Let’s talk about breasts

October is Breast Cancer awareness month

Which means pink ribbons appear everywhere, social media fills up with messages about checking your breasts, and suddenly even serious health campaigns come with a pink cupcake.

And while I have nothing against a pink cupcake, I would like us to talk about something a little more useful.

As a GP and menopause specialist, I see how often women become anxious about breast cancer, particularly when menopause and HRT enter the conversation.

So, let's clear up a few things.

First: breasts are allowed to be different

One can be slightly bigger. One can sit slightly lower. They can feel lumpy at different times of life and change with age, pregnancy, breastfeeding, weight changes and hormonal fluctuations.

Being breast aware doesn't mean examining yourself every morning with a clipboard.

It simply means knowing what is normal for you.

Look. Touch. Notice.

A new lump, change in breast size or shape, skin dimpling, nipple inversion, unusual discharge, or a persistent new change in the breast or armpit should be assessed by a healthcare professional.

And here is something reassuring, most breast changes are not cancer.

But unusual changes should still be checked.

Mammograms are important, but they don't replace breast awareness

In England, routine breast screening is currently offered every three years from age 50 to 71. Screening can detect some cancers before they can be felt.

But no screening programme detects every cancer.

So think of screening as one safety net, and knowing your own breasts as another.

Now, let's talk about HRT

This is probably the question I hear most often:

Does HRT cause breast cancer?

The honest answer is it's more complicated than that.

Combined HRT - oestrogen plus a progestogen, is associated with an increased risk of breast cancer, particularly with longer use.

For oestrogen-only HRT, NICE states that there is very little or no increase in breast cancer risk.

So neither “HRT causes breast cancer” nor “HRT doesn't increase breast cancer risk” tells the whole story.

The type of HRT, duration of treatment, age, personal and family history and an individual's other risk factors all matter.

That is why menopause prescribing should be individualised.

HRT is not something every woman needs, but neither is it something women should automatically be frightened of.

It is a medical treatment with benefits, risks and individual considerations.

What if you've had breast cancer?

This needs a different conversation.

Systemic HRT is generally not routinely recommended after breast cancer, and decisions about managing menopausal symptoms should take into account the type of breast cancer, previous treatment and the individual's circumstances.

But “I've had breast cancer, so there is nothing I can do about my menopause” is not the end of the conversation.

And now for the boring, but important bit

Some lifestyle factors also influence breast cancer risk.

Being physically active, maintaining a healthy weight, not smoking and keeping alcohol consumption within sensible limits can all contribute to reducing risk.

Unfortunately, there is no magic supplement, detox or £90 “hormone-balancing” powder that makes cancer risk disappear.

The boring things still matter.

So, this October...

Wear pink if you want to.

But most importantly:

• Know your breasts.
• Attend breast screening when invited.
• Don't ignore a new or unusual change, and
• Don't make decisions about HRT based on frightening headlines.

Ask questions. Look at the evidence. Have an individual conversation with an appropriately qualified healthcare professional.

Because breast awareness isn't about being frightened of breast cancer.

It is about knowing your own body well enough to notice when something changes, and confident enough to do something about it.