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Lillie D. Shockney, RN, BS, MAS

Lillie D. Shockney served as administrative director of breast center from 1997 to November 2018 and director of cancer survivorship programs from 2011 to November 2018, at which time she retired from her hospital leadership roles. She continues to serve on the faculty in the Johns Hopkins University School of Medicine and also as the co-developer of Work Stride - Managing Cancer at Work, an employee benefit developed for Hopkins employees that now is being utilized by businesses and corporations nationally. 

Her name is well known in the cancer field, especially in navigation, survivorship, patient-centered care, preservation of quality of life, end-of-life planning and care, improving the cancer patient's experience, breast cancer, and clinical outcomes. She clinically specializes in breast cancer care. Her public speaking, literary work, and notable roles she has held over the last 40+ years are well known to many.

  • University Distinguished Service Professor of Breast Cancer (2016-present)
  • Former Administrative Director, Johns Hopkins Breast Center (1997-2018)
  • Former Director, Johns Hopkins Cancer Survivorship Programs (2011-2018)
  • Professor of Surgery, Johns Hopkins University School of Medicine (2016-present)
  • Co-Developer and medical advisory of Work Stride: Johns Hopkins Managing Cancer at Work Program (2012-present)
  • Co-founder, the Academy of Oncology Nurse & Patient Navigators (AONN+) (2009- present)
  • Co-founder, the Association of Chronic & Complex care Nurse Navigators (ACCCNN) 2021-present
  • Former Program Director of AONN+ (2009-2019)
  • Editor-in-chief of the Journal of Oncology Navigation and Survivorship (2012-2023)
  • Author of 30 books and > 350 articles on various cancer topics and 20 book chapters
  • National and international public speaker (1997- present)

A two-time breast cancer survivor, originally diagnosed in her 30s, Lillie has worked tirelessly to improve the care of breast cancer patients around the world. She has worked at Johns Hopkins since 1983. Lillie takes great pride in the Academy of Oncology Nurse & Patient Navigators (AONN+) which has more than 9,000 members. She has served as a consultant for breast cancer for national ABC News and Good Morning America, and has been also consulted regularly by the Today Show and CNN. Lillie serves on 28 medical advisory boards currently.  

In 2008, The President of The Johns Hopkins University and their Board of Trustees appointed her to a Distinguished Service Faculty Chair. This is the first and only time in the history of the institution that a hospital nurse has been appointed to a distinguished service designation. She continued to climb the academic ladder and in 2016 was promoted to full professor and is the only nurse at Johns Hopkins to have a primary faculty appointment in the School of Medicine and the only nurse in the country to have reached the highest academic faculty ranking and be appointed to a faculty chair as a University Distinguished Service Professor of Breast Cancer at Johns Hopkins University School of Medicine

In 2009 she co-founded the Academy of Oncology Nurse & Patient Navigators, a national professional organization for those working in the navigation space with oncology patients.

In 2012, she and a colleague created an employee benefit called Work Stride- Managing Cancer at Work. Though originally developed for Johns Hopkins employees, its success resulted in it being offered nationally to other businesses and corporations across the country. She continues her work as a medical advisor within Johns Hopkins Healthcare Solutions to enhance the program and continue to support its growth.

In 2021/2022, she co-founded the Association of Chronic & Complex Care Nurse Navigators, a national professional organization for those working in the navigation space with chronic illness and complex care patients. 

She has authored 30 books and more than 350 articles on breast cancer, oncology navigation, survivorship, patient advocacy, communicating bad news, end of life, and most recently, chronic illness and complex care. 

She has received 62 awards—55 national, 6 state, and 1 international award including being inducted into the Maryland Women Hall of Fame, Women in Business Healthcare Trailblazer Award, Johnson & Johnson's Most Amazing Nurse in America award, National Komen for the Cure's Professor of Survivorship award, and several national life time achievement awards. Her research area of focus is preservation of quality of life for patients with metastatic breast cancer. 

A documentary was made about three key components of her life's work over a 5 year period and completed in 2022. It launched to audiences nationally and internationally in 2023 and is calle

Full Bio

Normal Breast Changes Over a Lifetime Zigic

Normal Breast Changes Over a Lifetime

What normal breast changes can I expect during my lifetime?

Ask the Expert

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What normal breast changes can I expect during my lifetime?


Breasts undergo a series of normal changes throughout the life span. It is important to understand these basic stages of breast development and to know when to bring any abnormalities to your health care professional's attention.

By the time you are born, the nipple and the first stages of the milk duct system have already been formed. At puberty, the ovaries begin to produce and secrete estrogen, and fat within the breast connective tissue accumulates. This causes the breast to start growing and changing in appearance. The first things you will probably notice are raised nipples, darker color of the areola (skin surrounding the nipple) and some swelling of the breast itself. By the time you reach adulthood, your breasts will be fully grown.

After you begin menstruating (and ovulating), the breasts form secretory glands at the end of the milk ducts. As the breasts and duct system mature further, the secretory glands and lobules develop. During the menstrual cycle, as the levels of the hormones estrogen and progesterone change, your breasts may feel painful, tender, or they may swell due to temporary fluid retention. You may even feel a lump or two. If you are receiving hormone replacement therapy or are taking birth control pills, you may experience similar breast conditions.

During pregnancy, increasing levels of progesterone and estrogen cause several changes in the breast, all designed to prepare the breast for lactation and breastfeeding. The milk duct system is augmented by the formation of more lobules. Even early in pregnancy the areola becomes darker, and the breast increases in size and may be sore and tender. By the sixth month of pregnancy, the breasts are able to produce milk. Interestingly, it is hypothesized that the areola and nipple darken so it is easier for the baby to find it, since when they are young they can only distinguish light and dark. If you breastfeed after giving birth, you may develop a common infection called mastitis, which may be caused by a blocked milk duct. The symptoms are lumpiness, redness, tenderness, and warmth at the site. Usually, the condition clears up by taking antibiotics; more serious cases require the duct to be drained.

Most women, whether or not they have been pregnant or lactated, develop some type of breast condition during their life. Most of these changes are benign, but some may be malignant (breast cancer). The most common type of benign breast condition is fibrocystic change. Fibrocystic changes most often occur in women of childbearing age, but can develop at any age. Just prior to the beginning of the menstrual cycle, cysts can get larger and cause pain. If you have any of the following symptoms, contact your health care professional right away to determine the cause: lumpiness, tenderness, pain or nipple discharge. Other common benign breast conditions that should be attended to are benign tumors and breast inflammation.

Breast cancer affects approximately one in eight women during their lifetime with risk increasing with age. A suspicious lump, meaning one that is hard and irregular, can be detected by a mammogram or felt upon exam. Diagnosis can be confirmed by testing a tissue sample (biopsy) obtained either through a special needle or by surgical removal. Treatment depends on the stage of the cancer, and usually consists of surgery, chemotherapy and/or radiation therapy, and possibly hormonal therapy. Today 80 percent of women are good candidates for breast conservation surgery and 85 percent will be long-term survivors of the disease.

Menopause brings many hormonally related changes to the body, including breast changes. Lower hormone levels cause the breasts to have less glandular and more fatty tissue and for the connective breast tissue to become dehydrated and less supple. These changes can make the breast lose its once rounded shape and hang low or sag. Other common breast conditions are intraductal papilloma (wart-like growth inside the nipple) and mammary duct ectasia (swollen, clogged milk duct beneath the nipple); both of these conditions can happen at any age.

The best way to maintain breast health is to do monthly breast self-exams, have annual physical checkups that include a clinical breast exam and get regular mammograms (frequency depends on your age; ask your health care professional).

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