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Breast cancer


Expert reviewer, Mr Giles Davies, Consultant Breast Surgeon
Next review due January 2022

Breast cancer is caused by an abnormal and uncontrolled growth of cells in your breast tissue. It’s the most common cancer in the UK – one in seven women will develop breast cancer in their lifetime. It’s most common in women over the age of 50.

With the range of treatments now on offer, more women than ever are surviving breast cancer for longer.

“Being diagnosed with breast cancer can be a huge shock; but the outlook has never been better. If you have symptoms, seeking help straight away gives you the best chance of beating breast cancer.”

Louise Spence, Oncology Nurse Adviser at Bupa UK

Types of breast cancer

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

Image showing the structures of the breast

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

  • Invasive ductal breast cancer is the most common form of breast cancer – around seven in 10 breast cancers are this type. This is cancer that started in the lining of your milk ducts and has spread into the surrounding breast tissue.
  • Invasive lobular carcinoma (ILC) is breast cancer that developed in cells lining your breast lobules and has spread into the surrounding breast tissue. Around one in 10 breast cancers diagnosed are this type.
  • 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. Many of these cancers are only picked up through breast screening. There's a possibility that if not treated, this type of cancer may progress to become invasive cancer.

If left untreated, cancer cells can spread to other parts of your body – this is known as metastatic cancer.

Breast cancer can also be classified depending on how sensitive it is to different hormones and chemical substances in your body. This helps doctors to understand how your cancer might develop, and the best way to treat it. Your cancer may be classed as one of the following types.

  • Oestrogen receptor-positive breast cancer. This means the cancer is sensitive to the hormone oestrogen. Six to seven in 10 people have this type.
  • HER2-positive breast cancer. This means the cancer is sensitive to a protein called HER2. Two to three in 10 people have this type. These cancers can be more aggressive and more likely to spread. But there are now several drugs available that target the HER2 protein and are used in the treatment of these cancers.
  • Triple negative breast cancer. One or two in 10 people have this type. These cancers aren’t sensitive to oestrogen, progesterone or HER2. This means hormone and targeted treatments aren’t used for this type of cancer.

You can find out more about the different treatments for breast cancer in the treatment section below.

Symptoms of breast cancer

Having a breast lump – or an area that feels thicker – in your breast is the most common symptom of breast cancer. But there are lots of other symptoms too, which are important to be aware of. The illustrations below show you what to look out for. But, remember that these symptoms might happen on a different part of the breast area than that shown in the picture. When you’re checking your breasts, it’s important that you cover the whole of your breast area. This includes both breasts, your armpits and up to your collarbone.

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Many women don’t notice any symptoms of breast cancer, and it's only picked up on a screening mammogram.

If you notice any changes in your breast like those above, you should see your GP even if you feel well. These symptoms don't necessarily mean you have cancer. They are often due to normal changes or other less serious conditions. But if you do have breast cancer, the sooner you’re diagnosed and start treatment, the more successful your treatment is likely to be.

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Diagnosis of breast cancer

Seeing your GP

Your GP will ask you about any symptoms you’ve noticed, as well as your medical and family history. They’ll also examine both your breasts for lumps and for other signs, such as changes to your skin or nipples.

If your GP thinks your symptoms need further assessment, they'll refer you to a specialist breast clinic at a hospital. How quickly you're referred will depend on what symptoms you have and your age.

You may also be asked to go to a breast clinic for further assessment if you've had a screening mammogram that has identified potential signs of cancer. There are many reasons why you may be invited for further assessment – most women who are recalled following screening do not have breast cancer.

Triple assessment

Breast cancer is diagnosed by a process called triple assessment. There are three parts to this process; they are outlined below.

  • Clinical examination. A doctor or, in some breast units, a nurse specialist will carry out a physical examination of your breasts. They will examine any lumps in your breasts, as well as any other changes you've noticed. They'll also feel under your arms and at the base of your neck to see if you have any enlarged lymph nodes.
  • Imaging. You'll be offered either a mammogram (an X-ray of your breasts) or an ultrasound or both. To find out more about a mammogram procedure, take a look at our information on having a mammogram.
  • Biopsy. If your doctor has seen anything they’re concerned about in your examination or imaging tests, they'll ask you to have a biopsy. This means taking a sample of cells from your breast lump to test whether it’s cancerous or non-cancerous (benign). Tests on these cells can also show whether your cancer is sensitive to oestrogen, progesterone or HER2. Read our information on having a breast lump biopsy for more information.

You should be able to have all these tests, including the biopsy, during a single clinic visit. The results of the triple assessment can help your doctor decide if you need any more investigations or treatment.

Further tests

If the lymph nodes in your armpit or around your neck are swollen, your doctor will recommend you have an ultrasound scan and biopsy of these too. Lymph nodes are part of your immune system. Looking at the cells in your lymph nodes can help your doctor tell if your cancer has started to spread.

