Breast cancer is the most common cancer in the UK. While the majority of cases occur in women over 50, younger women and men can also develop it. Early detection and treatment are key to preventing the cancer from spreading to other parts of the body.
Anatomy of the Breast
The breast comprises fat, connective tissue, and thousands of tiny glands called lobules that produce milk. Ducts deliver milk to the nipple for breastfeeding. Normally, cells in the body grow and multiply in an orderly way, but cancer disrupts this process, causing cells to grow uncontrollably.
Symptoms of Breast Cancer
Common symptoms of breast cancer include:
- A lump or thickened tissue in the breast.
- Changes in the size or shape of one or both breasts.
- Nipple discharge, possibly streaked with blood.
- Lumps or swelling in the armpits.
- Dimpling or skin changes on the breast.
- Rash on or around the nipple.
- Nipple changes, such as inversion.
Breast pain on its own is typically not a sign of breast cancer. If you notice any changes, see your GP, who may refer you for further tests, such as a mammogram or biopsy.
Types of Breast Cancer
Breast cancer can develop in different parts of the breast and is categorized into two main types:
Non-Invasive Breast Cancer:
- Also known as carcinoma in situ.
- Typically found in the ducts and does not spread outside the breast.
- Commonly detected during mammograms.
Invasive Breast Cancer:
- Can spread outside the breast.
- The most common type is invasive ductal breast cancer, comprising 80% of cases.
Other less common forms include invasive lobular cancer, inflammatory breast cancer, and Paget’s disease.
Breast Cancer Screening
Early detection through regular screening significantly improves recovery chances. Women aged 50 to 70 in the UK are invited for screening every three years. Women over 70 can also request screening. High-risk individuals may be offered additional genetic testing and screenings.
Treating Breast Cancer
Treatment options depend on the type and stage of breast cancer. Common treatments include:
- Surgery: Removes the tumor.
- Chemotherapy: Uses drugs to kill cancer cells.
- Radiotherapy: Uses high-energy rays to target cancer cells.
- Hormone and Biological Treatments: Target specific cancer cells.
For metastatic or advanced breast cancer, treatment aims to manage symptoms and slow progression.
Preventing Breast Cancer
Although the exact causes are not fully understood, you can reduce your risk by:
- Maintaining a healthy weight.
- Regular exercise.
- Limiting saturated fat and alcohol intake. Studies suggest that regular physical activity can reduce the risk of breast cancer by up to a third, especially after menopause.
Living with Breast Cancer
Coping with breast cancer varies from person to person. Available support includes:
- Family and friends.
- Support groups and connecting with others in similar situations.
- Educating yourself about your condition.
- Self-care: Prioritize rest and personal well-being during treatment.
Symptoms of Breast Cancer
The first symptom of breast cancer that most women notice is typically a lump or an area of thickened tissue in the breast. While 90% of breast lumps are not cancerous, it’s crucial to have any unusual changes examined by a healthcare professional to rule out cancer.
When to See a GP:
Speak with your GP if you notice any of the following signs or symptoms:
- Lump or thickened tissue in either breast.
- Change in size or shape of one or both breasts.
- Nipple discharge, which may be streaked with blood.
- Lump or swelling in either armpit.
- Dimpling on the skin of the breasts.
- Rash on or around the nipple.
- Nipple changes, such as becoming sunken or inverted.
Note: Breast pain on its own is not generally considered a symptom of breast cancer.
Breast Awareness
Being breast aware means knowing how your breasts normally look and feel at different times of your life. This awareness makes it easier to spot any changes or abnormalities, allowing for early detection and prompt medical attention.
Helpful Resources:
Causes and Risk Factors of Breast Cancer
The exact causes of breast cancer are not fully understood, but several factors are known to increase the likelihood of developing the condition. Some of these factors are beyond an individual’s control, while others may be modified through lifestyle changes.
1. Age
- The risk of breast cancer increases as you age, with the majority of cases occurring in women over the age of 50. All women aged 50-70 are invited for breast cancer screening every three years as part of the NHS Breast Screening Programme. Women over 70 can also arrange screenings through their GP.
2. Family History
- If close relatives (mother, sister, daughter) have had breast or ovarian cancer, especially under the age of 50, you may have a higher risk due to genetic factors.
- Specific gene mutations, such as BRCA1, BRCA2, and TP53, are linked to an increased risk of breast cancer and can be passed down from parents.
3. Previous Diagnosis
- A previous diagnosis of breast cancer or early non-invasive cancer cells in breast ducts (ductal carcinoma in situ) increases the risk of developing breast cancer again.
4. Previous Benign Breast Lumps
- While benign lumps are non-cancerous, certain types like atypical ductal hyperplasia or lobular carcinoma in situ can raise your risk.
