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When Breast Cancer Doesn’t Start in the Breast

When Breast Cancer Doesn’t Start in the Breast Sometimes breast cancer starts in lymph nodes before it’s visible in the breast. Discover how this rare “hidden” form challenges what we think we know. Breast Cancer Can Start Outside the Breast When we think of breast cancer, most of us picture a lump in the breast — something we can feel or see. But what if breast cancer doesn’t begin there at all?It may sound surprising, but not every case of breast cancer starts inside the breast itself. In a small number of cases, doctors actually discover cancer cells in the lymph nodes before they find a tumor in the breast. The Hidden Form: Occult Breast Cancer This rare situation is called occult breast cancer, meaning “hidden” or “not easily seen.” It accounts for less than 1% of all breast cancer diagnoses. In these cases, imaging tests like mammograms and ultrasounds might show no visible tumor, yet a biopsy of a swollen lymph node in the armpit reveals breast cancer cells. Occult breast cancer is mysterious because the main tumor is often too small to detect — or in some cases, the original cancerous cells in the breast may have been destroyed by the body’s immune system, leaving only traces behind in nearby lymph nodes. Why This Matters This type of cancer challenges one of the most common assumptions about breast cancer — that it always begins with a breast lump. The truth is, breast cancer doesn’t always follow predictable rules. Because of this, paying attention to all changes in and around the breast area — not just lumps — is crucial.Watch for: Swelling under the arm or near the collarbone Changes in breast size or shape Skin dimpling or thickening Nipple changes or discharge Redness or warmth in the breast If any of these symptoms appear and don’t go away, it’s important to see a healthcare provider, even if a recent mammogram was normal. Detection and Diagnosis When a lymph node biopsy shows cancer cells but no tumor is seen on scans, doctors use advanced imaging like MRI to search for the source. Even if no tumor is found, treatment usually follows standard breast cancer protocols — often including surgery, chemotherapy, radiation, and hormone therapy, depending on the subtype. The Bigger Picture Occult breast cancer is a reminder that early detection isn’t just about finding lumps — it’s about knowing your body.Trusting your instincts and getting checked when something feels off can make all the difference. For most people, the risk of this specific type of breast cancer is very small, but understanding that breast cancer can sometimes begin outside the breast helps us stay alert in smarter, more informed ways.   Key takeaway: Breast cancer doesn’t always announce itself with a lump. Sometimes, it hides — and that’s why awareness, regular checkups, and self-advocacy are so important.

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Woman living with tissue expanders