If you have triple negative breast cancer (breast cancer that isn’t sensitive to oestrogen, progesterone or HER2), you’ll be offered genetic testing for the BRCA1 and BRCA2 genes.

Preparing for breast cancer treatment

If you're diagnosed with breast cancer, you'll be put under the care of a multidisciplinary team of breast cancer specialists. This will include breast cancer surgeons, doctors specialising in cancer treatments and diagnosis, and scientists trained in analysing breast cancer cells. You should also be allocated a nurse who specialises in breast cancer care, and who can support you through your diagnosis and treatment.

There are a number of different treatments for cancer, and your team will talk you through which ones may be suitable for you. This depends on a number of things, including the type of cancer you have, if it's spread and if it’s sensitive to certain drugs.

You'll be given time to think about your options and to discuss them with your team in order to make a decision that’s right for you. You'll need to agree to your care plan before any treatment can begin. Don't be afraid to ask questions if there's anything you don't understand – there’s a lot to take in and think about when you're first diagnosed.

The main treatment options for breast cancer are listed in the treatment section below.

Treatment options for breast cancer

Surgery

Surgery is usually the first treatment you'll be offered for breast cancer.

There are two main types of breast surgery that you may have.

  • Breast conserving surgery. This means that you keep your breast but have the lump, or sometimes a larger part of your breast, removed. Surgery to remove the lump is called a lumpectomy or wide local excision. If you’re just having the lump removed, your surgeon will usually need to remove a small area of surrounding healthy tissue at the same time.
  • Mastectomy. In a mastectomy, your surgeon will remove the whole of your affected breast. If you’re having a mastectomy, you’ll be offered surgery to have a breast reconstruction. It’s your choice whether or not to have a breast reconstruction; not all women want one. You’ll be given the option of a reconstruction at the same time as the mastectomy (immediate reconstruction) or to make the decision about having one at a later date.

Sentinel lymph node biopsy

If you have an invasive breast cancer, your doctor will usually recommend that you also have a sentinel lymph node biopsy during your breast surgery. This involves having an injection of a radioactive tracer (and sometimes a dye) to identify which nodes your cancer drains into first. These are called the sentinel nodes. They can be removed and checked for cancer cells.

You’ll be offered 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 – so they can give a more accurate check to see if the cancer has spread.

If your sentinel nodes are found to contain cancer cells, your surgeon may recommend you have a second operation to remove more lymph nodes (this is called axillary clearance). If there are only a small number of cancer cells, you may not need this operation. Very rarely, your doctor may recommend you have radiotherapy to your armpit instead of surgery.

Radiotherapy

Radiotherapy is a treatment to destroy cancer cells with radiation. You’ll usually be offered it after surgery in order to destroy any remaining cancer cells and so reduce the risk of your cancer coming back.

You'll need to go into hospital for your radiotherapy sessions. This will normally be every day, Monday to Friday, for three to five weeks.

Read our information on radiotherapy to find out more about what it involves.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells. You may have two or three different chemotherapy medicines as part of your treatment. You usually have chemotherapy through a drip into your arm. You probably need to go to a cancer clinic at a hospital every two to three weeks for up to 12 weeks to have chemotherapy.

You may have chemotherapy before surgery in order to shrink your cancer and make it easier to remove. Or you may have it after surgery, to destroy any remaining cancer cells in your body.

Chemotherapy medicines affect your whole body so they can cause many side-effects such as feeling sick, feeling very tired and losing your hair. Not everyone gets all these side-effects. Your cancer nurse or doctor can advise you how to cope with any side-effects you’re getting, and may be able to prescribe you some medicines to help.

Not everyone who has breast cancer will need chemotherapy. Scientists are doing more research all the time to find out who is likely to get the most benefit. You may be offered a test called Oncotype DX, which looks at your cancer in more detail to help decide if chemotherapy is needed.

Find out more in our information on chemotherapy.

Hormone therapy

Hormone (endocrine) therapy may be a treatment option for you if you have breast cancer that's sensitive to the female hormones, oestrogen and progesterone.

Hormone therapy includes tamoxifen and aromatase inhibitors. These medicines work by blocking the effects of oestrogen and progesterone on your cancer (tamoxifen) or by stopping your body from making oestrogen (aromatase inhibitors).

If you have hormone receptor-positive breast cancer, you may be offered hormone therapy to take after you’ve had surgery and finished chemotherapy. You'll usually need to take it for at least five years. Sometimes, you may be advised to have this type of therapy before surgery to shrink the cancer.

Biological therapy

You’ll be offered treatment with the monoclonal antibodies, trastuzumab (Herceptin) and pertuzumab (Perjeta) if your cancer is sensitive to the protein HER2. These drugs work by blocking the action of HER2. They’re usually given in combination via a drip into your arm, and you’ll generally need to have them every three weeks for a year.