5. Breast Density
- Women with denser breasts have a higher risk due to more breast cells that can become cancerous, and dense tissue can make detecting abnormalities more challenging on mammograms.
6. Hormonal Exposure (Oestrogen)
- Prolonged exposure to the female hormone oestrogen (such as starting periods early, entering menopause late, not having children, or having children later) may slightly increase breast cancer risk due to uninterrupted exposure.
7. Weight and Obesity
- After menopause, being overweight or obese can raise breast cancer risk due to higher levels of oestrogen produced by fat tissue.
8. Height
- Taller women may have a higher risk, possibly due to the interaction of genes, hormones, and nutrition.
9. Alcohol Consumption
- Drinking alcohol increases your risk of breast cancer, with the risk rising with greater alcohol intake.
10. Radiation Exposure
- Certain medical procedures that involve radiation, such as X-rays and CT scans, may slightly elevate breast cancer risk. Childhood radiotherapy for Hodgkin lymphoma to the chest area is particularly linked to increased risk.
11. Hormone Replacement Therapy (HRT)
- Both combined and oestrogen-only HRT are associated with a slightly increased risk of breast cancer, with combined HRT posing a slightly higher risk.
Reducing Your Risk
While some risk factors cannot be changed, lifestyle changes like maintaining a healthy weight, limiting alcohol, and engaging in regular physical activity may help reduce your risk. For those with a family history or known genetic predisposition, genetic counseling and testing are available.
Additional Resources
These resources provide more detailed guidance on understanding your risk and preventive measures.
Diagnosing Breast Cancer
When breast cancer is suspected, either due to symptoms or an abnormal mammogram, you’ll be referred to a specialist breast clinic for further testing.
What to Expect at the Breast Clinic
The specific tests and examinations at the clinic depend on your symptoms, age, and the results of your initial examination. In most cases, an initial assessment can be completed within two hours.
Initial Tests May Include:
- Clinical Breast Examination: A specialist will examine your breasts to determine if further tests are needed.
- Mammogram: An X-ray of the breast to detect any abnormalities. It is more commonly used for women over 40.
- Breast Ultrasound: Used for younger women or when a mammogram shows dense breast tissue. Ultrasound creates detailed images using sound waves, helping to differentiate between solid lumps and cysts.
Biopsy
A biopsy involves taking a sample of breast tissue to determine if it’s cancerous. Different types of biopsies may be used, including:
- Needle Aspiration: A small needle extracts cells for testing.
- Needle Biopsy: A larger needle takes a tissue sample, usually under local anesthesia.
- Guided Needle Biopsy: Ultrasound, X-ray, or MRI guides the needle for precise tissue sampling.
- Vacuum-Assisted Biopsy (Mammotome Biopsy): A needle with gentle suction collects tissue samples.
Read more:
- Breast Cancer Now: What Happens at a Breast Clinic Appointment?
- Macmillan Cancer Support: Breast Cancer
Further Tests for Diagnosis and Staging
Once breast cancer is confirmed, additional tests may be performed to determine the stage and grade of cancer and to tailor the treatment plan.
Imaging Tests:
- CT Scan, Chest X-Ray, or Liver Ultrasound: Checks for the spread of cancer to the lungs or liver.
- MRI Scan: Provides detailed imaging of the breast to assess the extent of the condition.
- Bone Scan: If bone involvement is suspected, a radioactive isotope is injected, highlighting affected bone areas.
Tests to Determine Treatment:
- Hormone Receptor Test: Determines if the cancer is hormone-receptor-positive (responding to estrogen or progesterone).
- HER2 Test: Identifies if cancer is stimulated by HER2, a protein that promotes cancer growth, and may be treated with targeted therapy.
Staging and Grading of Breast Cancer
The stage of breast cancer indicates the size and spread, while the grade describes cell appearance and growth rate.
Stages:
- Stage 0: Ductal carcinoma in situ (DCIS).
- Stage 1: Tumor under 2cm, no lymph node involvement.
- Stage 2: Tumor 2-5cm, may involve lymph nodes.
- Stage 3: Tumor involves lymph nodes and nearby structures.
- Stage 4: Cancer has metastasized to other body parts.
The TNM Staging System provides detailed diagnostic data:
- T (Tumor): Size of the tumor.
- N (Nodes): Lymph node involvement.
- M (Metastasis): Cancer spread.
Grades:
- Grade 1 (Low): Slow-growing, less aggressive cells.
- Grade 2 (Medium): Moderately abnormal cells.
- Grade 3 (High): Fast-growing, more abnormal cells.
For more detailed information:
- Cancer Research UK: TNM Staging for Breast Cancer
- Cancer Research UK: Stages and Grades of Breast Cancer
This comprehensive diagnostic process ensures accurate identification of breast cancer, guiding treatment options and improving patient outcomes.