Living with Tissue Expanders

What to Expect and How to Live Comfortably with Tissue Expanders Understanding the process, managing the discomfort, and finding confidence during recovery The Purpose of Tissue Expanders After a mastectomy, tissue expanders help prepare your chest for future implants or reconstruction. They gradually stretch the skin, creating a soft, natural-looking space over time. Though temporary, expanders are an important step toward healing and restoration. What to Expect During a Tissue Expander Fill Each fill appointment is typically quick and done right in your surgeon’s office. Your care team will locate a small magnetic or metal port under the skin and inject saline into the expander using a fine needle. This gently increases its size and helps your body adjust.   During the fill:You might feel tightness or pressure across your chest, similar to a firm stretch. Some people describe mild soreness or fullness afterward — especially after early fills — but it usually eases within a day or two. Many women don’t feel the actual needle prick at all because of numbness in the chest area following surgery. If you do feel the tiny pinch, take it as a good sign — it means that sensation and nerve connection are returning, which is a positive part of healing.   Tips to manage discomfort: Take slow, deep breaths during the fill to help your chest relax Wear a soft, wireless bra or compression bra for added comfort Avoid strenuous activity Fills are often scheduled every week, depending on your healing, but you can skip a week if you prefer or need extra recovery time. Each session brings you one step closer to your reconstruction goals. Items used during a tissue expander fill. From left to right: cleansing wipe, syring with solution, bandaids, magnetic device to find port Living With Tissue Expanders Once your expanders are in place, it’s completely normal for your chest to look and feel different than you expected. They can feel firm, high, and sometimes uneven, especially in the beginning. Tissue expanders don’t always expand in perfect symmetry — sometimes they stretch in whatever direction your body allows. One side might sit higher, push outward, or feel rounder than the other. Don’t worry — that’s all part of the process and will be corrected during your final reconstruction when your surgeon adjusts the shape and position.   You may also notice humps, ridges, or small firm areas under your skin. These are often caused by the fill ports (the small area your surgeon uses for saline fills) or natural folds in the expander shell as it adjusts. They can feel strange to the touch, but they’re usually nothing to be concerned about.   That said, if you feel a distinct knot, new lump, or area of tenderness, it’s best to mention it to your doctor. Most of the time it’s something minor, but it’s always worth checking for reassurance and safety.   Sleeping takes adjustment:Most people find it easier to sleep on their back, especially early on. A wedge pillow or recliner can help keep you propped up comfortably. Movement may feel tight:Stretching or reaching can feel restricted. Once your surgeon clears you, gentle shoulder rolls or arm stretches can help prevent stiffness. Clothing comfort matters:Soft fabrics, zip-front bras, and loose tops will make a big difference. Many women layer clothing to feel more balanced and confident during expansion. You might notice odd sensations:Some women describe pressure, tingling, or even faint “sloshing” sounds. It’s all normal — just saline shifting inside the expanders. 💡 Sizing & Comfort Tips 1. Try on a bra to gauge your size.If you were previously a B cup and plan to be a C cup, but aren’t sure if you’ve reached that size during your fills, try buying a C cup bra and see how it fits with your current expansion. It’s an easy, visual way to gauge your progress — and can help you decide whether you’re comfortable with your current fill size or want to go a bit further. 2. Judge your size with clothes on.When deciding what size you want to be, look at yourself in fitted clothes — not just in the mirror. Clothing often disguises fullness and shape, so what might feel large without a shirt could look perfectly balanced once you’re dressed. It’s a simple but smart way to decide what feels right for you. The Emotional Side Beyond the physical adjustments, tissue expanders can impact how you feel about your body. It’s okay to feel impatient, frustrated, or emotional — healing is as much mental as it is physical. Consider: Taking progress photos to see how far you’ve come Joining a support group or connecting with others who’ve been through it Giving yourself grace — recovery isn’t linear, but you’re doing something incredibly strong Looking Ahead When expansion is complete, your surgeon will schedule your implant exchange or next reconstruction step. Many women say this stage feels like a turning point — your chest softens, your shape feels more natural, and it’s a reminder that every step of discomfort was leading to healing.   Bottom line:Living with tissue expanders is temporary but meaningful. It’s a process of patience, strength, and progress — and every fill, every stretch, and every moment of healing brings you closer to feeling like you again.

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Pink breast cancer ribbon for awareness

