The biggest misconception about breast cancer continues to surprise Dr. Megan Miller almost daily in her practice at University Hospitals.
"I don't have a family history of breast cancer. Nobody in my family has ever even had a breast problem. Why do I have breast cancer?" Miller, a breast surgical oncologist, hears this question regularly from patients who are shocked by their diagnosis.
The reality, she explains, is that the vast majority of breast cancer cases are sporadic events that don't stem from family history or genetic mutations like BRCA1 or BRCA2.
"Everybody needs to get screened for breast cancer, whether you have a family history or not," Miller emphasized. "If you're a woman and you're age 40 or older, please, please, please get your mammogram once a year."
Despite ongoing confusion about mammogram recommendations, Miller points to clear guidance from the American Society of Breast Surgeons and the American Cancer Society: annual mammograms starting at age 40 and continuing as long as a woman's life expectancy makes screening beneficial.
"There's not like an age," Miller said, noting there's no specific cutoff at 75 or 80. "It's when your life expectancy is probably less than 10 years."
Women with additional risk factors—including dense breast tissue, family history, or previous biopsies showing atypia—should consult with a breast specialist for personalized screening recommendations that may include supplemental MRI imaging.
Miller also addressed another area of confusion: monthly breast self-examinations. While some women complain their breast tissue feels "lumpy bumpy," that familiarity is precisely the point.
"The idea of the self-exam is that you get to know your own breasts," she explained. "Are they lumpy bumpy in the same way each month? That helps us to know whether there's a change."
Breast cancers typically present as hard nodules that feel distinctly different from normal tissue. Other warning signs include spontaneous nipple discharge that is bloody and one-sided, persistent skin rashes that don't respond to antibiotics, or unexplained lumps under the arm.
Miller recommends performing self-exams at the same time each month—either when menstruation starts or on the first day of every month—along with annual clinical breast exams by a healthcare provider.
Dense breast tissue can make cancers harder to detect on mammograms because both appear white on imaging, while fatty tissue appears black. However, Miller stressed that this doesn't make mammograms ineffective—it just means some women need additional screening tools.
Modern breast cancer treatment bears little resemblance to approaches from just 10 to 15 years ago, according to Miller. Early detection through regular screening means most cancers are found at treatable, often curable stages.
While nearly all breast cancers still require surgery, far fewer patients need chemotherapy than in the past.
Even when chemotherapy is necessary, new technologies like cold cap therapy can significantly reduce hair loss—addressing one of patients' most common concerns.
Radiation requirements have also decreased, and many women have choices about surgical approaches. Early-stage disease often allows for lumpectomy rather than mastectomy, meaning women can keep most of their breast tissue.
Breast reconstruction has evolved from an afterthought to a standard part of treatment planning. Miller emphasized that reconstruction is not elective cosmetic surgery—federal law mandates insurance coverage for any reconstruction related to breast cancer treatment.
Miller predicts that breast cancer treatment will continue trending toward less intervention as therapies become more targeted and effective.