Treating Breast Cancer
The treatment plan for breast cancer depends on the type, stage, and specific characteristics of the cancer. The main treatments include surgery, radiotherapy, chemotherapy, hormone therapy, and biological (targeted) therapy. Often, a combination of treatments is used.
Surgery
Surgery is often the first treatment option for breast cancer and can involve:
- Breast-Conserving Surgery (Lumpectomy): Removal of the cancerous lump and a small margin of surrounding healthy tissue. This approach is usually followed by radiotherapy to ensure any remaining cancer cells are destroyed.
- Mastectomy: Removal of the entire breast. This can be followed by breast reconstruction surgery, either immediately or at a later stage.
Reconstruction Options
- Implant Reconstruction: A silicone or saline implant is used to recreate the breast.
- Autologous Reconstruction: Tissue from another part of your body (e.g., abdomen, back, thigh) is used to recreate the breast.
Lymph Node Surgery
To determine if cancer has spread, a sentinel lymph node biopsy may be performed. If cancer cells are found, further removal (axillary clearance) may be necessary.
Radiotherapy
Radiotherapy uses high-energy rays to target and kill cancer cells. It’s commonly used after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. Types of radiotherapy include:
- Breast Radiotherapy: Targets the whole breast after lumpectomy.
- Chest Wall Radiotherapy: Given after mastectomy.
- Boost Radiotherapy: Additional focused radiation to the area where the tumor was removed.
- Lymph Node Radiotherapy: Targets lymph nodes in the armpit or nearby areas.
Common side effects of radiotherapy include skin irritation, fatigue, and potential lymphoedema (swelling in the arm).
Chemotherapy
Chemotherapy uses anti-cancer drugs to kill cancer cells and may be given:
- Adjuvant Chemotherapy: After surgery to reduce the risk of recurrence.
- Neoadjuvant Chemotherapy: Before surgery to shrink a large tumor.
- Chemotherapy for Secondary Cancer: To manage cancer that has spread.
Chemotherapy can cause side effects like nausea, fatigue, hair loss, and increased infection risk.
Hormone Therapy
Some breast cancers are hormone-receptor-positive, meaning they grow in response to hormones like estrogen or progesterone. Hormone therapy blocks the effect of these hormones. Options include:
- Tamoxifen: Blocks estrogen receptors.
- Aromatase Inhibitors (e.g., Anastrozole, Letrozole): Lower estrogen levels in postmenopausal women.
- Ovarian Suppression: For premenopausal women, involves stopping estrogen production by the ovaries through medication, surgery, or radiotherapy.
Biological (Targeted) Therapy
For cancers that are HER2-positive, treatments like trastuzumab (Herceptin) target the HER2 protein to stop cancer cell growth. It’s usually given intravenously and may have side effects, including potential heart problems.
Clinical Trials
You may be offered the opportunity to participate in clinical trials that compare new treatments or combinations of treatments to existing standard care.
Psychological Support
Breast cancer treatment can be emotionally challenging. Support is available through:
- Counseling and Therapy: Talking with professionals about your feelings.
- Support Groups: Connecting with others who have had similar experiences.
- Complementary Therapies: Such as massage, acupuncture, and relaxation techniques, used alongside conventional treatments to enhance wellbeing.
Complementary Therapies
These holistic therapies focus on improving physical and emotional health, often used alongside standard medical treatment.
Living with Breast Cancer
Recovery
Recovery after breast cancer treatment, particularly surgery, can take time, and it’s important to allow your body to heal. Rest is essential, and you should avoid lifting heavy objects or engaging in strenuous activities such as heavy housework and driving until you are cleared to do so by your healthcare team. Treatments like radiotherapy and chemotherapy can also lead to fatigue, so take breaks and ask for support from family and friends when needed.
Follow-Up Care
You’ll typically have regular follow-up appointments every three months for the first year after your treatment ends. This helps your healthcare team monitor your recovery and detect any potential issues early. During check-ups, your doctor may examine you, order blood tests, or conduct imaging tests, such as mammograms, to check for any signs of cancer returning.
Long-Term Complications
Some women may experience long-term complications, including:
- Pain and Stiffness: In the arms and shoulders, possibly due to surgery or radiotherapy.
- Lymphoedema: Swelling caused by a buildup of lymph fluid if the lymphatic drainage system has been damaged.
Discuss any long-term issues with your healthcare team so they can provide appropriate management strategies.
Changes to Your Body and Breasts
Breast cancer treatment can lead to changes in body image and self-perception. Adjusting to these changes can take time, and everyone’s experience is different. If you find it challenging to cope, consider seeking support from healthcare professionals, counselors, or support groups.
