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Breast cancer

Key points

  • Breast cancer is the most common cancer in women in the UK.
  • A process called triple assessment is used to diagnose breast cancer.
  • Breast cancer is usually treated with surgery.
  • A multidisciplinary team of health professionals are involved in the treatment of breast cancer.

 

Breast cancer is caused by an abnormal and uncontrolled growth of cells in your breast tissue.

How cancer develops

About breast cancer

Your breasts are made up of fat, connective tissue and gland tissue that’s divided into lobes. The lobes are connected to your nipple by milk ducts. Breast cancer usually starts in the cells that line your milk ducts.

Illustration showing the structures of the breast

In the UK, breast cancer is the most common cancer in women – over 49,000 women are diagnosed each year. The risk of breast cancer increases with age – it’s most common in women over 50. Men can also get breast cancer but it’s less common – about 400 men are diagnosed each year in the UK.

Types of breast cancer

There are different types of breast cancer named after the type of cell the cancer first occurs in, and how far it has spread. The three most common types of breast cancer are described below.

  • Ductal carcinoma in situ (DCIS), or ‘non-invasive breast cancer’ is the earliest possible type of breast cancer. The cancer cells are only found inside the milk ducts and haven’t spread into the breast tissue.
  • Invasive (or infiltrating) ductal carcinoma (IDC) is breast cancer that has spread outside the milk ducts into the breast tissue. This is the most common type of breast cancer.
  • Invasive lobular carcinoma (ILC) is breast cancer that starts in the cells that line your lobes.

Symptoms of breast cancer

It’s important to check your breasts regularly as this will help you spot any changes. Symptoms of breast cancer include:

  • a lump in your breast or armpit
  • a change in your skin, such as dimpling
  • a change in the shape of your nipple – for example, it may turn inwards
  • a rash on or around your nipple
  • discharge from your nipple
  • a change in the size or shape of your breast

If you have any of these symptoms, see your GP. If you do have breast cancer, the sooner you’re diagnosed and can start treatment, the more successful it’s likely to be.

It’s possible you might not have any symptoms of breast cancer and it might be found during breast screening.

Causes of breast cancer

The exact reasons why you may develop breast cancer aren’t fully understood at present. However, you’re more likely to develop it if you:

  • have a family history of breast cancer or ovarian cancer
  • started your periods early, or the menopause late
  • don’t have children
  • have children, but had your first child when you were older (over 30)
  • have never breastfed
  • take a contraceptive pill that contains oestrogen
  • take hormone replacement therapy (HRT) – combined HRT (oestrogen and progesterone) is more likely to cause breast cancer than oestrogen-only HRT
  • are overweight or obese
  • regularly drink alcohol
  • don’t regularly exercise

Breast screening

Having regular breast screening can help to detect changes in your breast that may be an early sign of breast cancer. The NHS Breast Screening Programme invites all women between the ages of 50 and 70 for breast screening every three years. If you’re in your late 40s or up to 73 years old, you may also receive an invitation to go for screening.

Diagnosis of breast cancer

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

If your GP suspects you have breast cancer, or it was detected in screening, you will be referred to a specialist breast clinic.

A process called triple assessment is used to diagnose breast cancer. There are three stages to this.

  • Examination. A doctor or nurse will ask about your medical history and examine one or both of your breasts.
  • Imaging. A radiographer (a health professional trained to perform imaging procedures) will take pictures of the inside of your breast. He or she may use ultrasound, X-rays or a combination of both.
  • Needle biopsy. A doctor will remove a sample of your breast tissue and send it to a laboratory for testing. This will determine if the lump is cancerous or non-cancerous (benign).

The results of a triple assessment can help your doctor decide if you need any more investigations and treatment.

If you’re diagnosed with breast cancer, you may need to have other tests to find out how advanced it is. This process, known as staging, takes into account whether the cancer has spread and how big it is. Your doctor will usually advise you to have scans, such as an ultrasound, MRI or CT, to check your breasts, abdomen (tummy) and lymphatic system. Your lymphatic system is the tissues and organs that are part of your immune system.

