40s: Your risk of developing breast cancer in this decade: 1 in 70
You should know: After years of bickering, most experts now agree that mammograms save lives for women over age 40. Alas, only 64 percent of 40-somethings show up for regular screenings, according to the American Cancer Society (ACS). If cancer is found, be prepared for intensive treatment. Cancer in these years tends to be more aggressive and less likely to respond to estrogen-blocking therapies such as tamoxifen. But younger women typically can tolerate more treatment side effects, so you can get larger, more effective doses of chemo drugs, says Gabriel Hortobagyi, MD, chairman of the breast medical oncology department at the University of Texas M.*D. Anderson Cancer Center. "On average, chemo in women younger than 50 reduces recurrence rates by as much as 55 percent, compared with 20 to 30 percent in older women," Hortobagyi says.
Essential steps: Ask for a digital mammogram, which does a better job for younger women, who tend to have denser breasts. In a large, multi­center study, digital scans found 15 percent more cancers than standard mammograms in women under age 50. (Don't be dismayed if you're called back for another exam. It's harder to get a good view in women in their 40s, so they're more often recalled for additional tests.)
50s: Your risk of developing breast cancer in this decade: 1 in 40
You should know: Breast cancer rates have declined significantly among women 50 and older since 2001, in large part because of the drop in the use of hormone therapy, says Debbie Saslow, PhD, director of breast and gynecologic cancers for the ACS.
Essential steps: Don't forget your mammogram. Even with the recent drop in incidence, your risk of developing cancer remains higher than for younger women—yet mammography rates in this age group have fallen 7 percent since 2000. Early detection pays off: Breast cancer that develops in a woman's 50s is more likely to be estrogen receptor positive, so there are more drugs available to treat it.
Nip/Tuck
A life well lived leaves traces on your body: laugh lines, crow's feet, and, yes, breasts that aren't as firm as they used to be. One perfectly good reaction: Shrugging at the changes—especially if the shrugging is done in the right bra. But for some women, that gesture doesn't have the desired oomph. More than 163,000 women over age 40 got gravity-defying help from a scalpel in 2007, spurred on by improved surgical techniques and the return of the silicone implant. Here, Prevention investigates the benefits and downsides of nips, tucks, and more.
Lift
The rate of lift surgery has nearly doubled since 2000, according to the American Society of Plastic Surgeons, with well over 53,000 procedures in 2007.
How it works: By removing excess skin and tightening the surrounding tissue, surgeons can raise and reshape the breasts. A new technique leaves a smaller scar that can be neatly camouflaged by the nipple's areola—although many factors determine whether this less conspicuous approach or the older anchor lift is right for you.
Downside: The procedure can't replace lost volume, so if breast deflation is a big issue for you in addition to sag, a lift may not be adequate.
Breast Implants
The number of women over 40 getting breast implants increased by 17 percent between 2005 and 2006; in 2007, more than 107,000 women in that age range got the procedure.
How it works: Adding implants during a breast lift helps with sag and loss of volume. A 1994 study from Washington University School of Medicine found that 95 percent of women felt better about themselves after the surgery. But it presents a tough choice: saline or silicone. Silicone implants look and feel more natural than saline, but in 1992, they were pulled off the market for use in cosmetic procedures because of concerns they might raise the risk of scleroderma or other disorders. Now, after several large National Cancer Institute studies, silicone is back. "Breast implants have been studied more extensively than any other medical device," says Donna-Bea Tillman, PhD, director of the Office of Device Evaluation at the FDA. "And our experts concluded that they're safe and effective."
Downside: About 10 percent of implants—saline or silicone—rupture within 5 years, and the rate goes up as time passes. To make sure ruptured implants are detected and removed, women should get an MRI 3 years after surgery and then again every 2 years (in addition to their annual mammogram). Implants can also harden—it happens with up to 80 percent of the silicone variety and 40 percent of saline ones. All told, most women need to replace or remove an implant within 15 to 20 years, says Walter L. Erhardt, MD, past president of the ASPS. Implants can also make mammograms harder to read, though technologists who perform the exam make adjustments. A study from the University of Washington found that mammograms missed 55 percent of breast cancers in women with implants, versus only 33 percent among women without them. Fortunately, there's no sign that the murky mammograms affect mortality. "Women with augmentation may be more breast aware and seek medical care more quickly," suggests study author Diana L. Miglioretti, PhD.
Reduction
More than half of reduction surgeries were in 40-plus women in 2007, according to the ASPS; more than 56,000 women over 40 got the procedure. Small wonder: By that age, the health effects of large breasts—chafed skin, back and neck pain, and grooves in the shoulders from ill-fitting bras—are mounting. In a recent study, discomfort was vanquished or greatly reduced 1 year after surgery for 88 percent of patients. "Women invariably say they wish they'd had it sooner," Erhardt says. Benefits go beyond comfort. Breast exams and mammograms are often easier to perform and more effective after surgery. And some research suggests it can even reduce the risk of breast cancer, especially in those over age 50.
Bonus: Because of the health problems that can result from uncomfortably large breasts, insurance often picks up the tab.
Downside: The surgery can cause a loss of nipple sensation, and in some cases, can result in asymmetry of the breasts.
Ask For It:
If you have a family history of breast cancer, an MRI does a more reliable job than a standard mammogram. It's too sensitive for other women, though—it's likely to cause a false alarm.
How to Find the Right Bra
Before you consider anything radical (like surgery) for the problems that come with age, explore a solution that's affordable, risk free, and effective. The right bra can lift your bosom and coax it forward, says Susan Nethero, founder and chief fit stylist of Intimacy lingerie shops. The key: Get one that fits right—which is more likely after a professional bra fitting. (For a fitter with extra training, go to prevention.com/links for a list of specialty stores near you.)
http://www.youtube.com/watch?v=ywR3GHkyUmc
It's especially important to choose a bra that's tight in the band. That's where most of the support comes from (a snug band also causes fewer unsightly ridges in back). You should experiment with different styles; many women who started wearing bras in the age of the natural look prefer a seamless bra, Nethero says, but one with seams gives more support. And check out unfamiliar brands. American bra companies produce just seven cup sizes, from AA to DDD. In contrast, European brands offer 14 cup depths—up to JJ. That can allow you to get a better fit, she says.