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“How do we take what we know about breast health and breast cancer awareness and get past the fears that women have about breast cancer?” Bradley asked. Her strategy: meeting women where they are. “Midwives are pragmatists,” she said. “We understand the importance of understanding what’s generating a woman’s fear or motivating her not to take care of herself. We need to help women understand that the earlier breast cancer is diagnosed, the more curable it is.”
Bradley considers women’s fears, including family history of breast cancer, as she guides them toward good breast health. She advocates eating a low-fat diet, maintaining a healthy weight, and avoiding excessive alcohol use and all tobacco. “A midwife’s role is knowing her patient, helping her find what preventive measures suit her best, and how to keep her moving in a direction of healthy living,” she said.
To advance breast health, Bradley urges all women to have a baseline mammogram at age 35. “It’s old school but the younger we are, the more aggressive breast cancer is,” she said. She also recommends mammography and ultrasound for analyzing dense breast tissue, which is common among young women. “When women are 35 they’re going to have dense tissue, and density is a breeding ground for mutation," she said. "That’s what screening is about: finding something in its earliest developmental mutation, when it’s most curable.”
She recommends a second mammogram at age 40—providing the baseline revealed nothing abnormal—and follow-ups every 18 months to two years during a woman’s 40s; yearly between ages 50 and 60; and every other year after age 60.
After age 70, women probably don’t need a mammogram, unless they’re on hormone therapy. “If you’re going to continue hormone therapy, then you have to get a mammogram every year because the hormones that disappeared after menopause, and that are associated with breast cancer, are still present for you,” she said. Women with a personal or family history of breast cancer also may require more frequent mammograms.
Monthly SBE is commonly prescribed but the frequency may make women too anxious to examine themselves at all, Bradley warned. Although she likes patients to examine themselves at different times of the month so they can recognize the lumps and bumps that come and go with their periods, she realizes that most don’t.
Ultimately, reminding women of the family members who love and depend on them might be the surest way to conquer their fear of breast cancer screening. “I tell them, ‘You’re taking care of all these people, so what happens if something happens to you?'" she said. "Early detection is going to be your best bet."
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