Throughout the world, one million breast cancers are discovered each year, causing 400,000 deaths. Breast cancer is the most frequent cancer in women, accounting for approximately 45,500 cases in the UK each year. One in nine women develop breast cancer at some point in their life, although it is more common after the age of 50. It is the main cause of mortality in woman between 35 and 65. Breast cancer can occur in males, although it is very rare. Breast cancer screening has saved lives by detecting cancers earlier. Breast cancer has a better outcome the earlier it is detected.
Risk increases with age , with most breast cancers being diagnosed after the age of 50. The risk approximately doubles every 10 years.
- Starting your periods at an early age.
- Late menopause occurring after the age of 55.
- If you have not had children or become pregnant after 30 years of age.
- If you have had previous breast cancer.
- If members of your family have had breast cancer - see below.
- If you are taking hormones such as HRT (Hormone Replacement Therapy) or an oral contraceptive pill.
- If you are diabetic.
- Lifestyle factors: obesity; excess alcohol; little exercise; working night shifts.
Most cases of breast cancer are spontaneous, however if you have certain genes, you have a higher risk of developing breast cancer. These "faulty" genes are passed down through families and have been identified as BRCA1 and BRCA2. Women with these genes often develop breast cancer at an earlier age. If there are multiple female family members or a male relative with breast cancer, you should consult your GP as you may be referred to a genetic clinic for investigation and screening.
Breast cancer usually presents with a painless breast lump. Most lumps found in the breast are NOT cancerous but if you find a lump, or are concerned about any of the symptoms listed below, you should consult your GP as soon as possible.
Other symptoms can include:
- Enlargement of a change in shape of your breasts
- Skin changes: eczema-like rashes, thickening, or dimpling
- Nipple inversion (turning inwards) or discharge
- Breast pain (mastalgia), although this is not usually due to cancer
- A lump in your armpits which could be an enlarged gland (lymph node)
- Non-specific symptoms such as back pain or weight loss
Types of Breast cancer
The treatment and prognosis of your breast cancer depends on the exact type of cancer you have and whether it has spread . Your specialist will be able to give you these details.
Carcinoma in Situ
Carcinoma in Situ means that the cancer cells have been contained within a duct or lobule within the breast.
The most common is Ductal Carcinoma in Situ (DCIS), accounting for 20% of new cancer cases.
Invasive breast cancers mean that the cancer has grown out of a duct or a lobule. They can then grow in to surrounding blood vessels and lymphatic system
. The most common is Invasive ductal Cancer (sometimes called ductal carcinoma), which is responsible for 70 - 80% of total breast cancers. Invasive lobular cancer is mostly found in women aged 45 to 55 years old, and account for 10% of breast cancers.
Other rare types
There are rarer types of breast cancer. These include:
- Inflammatory breast cancer - 1% of breast cancers and present with swollen, red, and hot breast tissue.
- Paget's Disease - this involves an itchy, red, scaly rash starting around the nipple, sometimes mistaken for eczema. It accounts for 1 - 2% of cases.
- Male Breast Cancer - 300 men in the UK per year are affected by breast cancer.
- Special and rarer types - including medullary, mucinous (mucoid or colloid), tubular, adenoid cystic carcinoma, papillary, metaplastic, angiosarcoma, phyllodes or cytosarcoma phyllodes, basal type, and lymphoma of the breast.
If your GP suspects breast cancer, then you will be referred to a specialist for further investigation.
Tests that the specialist may request include:
- Mammogram - this a special x-ray of your breasts.
- Ultrasound scan (USS) - sometimes breast tissue is dense and abnormalities are easier to identify or clarify with an USS than a mammogram, especially in younger women.
- MRI scan - this is a more detailed scan usually reserved for those who are young or have a strong family history.
- Biopsy - if you have a lump, a biopsy will be performed. This involves insertion of a needle into the lump to obtain some cells that can be examined under a microscope to determine if you have cancer or not.
- If you are diagnosed with breast cancer, you may have more investigations to ascertain whether the cancer has spread. These include blood tests, USS of your liver, chest x-ray, CT scans and bone scans.
