase in risk for each 10g (~1 drink) alcohol consumed daily by adult women.” (Source: "Links between alcohol consumption and breast cancer: a look at the evidence,” 2015)
- Food:Having a healthy diet also helps decrease the risk for invasive breast cancer in women.
- Vitamin D: Getting vitamin D exposure, either through food or the sun, will also help reduce risk, says Lindner.
- Birth control: Contraceptives that prevent ovulation — like birth control pills — are going to have the biggest impact on your cancer risk. Taking oral contraceptives for five years — consecutively or not — in your 20s or 30s will reduce your risk by “nearly half,” says Bright Pink.
- Smoking:No smoking, ever.
For more information, visit Bright Pink.
Keep tabs on how your breasts usually look and feel. Are they the same color, shape and size as usual? All breasts are different, so what’s standard for you may not be standard for anyone else. Pay close attention to any changes you see.
If these symptoms occur for a couple of weeks or more, alert your doctor:
- Swelling, soreness or rash
- Dimpling or puckering of skin
- Change in size or shape of breast
- Nipple is itchy, has scaly sore or rash
- Nipple becomes flat or inverted
- Nipple discharge
- Persistent pain in one spot
- Bumps that look like bug bites
- A lump that feels like a frozen pea
There’s no sure way to tell if you have ovarian cancer.
At a well-woman exam, a pap smear is taken to check if you have cervical cancer. However, pap smears rarely, if ever, detect ovarian cancerunless it’s already in the later stages.
Sometimes a doctor will also perform a pelvic exam by placing one hand on your abdomen, and reach with the other into your vagina to feel if there is any ovary enlargement or masses on them. But it often takes surgery to confirm if there’s cancer or not.
This is why it’s difficult to detect ovarian cancer, and why it’s often found in the later stages.
Another reason: Symptoms of ovarian cancer can be similar to what a woman might feel if she’s on her period. They are:
- Urinating often
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
Other symptoms, according to Bright Pink’s website:
- Upset stomach or heartburn
- Back pain
- Pain during intercourse
If you these problems persist for more than two to three weeks, ask your doctor if something is wrong.
Having proactive conversations with your healthcare providers on a regular basis is key. That’s why going to see a gynecologist every year for your well-woman exam is a good idea. Not only does it help you build a trusting relationship, but it also helps your physician to know what your body’s standard of “normal” is. Ideally, once there’s a change happening to your body, both you and your medical provider will be alert and ready to respond.