Podcast Summary:

BETTER! Muscle, Mobility, Metabolism & (Peri) Menopause with Dr. Stephanie
Episode: Breast Health Masterclass: Pain, Lumps & Cancer Screening with Dr. Ebuoma
Date: February 9, 2026
Host: Dr. Stephanie Estima
Guest: Dr. Lillian Iboma, Harvard-trained breast radiologist

Main Theme & Purpose

This episode is a comprehensive “masterclass” on breast health, tailored for women (and men) of all ages and backgrounds. Dr. Stephanie Estima hosts Dr. Lillian Iboma, an expert breast radiologist, to break down breast biology, development, common problems (pain, lumps, discharge), the nuances of screening (mammograms, ultrasound, MRI), density, cancer risk, and prevention. The tone is practical, empathetic, and myth-busting, with many actionable insights, memorable metaphors, and real-world advice.

Key Discussion Points & Insights

1. Breast Development & Anatomy

• Embryology:
  • Breast tissue develops along "mammary ridges" stretching from mid-thigh to armpit in utero. Remnants can persist, leading to tissue or even milk in unexpected locations later (e.g., armpit or thigh).
    • Dr. Iboma: "A fun fact that a lot of people don't know is you develop... these breast ridges... from your mid thigh all the way up to your armpit area." (00:00)
• Asymmetry:
  • Breast development typically is uneven—one breast may develop earlier or become larger.
  • Asymmetry is the norm, not the exception.
• Breast Development in Males:
  • Male babies may have transient breast tissue from maternal estrogen, usually resolving on its own (05:20).
  • Gynecomastia can occur across the male lifespan, especially with obesity, certain medications, steroids, or marijuana use—adipose tissue increases estrogen via aromatase (11:28, 11:58).

2. Breast Pain (Mastalgia) Across the Lifespan

• Cyclical Pain:
  • Linked to the menstrual cycle, generally normal, often bilateral but may be asymmetric.
  • Caffeine, chocolate, and individual triggers may worsen pain. Vitamin E and primrose oil anecdotally help some (12:41).
• Non-Cyclical Pain:
  • Especially in perimenopause/menopause, often random and worrying due to hormonal shifts.
  • "Pain and breast cancer: what came first, the chicken or the egg?" Sometimes, pain may precede cancer, but not always (16:40).
  • More important to check out persistent pain rather than self-diagnose or dismiss.

3. Lumps: What to Know & When to Worry

• Painful vs. Painless:
  • Classic teaching is that “painless, fixed lumps are concerning,” but Dr. Iboma cautions against relying solely on this:

    "To me, that's just a lot to put on a woman to discriminate. ... I always say, just get it checked out and get the reassurance." (19:21)

• Self-Exams:
  • Knowledge of one’s “normal” is important, but self-exams aren’t a replacement for screening mammograms.
  • Technique varies; use a mirror to catch visual changes: skin color, dimpling (Paul d’orange – orange peel appearance, 24:07), or inversion.
  • Visual signs (discharge, skin changes) can be as important as lumps (20:55, 23:47).

4. Nipple Discharge & Skin Changes

• Types of Discharge:
  • Concerning: Bloody or clear discharge, especially if spontaneous (30:48, 30:59).
    • Suggests possible papilloma or papillary carcinoma—warrants immediate workup.
  • Typically Benign: Bilateral, green/yellow, or milky discharge only with expression (though persistent milky discharge in non-lactating women should prompt evaluation for prolactinoma).
  • Brown (“old blood”) or crusting: border cases needing a physician’s eye.
• Montgomery Glands:
  • Small glands around the areola, can secrete or swell, sometimes mistaken for discharge (36:26).

5. Mastitis & Clogged Ducts

• Types:
  • Infectious (typically in breastfeeding): redness, pain; treat with antibiotics, keep breastfeeding.
  • Non-infectious: e.g. granulomatous mastitis, more rare; requires biopsy and sometimes steroids (37:07).
• Dr. Iboma advises:
  • Don’t stop breastfeeding if you develop mastitis or a clogged duct—decompress, continue to express milk, monitor symptoms (41:09).

6. Breast Density: Why It Matters

• Breast density is mostly genetic (can’t be changed): about half of women have “dense” breasts (47:41).
• Dense tissue makes cancer detection harder on mammograms; cancer and dense tissue both appear “white.”
• New Tools:
  • 3D Mammography (tomosynthesis) and AI improve detection in dense breasts.
  • Automated Breast Ultrasound (ABUS) offers standardized supplemental screening.
• Legislation:
  • Patients must be notified of density; most US states now mandate insurance options for supplemental screening (MRI is gold standard but not always accessible or covered) (47:41-55:45, 56:46).

7. Cancer Risk, Demographics & Health Disparities

• Triple Negative Breast Cancer:
  • Higher prevalence and mortality in African American women (40% higher mortality; often puts them in high-risk screening protocols) (29:16).
• Cultural & Systemic Gaps:
  • Distrust or fear of medical establishment is a significant barrier in some populations; solutions include patient advocacy, community education, and care navigation (71:20).

