October is an important month for many, but I’m not actually talking about Halloween. However, for many, it can be a reminder of something very scary that happened in their lifetime. For me, it isn’t October, a month dedicated to breast cancer awareness.

March was when breast pain and a self-detected lump would lead me on an exhaustive journey for answers. Something evil had definitely been brewing, like a witch’s pot, prior to discovering there was an abnormality. When I saw what appeared as white webbing on my mammogram, I knew it wasn’t from a spider, but it compelled me to assume there was something seriously wrong. I’m normally not so fair-skinned, but that day I bet I was as pale as a ghost. My first thought was I had breast cancer. I had never heard of BIRADS-5, and unknowingly at the time, that was the category of my mammogram result; highly suspicious of breast cancer. It then made sense why my PCP called ahead of my core needle-guided breast biopsy procedure, requesting to schedule an appointment with a surgical breast oncologist. It was then I deeply suspected my breast lump just wasn’t a benign finding. I was scared, to say the least.

To keep a long story short, I was diagnosed with a benign breast disease known as granulomatous mastitis (GM). It’s important to note that there are actually many subtypes of GM too, like CNGM (often an infectious form), PAGM, IGM, ILGM, and GLM. While I was certainly relieved, I was completely unaware of what a monstrous year and a half I faced ahead. Untraditional pathology testing would result in an often environmentally associated bacteria as the cause of my GM. The disease has many underlying causes and can present similarly to traditional mastitis for some at first, which many associate with breastfeeding. However, it can be caused by non-lactational reasons. It isn’t always the cause, just like with GM, as I had never been pregnant, let alone breastfed. While mastitis can be more self-limiting, that is not so much the modern-day case with GM. Mastitis, though, can also cause a woman to feel a breast lump or an area of hardness.

I would imagine most women who self-discover a lump or have an abnormality detected in any imaging assume the worst, being a breast cancer diagnosis. While I was grateful I was not facing a breast cancer journey, I also had no idea at the time about the breast cancer risks that can sometimes accompany the emerging chronic inflammatory breast disease. My own surgical breast oncologist, friend, and also a personal contributor to my book, Diagnosis Detective: Curing Granulomatous Mastitis, often shares specific information now with patients diagnosed with the same disease I am blessed to be in full remission from. For some women with GM, the unresolved condition has led to a breast cancer diagnosis. This is one reason I continue to educate and advocate.

Dr. Kelly McLean states:

Granulomatous mastitis’ association with breast cancer is multifaceted. Even though granulomatous mastitis is a benign infectious and inflammatory condition, when it presents, it can look and feel like breast cancer. The prolonged, chronic inflammation increases the risk of developing breast cancer. During the time that patients have this painful disease, which can last over a year, they avoid imaging because of the discomfort. In addition, the disease distorts the tissue on a mammogram, making new cancers harder to detect. All of these factors can contribute to delayed detection of new breast cancers.

It is human nature to think a breast lump is breast cancer. While there are a significant number of breast cancer diagnoses each year, there are the aforementioned two conditions that can present breast lumps, which are not always breast cancer. There are also many other differentials often diagnosed as well, like cysts, fibrous growths; with a significant number sometimes leading to fibrocystic breast disease (FBD), or breast implants; which can cause lumps to be felt if fluid builds up or pockets of silicone occur. It’s also important to note the potential risks associated with breast implants and to reference an increasingly succeeding outcome known as breast implant illness. Normally, a cyst of the breast is fluid-filled and a non-cancerous sac, whereas a fibrous growth or fibroadenoma is a solid lump. FBD typically causes a breast to feel lumpy, similar to nodular tissue. However, there is often an underlying influence such as estrogen dominance, though then there are many underlying causes of estrogen dominance. It’s kind of like what came first: the chicken or the egg? One thing to note is FBD can increase breast cancer risks, sometimes even fourfold. Several women diagnosed with this condition often seek non-conventional advice with the help of root-cause approach practices like functional medicine.

We have ample resources when it comes to breast cancer screening, but equally important is breast cancer prevention. Sure, there are genetic factors to consider increasing risks; however, we should not think our genes are the absolute destiny, as there’s gene expression to consider. There are many factors that can cause gene expression to occur, like environmental factors, genetic design, age, and harmful chemicals or substances, as certain examples. We have the ability to limit some of these factors, which is why personally I strive to live a healthy, more holistic lifestyle. I read labels for everything I consume, put on my body, or use within my home. Being a survivor of a chronically inflammatory breast disease, I also make it a priority to focus on breast health and do my best to eat an anti-inflammatory diet. I discuss in more detail in my book the various ways I and others can conceivably achieve better overall breast health and potentially decrease breast cancer risks. There is much to admire about my surgical breast oncologist, but one thing I applaud her for is the advice she gives her patients regarding nutrition, diet, and lifestyle. She also takes pride in taking care of herself too. I personally think if a doctor takes care of themselves, they can help better advise and take care of you too.

Back to Dr. McLean:

While some factors that contribute to the development of breast cancer are not in our control, we can control some, including maintaining a healthy body mass index of 25 or less, exercising regularly consisting of 75 minutes of strenuous exercise per week or 150 minutes of moderate exercise per week, and following the Mediterranean or DASH diet. Developing these three simple habits can reduce your risk of developing (or re-developing) breast cancer by 40 to 50 percent, not to mention the myriad of other health benefits they provide. In addition, we recommend 2-3 sessions of strength training per week to maintain muscle mass, bone health, metabolism, and balance, all important for living a long, independent life.

While Breast Cancer Awareness Month is focused on breast cancer, I think we should collaboratively allow this time to be a reminder to all of us to be proactive with self-breast exams, applying prevention opportunities, and, of course, screening. Taking care of the Tatas could help save the Tatas. We think we may have all the time in the world, but time can be of the essence when it comes to breast cancer, and even better treating other breast conditions. It is so true that health is wealth. If you think it’s expensive to live healthily, just wait until you get sick. I took significant time off from working when I had GM due to the nature of the disease; honestly, I felt I had no choice. The business trip I took where ultimately it is believed I contracted GM resulted in me losing money versus making it due to the care needed for treating the disease and the time involved in doing so.

My advice is to be as proactive as you can so hopefully one day you won’t have to be reactive. As for October, I’d rather you be celebrating Halloween than celebrating remission. I hope you only have to be scared of ghosts and witches, instead of a breast lump. Sure, finding a lump can be scary, but ignoring it can be scarier. One thing is for sure though, as Dr. McLean says, “If you feel a breast mass, you go right in and get that checked out because you want to make sure that you catch anything that’s bad.”

Tami Burdick is a patient advocate and author of Diagnosis Detective: Curing Granulomatous Mastitis.

Kelly McLean is a surgical oncologist.