Early Menopause
Some women may experience early menopause due to cancer treatment, with symptoms like hot flushes, vaginal dryness, and reduced sexual desire. Speak with your healthcare team for advice on managing these symptoms.
Prosthesis and Reconstruction
After a mastectomy, you may be offered a breast prosthesis, a lightweight artificial breast to be worn inside your bra. You can also discuss breast reconstruction options with your healthcare team, which may involve implants or using tissue from another part of your body.
Relationships with Family and Friends
Talking openly with family and friends about your diagnosis and treatment can help reduce feelings of awkwardness and improve communication. Let them know how they can support you, but don’t be afraid to ask for time to yourself when needed.
Impact on Your Sex Life
Breast cancer and its treatment can affect your sexual desire and confidence. Fatigue, emotional stress, and changes to your body can make intimacy challenging. Share your feelings with your partner, and consider seeking advice from a counselor or sex therapist if needed.
Financial Support
Cancer treatment may affect your ability to work, leading to financial difficulties. Depending on your circumstances, you may be eligible for financial support, such as:
- Statutory Sick Pay
- Employment and Support Allowance
- Carer’s Allowance, if you care for someone with cancer
Consult with the hospital social worker or contact relevant organizations to find out what help is available.
Support Networks
Talking to others who have experienced breast cancer can be comforting. You may find local support groups or online communities helpful. Healthcare professionals, counselors, and helplines can also provide emotional support and guidance.
Preventing Breast Cancer
Diet and Lifestyle
While the exact causes of breast cancer aren’t fully understood, maintaining a healthy lifestyle can play a role in reducing your risk. A balanced diet and regular physical activity are recommended, not only to prevent breast cancer but to also reduce the risk of various other conditions, such as heart disease and diabetes. Key lifestyle recommendations include:
- Regular Exercise: Engaging in regular physical activity can lower your risk of developing breast cancer. Exercise is particularly beneficial for women who have gone through menopause, as it helps in maintaining a healthy weight. Excess weight and obesity after menopause increase oestrogen levels, which may elevate the risk of breast cancer.
- Healthy Diet: Eating a balanced diet that is low in saturated fats and high in fruits, vegetables, whole grains, and lean protein can contribute to overall health and potentially reduce cancer risk.
Breastfeeding
Evidence suggests that breastfeeding may lower the risk of developing breast cancer. This protective effect might be due to hormonal changes that occur during breastfeeding, including a reduction in regular ovulation and more stable oestrogen levels.
Treatments to Reduce Risk
For women with an increased risk of breast cancer, certain treatments can lower the chances of developing the condition. Your risk level is determined by factors such as age, family medical history, and genetic testing results. If you have a higher risk, you’ll typically be referred to a specialist genetics service to discuss available treatment options. These may include:
1. Mastectomy
- Preventative Mastectomy: This involves the surgical removal of one or both breasts and can reduce the risk of developing breast cancer by up to 90% in women from high-risk families.
- Considerations: As with any major surgery, there are risks involved. The emotional impact of having a mastectomy can be significant, affecting body image and intimate relationships.
- Breast Reconstruction: Many women choose to have breast reconstruction at the same time as a mastectomy or at a later date. The new breast shape can be created using implants or tissue from another part of the body. Alternatively, prosthetic breasts can be worn inside a bra.
2. Medication
- Tamoxifen and Raloxifene: In 2013, the National Institute for Health and Care Excellence (NICE) approved the use of tamoxifen and raloxifene for reducing breast cancer risk in women with an increased risk of developing the condition. Tamoxifen is suitable for women both before and after menopause, while raloxifene is only used for women after menopause.
- Suitability: These medications are not recommended for women who have had previous blood clots, womb cancer, or a higher risk of developing these conditions.
- Side Effects: Raloxifene may cause flu-like symptoms, hot flushes, and leg cramps. Tamoxifen may lead to hot flushes, changes to your menstrual cycle, nausea, and vomiting. Tamoxifen also carries a risk of blood clots, so it should be stopped six weeks before any planned surgery.
- Pregnancy Considerations: Tamoxifen can increase the risk of birth defects, so it’s advised to stop taking it at least two months before trying to conceive.
Additional Tips for Prevention
- Reduce Alcohol Consumption: Limiting alcohol intake can help lower your risk of developing breast cancer.
- Quit Smoking: Although smoking is more closely linked to other cancers, some studies suggest a possible link to increased breast cancer risk, particularly in younger women.
- Breast Screening: Women between the ages of 50 and 70 are encouraged to have mammograms every three years as part of breast cancer screening programs. Those over 70 can also arrange screening through their GP.
By making healthy lifestyle choices and discussing preventative treatments with healthcare providers, women—especially those at increased risk—can take proactive steps to reduce their chances of developing breast cancer.
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