Breast Cancer Awareness Month: More Than Pink Ribbons

Breast Cancer Awareness Month: More Than Pink Ribbons Recognizing courage, learning the story behind the pink ribbon, and motivating compassionate awareness and action that lasts far beyond October 🎀 Breast Cancer Awareness Month: More Than Pink Ribbons October is about more than pink. It’s about people—their strength, stories, and the compassion that connects us all. Every October, pink ribbons appear on everything from coffee cups to city skylines. Breast Cancer Awareness Month highlights early detection, honors survivors, and remembers those lost. But beyond the fundraising walks and pink displays, this month is really about human connection. 🩺 The History Behind the Movement Breast Cancer Awareness Month (BCAM) began in 1985 as a partnership between the American Cancer Society and Imperial Chemical Industries, the maker of tamoxifen, one of the earliest breast cancer treatments. At the time, mammograms were still new, and many women didn’t know their importance. The goal was to promote early detection—a message that remains just as vital today. By the 1990s, awareness had grown far beyond hospitals and research centers. BCAM evolved into a worldwide movement, uniting survivors, families, and advocates everywhere. 💗 The Story of the Pink Ribbon In 1991, the Susan G. Komen Foundation handed out pink ribbons at its Race for the Cure in New York City. That same year, SELF magazine editor Alexandra Penney and Estée Lauder executive Evelyn Lauder launched a national breast cancer awareness campaign. They drew inspiration from activist Charlotte Haley, who had been distributing peach-colored ribbons to call attention to low cancer-prevention funding. When Haley declined collaboration to keep her movement non-commercial, Penney and Lauder chose pink instead—a color symbolizing hope, health, and femininity. The rest is history. The pink ribbon spread worldwide, appearing on beauty counters, billboards, and campaigns everywhere. Evelyn Lauder later co-founded the Breast Cancer Research Foundation (BCRF) in 1993, funding life-saving research that continues today. 💬 What to Say (and Not Say) A question that comes up every October:Should you say “Happy Breast Cancer Awareness Month”?   👉 Probably not.   While it’s meant kindly, it can feel insensitive. For those who’ve been through breast cancer—or lost someone—it’s not a “happy” occasion. Try something more heartfelt: “I’m thinking of you this month.” “I’m learning more about breast cancer and how to help.” “I admire your strength.” “Is there anything I can do to support you?” Awareness Month isn’t a celebration—it’s a time for reflection, empathy, and understanding. 🤝 How to Support Someone with Breast Cancer If you know someone facing breast cancer: Listen without fixing. Sometimes they just need to be heard. Skip the toxic positivity. “You’ve got this!” can feel dismissive. Try “I know this is hard, and I’m here.” Offer real help. Meals, childcare, rides—practical support matters most. Respect boundaries. Let them guide the conversation. Stay connected. The need for support continues long after treatment ends. 🌸 Beyond Awareness Wearing pink is nice—but real impact comes from action: Donate to organizations like BCRF or Susan G. Komen. Schedule your own mammogram. Share accurate, science-based information. Be there for someone quietly facing treatment or recovery. 💖 The Takeaway Breast Cancer Awareness Month isn’t about celebration—it’s about connection and compassion. “I see you. I support you. And I’m committed to raising awareness—not just in October, but all year long.”

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Two different types of cancer

Can Someone Get Two Different Cancers in Their Lifetime?

