Dear Doctors: I faceplanted while ice skating and got a big bruise on my chest. The skin on that part of my breast got puckered up, and my mom kind of freaked. She says it can be a symptom of breast cancer. Is that true? Should I be worried? The bruise and the puckering are both gone now.

Dear Reader: When someone develops breast cancer, it means that some of the cells within the breast have become abnormal and are growing out of control. This often causes changes in the breast that can be felt or seen. The most common, which many women are familiar with, is a lump or a thickening. It may occur within the breast tissue or in the area of the armpit. Additional symptoms of breast cancer include changes to the appearance of the nipples, discharge from a nipple, an increase in the size of a breast, a sensation of heat within the breast and unexplained pain. And, yes, your mother is correct that certain changes to the surface of the breast can also be an indicator of cancer. This includes skin that becomes dimpled, rippled or puckered.

These changes to the appearance of the breast occur because as the cancer cells multiply, they distort the natural architecture of the breast tissue. The growth of a tumor within the breast may pull at the tissue above it, which can cause the skin to dimple. A tumor growing close to the surface of the breast may cause the skin above it to ripple. A rare form of breast cancer, which occurs in the cells of the milk ducts, can also cause dimpled skin. All of this makes it important for women who do a regular breast self-exam to include a visual assessment of any physical changes.

Another possible cause of puckered or dimpled skin on the breast is something known as a breast hematoma. The word “hematoma” refers to an area where blood has pooled and then clotted. It’s typically due to the presence of broken or damaged blood vessels. This can occur as a result of physical injury, and it can also be a side effect of surgery.

A breast hematoma can form a lump that is palpable below the skin. It can also exert the same type of tugging pressure as a tumor, and thus cause the skin above it to pucker, ripple or become dimpled. However, the lumps formed by breast hematomas are not cancerous.

In most cases, the body’s natural processes will heal the damaged walls of the blood vessels and prevent additional blood from pooling. Meanwhile, certain cells in the immune system will break down and carry away the dead blood cells and other debris.

Just as it takes time for a bruise to vanish, a breast hematoma will often gradually resolve. Because the dimpling on your breast appeared in the area of your injury and disappeared as the bruised area healed, it has the hallmarks of a breast hematoma. But if the dimpling persists, or you are concerned, seek guidance from your health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I live in Boston, and the news here seems to be fixated on a brand-new COVID-19 variant. Omicron was all everyone talked about for a long time. Does this mean the new variant we are hearing about is worse? What are we supposed to do to protect ourselves?

Dear Reader: You’re referring to XBB.1.5, an offshoot of the omicron variant. Omicron is itself one of the numerous descendants of SARS-CoV-2, the novel coronavirus that launched the COVID-19 pandemic three years ago. The reason you’re hearing so much about this new variant, which is being referred to simply as XBB, is that it has become the dominant strain of the novel coronavirus in your area.

According to the Centers for Disease Control and Prevention, genetic testing suggests that the majority of new cases of COVID-19 in the northeastern U.S. are now caused by XBB. Nationally, XBB has gone from causing fewer than 2% of COVID-19 cases at the end of 2022 to more than one-fourth of all cases at the start of 2023.

As with all viral variants that begin to circulate in great numbers, the success of XBB is due to the presence of certain mutations. In coronavirus variants, mutations include changes to the spike proteins on the outer shell. These structural changes make the variants more successful at slipping past the body’s existing defenses. This includes evading both naturally acquired immunity and immunity conferred by vaccines and boosters.

While XBB has proven to be more contagious than its predecessors, it does not appear to be more dangerous. At this time, there has not been a spike in either hospitalizations or deaths due to XBB infections. However, this will likely change as the variant continues its geographic spread.

What’s particularly worrisome is that XBB has arrived at a time when vaccination rates against COVID-19 have dropped precipitously. Only 15% of those who are eligible have received the newer bivalent vaccine, which was developed with the variants in mind. On top of that, the majority of people in the U.S. have largely stopped taking protective measures, including the use of masks. That, along with indoor living that is necessitated by the cold winter weather, has increased the risk of infection.

And that brings us to your final question, which is how to guard against infection with XBB. The answer is to get back to the basics. It’s crucial to stay up to date with coronavirus vaccines and boosters, which have proven to be effective in protecting against severe illness. We urge anyone who hasn’t yet received the bivalent booster to do so. When spending time in public places, wear a good-quality and well-fitted mask. If you do become sick with COVID-19, see your doctor. Antiviral medications can ease symptoms and shorten the duration of illness. The coronavirus and its variants are with us for the foreseeable future. It’s up to us to remain vigilant and protect ourselves and those around us.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I have shared my home with pets my whole life. I am now a 76-year-old widow, and my menagerie is down to two small dogs. I just saw on the news that pets keep you mentally sharp. Is that true? I’d like to be able to reassure my sons that my furry companions are a boon and not a burden.

Dear Reader: We’re happy to report that a wealth of research continues to find that living with a companion animal is associated with a wide range of benefits. These include enhancing the pet owner’s physical, emotional and mental health, and generally improving their quality of life.

We suspect that the news report you saw was tied to a recent study that focused on pet ownership among older adults. The results, which were published last summer in the Journal of Aging and Health, suggest that growing older while living with a companion animal can play a role in preserving cognitive function. In their study, the researchers used data gathered by the Health and Retirement Study, an ongoing investigative project that involves about 20,000 adults in the United States, all of them 50 years of age or older. The researchers regularly conduct in-depth interviews with the participants and use tests and other diagnostic tools to amass data about aging. This includes details about physical health, social life, family life, employment, mental health and changes to cognition.

In the pet study you’re asking about, the researchers focused on 1,369 adults who did not have any existing cognitive problems. The participants were divided into three categories -- those without a pet, those whose pet had been with them fewer than five years and those living with a pet for five years or more. When the researchers analyzed the cognitive data collected over the course of six years, a surprising connection to pet ownership emerged. Those individuals who lived with a pet performed better on tests that measured both long- and short-term memory than did people of the same age but who did not live with a pet. This beneficial effect of living with a companion animal was even more pronounced in people whose pets had been with them five or more years. Interestingly, this protective effect was seen only in study participants who were 65 years of age or older. That’s the age at which it becomes more likely for the symptoms of either cognitive decline or dementia to begin to manifest.

As for why living with a companion animal appears to benefit cognition, the researchers suspect several factors may be at play. Health data showed that the pet owners in the study tended to have lower body fat percentages, better blood pressure and a lower incidence of diabetes than those without pets. This pointed to greater levels of physical activity, which has long been linked to improved cognitive health. The group with pets also reported lower levels of stress, anxiety, depression and loneliness, each of which have been shown to adversely affect mental function. We hope this helps you explain to your sons that your dogs are not only a bright spot in your life, but quite possibly just what the doctor ordered.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)