Treatment of breast cancer
Treatment will vary with each patient depending on the type and spread of your cancer. It is very important to consider the aim of treatment; it may be to cure your cancer, control it or to ease symptoms.
Breast cancer surgery
The choice of surgical techniques depends on the size and site of your cancer. Lumpectomies and Wide local excisions (WLE) are when the surgeon removes the lump and some of the surrounding tissue only. Hence, most of the breast is preserved. You may need radiotherapy after this operation to kill any cancer cells that could be left behind. A mastectomy removes the affected breast if the cancer is large or in the middle of the breast. The surgeon may also remove or biopsy (sentinel node biopsy) the closest glands or lymph nodes to check whether the cancer has spread. This will help to plan further treatment. Your specialist and breast cancer nurse will offer post-surgery advice and support. This will include exercises, physiotherapy and advice regarding clothing and lifting.
Radiotherapy uses beams of radiation to destroy and control the growth of cancerous cells. This treatment is usually performed in courses of 5 to 6 weeks but does not require a hospitalisation.
A new type of radiotherapy called "brachytherapy" is being trialled in the UK, where a radioactive implant is inserted into the affected breast.
Chemotherapy uses anti-cancer medicine to kill and stop cancer cells from multiplying. This may be used prior to surgery to shrink the cancer or for those women whose cancer has spread beyond the breast.
Certain breast cancers are affected by female hormone levels. Therefore treatments, such as tamoxifen and anastrazole, which reduce levels of oestrogen, can be very effective. Alternatively, ovaries can be removed in post menopausal women to stop the production of oestrogen altogether.
Some breast cancers can have certain receptors on their cells which allow certain hormones to attach to them and affect their growth. For example, drugs including herceptin are used in breast cancers with HER2 receptors.
Even after treatment, you will be monitored for recurrence with regular mammographies. You may remain under the care of you specialist for many years.
Plastic and reconstructive surgery of the breast, may be available after your mastectomy and involves rebuilding the contour of the breast with saline or silicone gel prosthesis. It can greatly restore your self-confidence after treatment for breast cancer. Your specialist can provide you with more information regarding reconstruction, and advise whether this could be a viable option for you. Breast reconstruction is usually carried out months or years after your initial surgery.
Several accessories are available to help you to cover or mask hair loss, such as scarves, hats, caps, turbans or wigs. Breast prostheses can help to make your breast silhouette look symmetrical and even. Prostheses are now well accepted by the public and often used to enhance breasts for women without a cancer diagnosis. Prostheses that can be put inside your bra can be purchased from many high street stores. More specialised products are also available and you can advice regarding these from your specialist, breast cancer nurse, or support organisations.
Breast cancer screening
The aim of breast screening is to detect cancer before the appearance of a lump or any symptoms or signs. It has been proven to reduce deaths from breast cancer. Since 1988, the NHS Breast Screening Programme has provided free breast screening every three to five years for all women in the UK aged 50 to 70. Around one-and-a-half million women are screened in the UK each year. Since its conception, more than 19 million women have been screened and 117,000 cancers have been detected. The programme is planning to extend the age range of women eligible for breast screening to those aged 47 to 73. Research by the World Health Organisation (WHO) suggests that breast screening reduces mortality by 35% in women aged 50 - 69 years old. Therefore, every 1400 lives are saved in the UK; so, one life is saved for every 400 women that are screened over a 10 year period. The screening involves mammography where 2 x-rays are taken of each breast. The appointment last approximately 30 minutes.
Contact your GP or NHS Direct (0845 464748) if you are over 50 and have not received any information about screening.
Self-examination of breasts
It is important to examine your breasts so you know what is normal for you and you can detect any abnormalities, even before national screening starts at age 50. This is even more essential if you are at additional risk, such as taking the oral contraceptive pill.
The easiest way is in the shower or bath, once a month, usually after your period. Raise each arm in turnand feel the breast keeping the fingers flat. You can also feel in your armpits for any lumps. You are looking for any of the signs mentioned above; a lump, skin changes, nipple abnormalities or discharge. If you are concerned, please do not hesitate to consult your GP.