Can Someone Get Two Different Cancers in Their Lifetime? It’s possible to face more than one cancer in life — but every step forward in science brings better ways to treat and thrive Multiple Primary Cancers When most people think about cancer, they picture it as a single, life-changing diagnosis. But it’s possible for someone to develop more than one type of cancer over their lifetime. Doctors call this situation multiple primary cancers — meaning the second cancer is a new and unrelated disease, not a recurrence or spread of the first.   How Common is it? In the general population, the lifetime risk of developing any cancer in the U.S. is about 40% for men and 38% for women. While most people who are diagnosed with cancer will only face it once, research shows that around 5–8% of cancer survivors develop a second, unrelated cancer during their lifetime. For cancer survivors, the odds are higher than average. In fact, today about 1 in 6 new cancer diagnoses is in someone who has already had cancer before.   Why Does This Happen? There are several reasons why someone may develop two different cancers: Shared risk factors: Certain habits or exposures can raise the risk of multiple cancers. For example, smoking increases the likelihood of lung, bladder, and head and neck cancers. Genetic predisposition: Some inherited conditions, such as BRCA mutations or Lynch syndrome, make people more susceptible to more than one type of cancer. Effects of treatment: Chemotherapy and radiation can be lifesaving, but in some cases they slightly raise the risk of a new cancer years later. Living longer after cancer: Advances in early detection and treatment mean survivors are living longer, which gives more time for a new, unrelated cancer to develop. Breast Cancer and Second Cancers Breast cancer is one of the most common cancers where doctors see survivors develop another, different cancer later in life. The risks vary depending on age, genetics, and treatment history. Second breast cancer: For most breast cancer survivors, the risk of a new cancer in the opposite breast is about 0.2–0.4% per year — roughly 4–8% over 20 years, but higher for those with BRCA mutations. Ovarian cancer: Women with BRCA1 mutations have a 39–44% lifetime risk of ovarian cancer; those with BRCA2 mutations have an 11–17% risk. Without these mutations, the average woman’s lifetime risk is less than 2%. Uterine (endometrial) cancer: Women who take tamoxifen for 5 or more years have about a 2–3 times higher risk of endometrial cancer. Even with that increase, the overall risk remains fairly low (around 1–2% over 10 years of use). Leukemia: Chemotherapy drugs such as anthracyclines or alkylating agents can increase the chance of leukemia. The risk is small — generally less than 1% of survivors. Other cancers: Studies show breast cancer survivors may also have a slightly elevated risk of colon, thyroid, and lung cancers compared to the general population, though these risks are less precisely measured. Because of these risks, breast cancer survivors are often advised to: Continue regular mammograms (and sometimes MRI for high-risk women). Stay up to date with gynecologic and colon screenings. Consider genetic counseling if they have a strong family history of breast or ovarian cancer. What Does This Mean for Survivors? Most survivors will not develop a second cancer, but it is something to be aware of. Doctors typically recommend ongoing follow-up care not only to check for recurrence, but also to monitor for new cancers. Healthy lifestyle choices — such as avoiding tobacco, maintaining a balanced diet, exercising regularly, and staying up to date on screenings — can help lower risk.   The Bottom Line While the idea of facing two different cancers can feel overwhelming, it’s important to remember that this is still relatively uncommon. Thanks to better treatments and survivorship care, many people who do experience a second cancer are diagnosed earlier and live longer, healthier lives. 📊 Breast Cancer Survivors: Risk of Second Cancers at a Glance Second Cancer Type Estimated Relative / Absolute Risk Notes & Source Any second primary cancers other than breast cancer About 25–30% higher chance of developing another, unrelated cancer compared to women who’ve never had breast cancer Meta-analysis pooling 30 studies on breast cancer survivors Overall risk of any new cancer (including another breast cancer) Breast cancer survivors are about 15–20% more likely to develop a new, different cancer than the general population Meta-analysis of 15 studies ACS Publications Cumulative incidence over time Roughly 1 in 25 survivors develop a new cancer within 5 years, 1 in 12 within 10 years, and 1 in 7 within 15 years From systematic review meta-analysis of breast survivors Second breast cancer (contralateral / SPBC) Women with BRCA1 mutations have about 5 times the risk, and those with BRCA2 have about 3 times the risk of developing cancer in the other breast Genetic risk review of second primary cancers in breast cancer survivors Endometrial (due to tamoxifen) Taking tamoxifen long-term can double the risk of endometrial cancer, but the overall chance stays low (around 1–2%) Dose-response meta-analysis of 26 studies Leukemia (from chemotherapy or radiation) A small increase — about 30% higher risk, but still less than 1% overall chance of developing leukemia Large cohort study Other radiation-related cancers Women who received radiation therapy have about a 25–30% higher chance of developing a new cancer in another part of the body Cohort study of 248,268 women Important Notes Numbers differ by time window (5, 10, 20 years vs lifetime), patient age, genetic status (BRCA/Lynch/etc.), and treatments received; older treatment eras had different risks than modern regimens. Use absolute risk alongside relative risk to avoid alarm. The Lancet Socioeconomic and behavioral risk factors (smoking, obesity) explain part of the increased second-cancer risk in some cohorts; screening access and deprivation also affect observed rates. The Lancet

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Woman standing confidently in front of mirror about to do a breast self exam

How to Perform a Breast Self Exam

How to Perform a Breast Self-Exam: Step-by-Step Guide Regular breast self-exams help you become familiar with your breasts and notice any changes early. While they don’t replace routine screenings like mammograms, knowing what’s normal for you is an important part of breast health Step 1: Choose the Right Time Menstruating women: 3–5 days after your period starts, when breasts are least tender or swollen Postmenopausal women: pick the same day each month for consistency Step 2: Look at Your Breasts in the Mirror Stand in front of a mirror with shoulders straight and arms on your hips: Check for changes in size, shape, or symmetry Look for dimpling, puckering, or bulging of the skin Notice changes in the nipple, such as inversion (if it wasn’t previously inverted) or discharge Then, raise your arms overhead and look for the same signs Tip: Take a photo reference (optional) to track changes over time, but only keep it private and secure Step 3: Examine While Lying Down Lie on your back with a pillow under your right shoulder Place your right hand behind your head Use the pads of your left hand to feel your right breast Use small circular motions with varying pressure: Light pressure for skin and tissue just beneath Medium pressure for tissue in the middle of the breast Firm pressure for deep tissue near the chest and ribs Follow a pattern: circular motions, vertical strips, or wedge shapes from the nipple outward Repeat on the left breast using your right hand Step 4: Examine While Standing or Sitting Many people find it easiest in the shower Use the same circular or vertical strip technique to feel for lumps or thickened areas Tip: Be consistent with your method so you can detect any new changes accurately Step 5: Know What’s Normal Breasts naturally feel lumpy or uneven, especially before your period. Look for new or unusual changes, such as: A hard lump or thickened area Swelling, warmth, or redness Skin changes (dimpling, puckering, rash) Nipple changes (discharge, inversion, pain) Step 6: Report Changes If you notice anything new, persistent, or unusual, contact your healthcare provider promptly Most changes are not cancer, but early evaluation is key to peace of mind and safety Key Takeaways Perform a self-exam monthly Pair with routine clinical breast exams and mammograms as recommended by your doctor Knowing your normal breast texture and appearance is the most important tool in early detection Early detection saves lives. Schedule regular screenings and consult your healthcare provider if you notice any unusual changes