You may also need to have a needle biopsy of the lymph nodes (glands) in your armpits. This will check if the cancer has spread.

Treatment options for breast cancer

There are a number of treatment options for breast cancer. The treatment you have will depend on your personal circumstances, such as your general health, age and if the cancer has spread.

A multidisciplinary team, including a surgeon, radiologist and oncologist (a doctor who specialises in cancer care) will discuss your treatment options with you. This team will also help you with the wider aspects of your care, such as emotional support and help with your day-to-day activities.

Surgery

Surgery is usually the first treatment option if your cancer is early-stage or hasn’t spread beyond your breast. Depending on the position and size of the cancer, your surgeon may suggest either surgery that means you keep your breast or a mastectomy.

  • Breast conserving surgery means that you don’t have your whole breast removed. It can range from a lumpectomy (removal of the lump) to removing part of your breast. Your surgeon will remove only the affected breast tissue (or lump), usually with some healthy tissue around it. You will need to have radiotherapy after breast conserving surgery for invasive disease, and possibly for DCIS.
  • In a mastectomy, your surgeon will remove the whole of your affected breast.

Your surgeon may also take a sample of tissue from the lymph nodes in your armpit and check to see if they are cancerous. This is called a sentinel lymph node biopsy. You may have this even if you had a small cancer and an ultrasound of your armpit suggested the lymph nodes were healthy. This is because your sentinel nodes are the first place that breast cancer spreads to. If your sentinel nodes are found to contain cancer cells, your surgeon will remove these during your operation.

If you have a mastectomy, you should also be offered surgery to have your breast reconstructed afterwards. Whether or not to have a reconstruction is your personal choice. Some women choose to have their breast reconstructed straight away, whereas others decide to have it at a later date, or not at all. Your surgeon will talk to you about your options.

Non-surgical treatments

Your doctor may recommend you have non-surgical treatments before surgery to help shrink your tumour, or after surgery to help stop it coming back. You may also be offered these treatments if you have cancer that has spread or come back. Non-surgical treatments available for breast cancer are listed below.

  • Radiotherapy is a treatment to destroy cancer cells with radiation. You may have it after surgery to destroy any remaining cancer cells. The aim of the treatment is to destroy cancer cells with minimal damage to your surrounding healthy tissue. There are a number of different methods of having radiotherapy. The method you have will depend on the type of cancer you have and what operation you have, such as a mastectomy or a lumpectomy.
  • Chemotherapy uses medicines to destroy cancer cells. You may need one or more different medicines as part of your treatment. You may have chemotherapy as a treatment for breast cancer that has spread or come back.
  • Endocrine therapy uses medicines to block certain hormones. Hormones, such as oestrogen, can affect the growth of breast cancer cells. Taking medicines that block these hormones can treat some types of breast cancer. You may have endocrine therapy after surgery and chemotherapy or before surgery to shrink the cancer.
  • Biological therapy uses specific antibodies that have been grown in a laboratory (monoclonal antibodies) to block the action of a substance called HER2. HER2 stimulates some types of cancer cells to grow. You may be offered treatment with the monoclonal antibody trastuzumab (Herceptin) if your cancer is this type.

You might be able to take part in a clinical trial as new treatments become available and need to be tested. Ask your doctor for information about clinical trials.

After treatment for breast cancer, you will have regular check-ups with your doctor to see if there is any sign that the cancer has returned. If the cancer has already spread, further support is available from specialist cancer doctors and nurses to get treatment for any symptoms. This is called palliative care.

Prevention of breast cancer

You can help to reduce your risk of breast cancer by living a healthy lifestyle. This means eating a healthy, balanced diet, staying a healthy weight, exercising and if you drink alcohol, only doing so in moderation.

If you have a high risk of getting breast cancer, you may decide to have a mastectomy to prevent it developing. If you take medicines such as tamoxifen, it may also reduce your risk of breast cancer. Ask your doctor for more information.

Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2014.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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