8. Prevention & Lifestyle

• Lifestyle as “the crux”:
  • Chronic inflammation and obesity are major drivers of cancer risk; healthy, anti-inflammatory eating and regular exercise reduce risk.
  • Not about perfection—find exercise you enjoy and will persist with (“Find your joy”).

    "Exercising daily makes women 25% less likely to develop breast cancer. Now if there was a pill … everyone would be taking it." (65:25)

• Movement can be anything:
  • Dr. Iboma’s favorite: VR/MetaQuest “Supernatural” (fun and effective VR fitness games).
  • Dr. Stephanie: any pleasurable movement, from pickleball to Pilates to weightlifting; the main thing is consistency over time (63:24–69:53).

9. Building Trust and Navigating Fear

• Barriers to screening or biopsy are often rooted in fear and past negative experiences.
  • Providers should ask, “What are you afraid of? How do you want me to take care of you?” (75:42).
  • Cultural awareness and patient-centered approaches bridge gaps and improve outcomes.
  • Use of nurse navigators and community workers makes a big difference.

Notable Quotes & Timestamps

• “A fun fact ... you develop ... breast ridges from your mid thigh all the way up ... to your armpit.”
  — Dr. Lillian Iboma (00:00)

• “You’re not going to have identical breasts ... it’s just nature—everything is not exactly proportional.”
  — Dr. Lillian Iboma (10:07)

• “Cancer is painless. But here’s a woman showing up with breast pain ... so we divide breast pain into cyclical and non-cyclical.”
  — Dr. Lillian Iboma (12:41)

• “To me, that's just a lot to put on a woman ... Does it move, is it painless, is it fixed?”
  — Dr. Lillian Iboma (17:24)

• “Breast radiology and breast imaging—we are like the primary care of breast health.”
  — Dr. Lillian Iboma (35:18)

• “Exercising daily makes women 25% less likely to develop breast cancer. Now if there was a pill … everyone would be taking it.”
  — Dr. Stephanie Estima (65:25)

• “Lifestyle change to me is ... the crux of everything we need to do as a society.”
  — Dr. Lillian Iboma (60:05)

• “We have to find your own path ... As long as you're moving, you're sweating, you're having joy ... and you could do it consistently.”
  — Dr. Lillian Iboma (68:31)

• “What are you afraid of? ... The biggest one is always, I'm afraid you're not gonna see me. I'm afraid you're not gonna listen to me.”
  — Dr. Lillian Iboma (74:13)

Timestamps for Key Segments

• [00:00] Breast embryology, development, mammary ridges
• [05:20] Breast development in boys, gynecomastia, hormonal influences
• [12:41] Breast pain: cyclical vs non-cyclical, management, reassurance
• [17:24] Lumps: diagnostic strategies, the limitations of self-exam
• [23:47] Visual self-exam; skin changes, peau d’orange (orange-peel dimpling), why the mirror is vital
• [29:16] Triple negative breast cancer and racial disparities
• [30:48] Nipple discharge: what’s normal, what’s not
• [37:07] Mastitis, clogged ducts: differentiation, management
• [47:41] Mammogram mechanics, myths, and the role of breast density
• [55:45] Supplemental screening: ultrasound, ABUS, MRI; legislative & insurance landscape
• [62:00] Lifestyle as prevention: nutrition, movement, anti-inflammatory strategies
• [69:53] Overcoming distrust, fear, and building bridges in healthcare
• [74:13] The importance of acknowledging and addressing patient fear

Memorable Moments

• Dr. Iboma debunks mammogram myths, comparing the radiation dose to a cross-country flight.
• Dr. Stephanie's humorous reflection on using potatoes and cabbage for mastitis—“I was like a salad!” (41:09)
• “Lifestyle is the crux” refrain, emphasizing movement for longevity and cancer risk reduction (60:05, 67:26).
• “What are you afraid of?” — a simple but profound bridge-building question in medical care (74:13).

Summary Takeaways

• Breast health is dynamic and individual. Development, pain, and breast tissue variation are mostly normal, but persistence or change should always be assessed by a professional.
• Self-knowledge and advocacy matter. Self-exams help you know what’s normal for you, but are not substitutes for professional screening.
• Screening must be tailored. Understand your breast density, family history, and risk; take advantage of improved screening tech where possible.
• Lifestyle has measurable power. Even modest, consistent exercise and healthy, anti-inflammatory eating make a substantial difference in cancer risk.
• No shame, no taboo. Breasts deserve open, empowered conversations in both health and illness.
• Health disparities exist; so does hope. Trust-building, cultural sensitivity, and honest communication are essential for improved outcomes and advocacy.

For more information:

• Dr. Lillian Iboma: www.lillianeboma.com | Instagram, Facebook, Pinterest @DoctoroEboma
• Dr. Stephanie Estima: Podcast and Resources

“Get your joy. ... As long as you’re moving, sweating, having joy ... and can do it consistently, that is the key.” – Dr. Lillian Iboma (68:31)