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Facts

About Breast Cancer Breast cancer is one of the most common cancers affecting women worldwide, characterized by malignant growths in breast tissue. Understanding your risks, recognizing symptoms, and seeking timely care are key to better outcomes General Info General statistics for understanding breast cancer Most common cancer in women (1 in 8 risk) Men can get it too (1% – 1 in 726 risk) Around 15% of women diagnosed have a family history of breast cancer Overall decline in death of 44% since 1989 Learn More Question 1 Which type of breast cancer accounts for roughly 70–80% of invasive cases? A Inflammatory breast cancer B Invasive ductal carcinoma (IDC) C Invasive lobular carcinoma D Medullary carcinoma Explanation: IDC is the most common invasive type, originating in the milk ducts. Risk Factors Evidence-based indicators linked to disease risk Age (50+) Family history & BRCA genes Hormones (early periods – before age 12, late menopause – after 55, HRT) Lifestyle (alcohol, obesity, inactivity) Learn more Symptoms Various signs that may indicate disease presence Lump or swelling Skin changes (dimpling, redness, itching) Nipple changes (inversion, discharge) Persistent breast pain and discomfort Learn more Question 2 Which type of mammogram is considered more sensitive for women with dense breasts? A 2D digital mammogram B Chest X-ray C Ultrasound D 3D tomosynthesis Explanation: 3D mammograms can detect small tumors in dense breast tissue more effectively. Screening Tests guided by clinical guidelines and risk profile Mammogram Ultrasound Genetic testing if high risk Self-exam: know your normal Learn More Treatment Approaches determined by current guidelines Surgery Radiation Chemotherapy Hormone Therapy Immunotherapy Targeted Therapy Learn more Outlook Outlook determined by evidence based results Localized stage: 5yr survival – 99% Regional stage: 5yr survival – 87% Distant stage: 5yr survival – 32% New cases risen an average 0.6% each year over 2013–2022 Rate of death declined an average 1.2% each year over 2014–2023 Learn More Question 3 Which group now has a significantly higher survival rate than it did 20 years ago, thanks to improved treatments? A People with metastatic (stage IV) breast cancer B People with HER2-positive breast cancer C People with hormone receptor–positive breast cancer D People with triple-negative breast cancer Explanation: Even advanced breast cancer has seen survival improvements because of new therapies, especially targeted and systemic treatments

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Welcome

Welcome Every Knot has a Story “It is not the strongest that survive, nor the most intelligent, but the one most responsive to change” Charles Darwin When I first heard the words, it is cancer, everything knotted up inside me – my thoughts, my body, my plans, my sense of control. If you’re here, maybe you’ve felt it too.    That knot, literal or emotional, is where this blog begins.    Welcome to Know the Knots. This space was born out of questions, quiet moments, hard days, and a fierce need to feel less alone. Whether you’re navigating breast cancer yourself of walking besides someone who is, I hope this blog becomes a companion for you.    Here is what you can expect: Clear Information – Because the science shouldn’t feel like a secret language Practical Support – From lifestyle tips to surgery advice. For the big and small moments A Resource Hub – Questions, links, and tools you can actually use More than anything, I hope you find something here that untangles a bit of what you’re holding, even just one knot.  Visit our Resource Hub Practical Tools and Science-Backed Guidance Come explore our library of resources created to support you RESOURCES

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