Bisphosphonates

Your doctor may also offer you treatment with medicines called bisphosphonates, which work to prevent bone thinning. They’re often given to help women who have bone pain, due to their breast cancer spreading. But more recently, doctors have discovered they may also be able to help stop breast cancer spreading or coming back in certain women. If you’ve gone through the menopause and have invasive breast cancer that shows signs of spreading, your doctor may offer you treatment with bisphosphonates. They’ll talk to you about the benefits and risks involved in taking the medicine first.

Treating advanced cancer

If breast cancer has spread to other areas of your body, the treatments listed above won’t be able to cure your cancer. But they can reduce your symptoms, help you to feel better and may help you to survive your cancer for longer. Your doctor may offer you treatment with hormone therapy, chemotherapy and biological therapy to help keep your cancer under control. There are various other treatments that can help with any symptoms you may have, such as bone pain, breathlessness and tiredness. Your healthcare team will support you and advise you on the best ways to manage your symptoms.

Causes of breast cancer

It's not possible to say exactly why some people develop breast cancer. But it’s likely to be due to a combination of genetic, hormonal and lifestyle factors.

There are a number of factors that are known to increase your risk. You’re more likely to develop breast cancer if you:

  • are over 50 – your risk of breast cancer increases as you get older
  • have a parent or sibling who’s had breast cancer or ovarian cancer
  • started your periods early or the menopause late
  • have never had children or didn't have children until after age 30
  • 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 once you've passed the menopause
  • drink alcohol – the more you drink, the greater your risk

Having any of these risk factors doesn’t mean you will definitely develop breast cancer – just that your chance of getting it is higher.

Prevention of breast cancer

Healthy lifestyle

There are some risk factors for breast cancer that you can't change – for example, getting older or having a family history of breast cancer. But there are some things you can do to help reduce your risk. In fact, around a quarter of all breast cancers in the UK are thought to be linked to lifestyle factors, and so could be prevented.

Eating a healthy, balanced diet, maintaining a healthy weight, keeping active, and only drinking alcohol in moderation can all help to reduce your risk. Breastfeeding is also known to help protect against breast cancer.

High risk of breast cancer

You may have a higher than normal risk of getting breast cancer if you have a strong family history of the condition. If you're concerned about your risk, talk to your GP. Depending on your family history, your GP may refer you to a breast clinic, family history or specialist genetics clinic for further assessment.

The health professionals at the clinic will talk to you about your risk and exactly what this means for you. You may be offered a genetic test to see if you carry a gene for breast cancer. You won’t be offered this until you’ve talked it all through with a genetic counsellor first.

If you’re assessed as having a higher than average risk of breast cancer, you may be advised to have breast screening from an earlier age, or more regularly than normal. You’ll also be advised about what lifestyle changes you can make to reduce your risk. If your risk of developing breast cancer is high, you may be offered a medicine called tamoxifen, which can reduce your risk of breast cancer. If you’re at very high risk of breast cancer, your doctor will talk to you about whether or not risk-reducing mastectomy may be an option for you. This is surgery to have both breasts removed, in order to prevent breast cancer developing. It’s only suitable for a small group of women.

Living with breast cancer

For the first two or three years after your treatment for breast cancer, you'll have regular check-ups with the breast care team. These are to see if there is any sign that the cancer has returned, and to monitor any side-effects from your treatment. You'll also be asked to return for a mammogram every year for five years, or longer if you’re not yet eligible for breast cancer screening. Your breast cancer nurse will be able to offer any support and advice you need as you recover from your breast cancer and treatment.

You're likely to have a range of emotions if you've been diagnosed with breast cancer. You may feel scared, upset or confused. As well as the emotional aspects, there can be a lot of practical issues to sort out – such as telling other people and taking time off work.

Talking to your family and friends can help them to understand what you’re going through and how you’re feeling. Organisations and support groups that specialise in breast cancer (such as those listed in the Other helpful websites section below) can also be a great source of information and support.

We have more detailed information on Coping with cancer and work, Coping with cancer at home, and Adjusting after cancer treatment to help you after a diagnosis. See our Related information section for more articles on some of the different aspects of living with cancer.

Frequently asked questions

  • A lumpectomy is an operation to remove the cancerous lump from your breast while leaving behind as much healthy breast tissue as possible. Your surgeon will try to keep the appearance of your breast as similar as possible to how it was before by reconstructing your breast tissue immediately surrounding the lump. You may be offered a lumpectomy as a treatment option for early breast cancer, as an alternative to mastectomy (where your whole breast is removed). You might hear a lumpectomy referred to as a wide local excision or as breast-conserving surgery.

    As well as removing the cancer, your surgeon will want to remove some healthy tissue from around it. This is so that doctors can be certain that all of the cancer has been removed, and no cancerous cells left behind. The tissue your surgeon removes will be sent to a laboratory for testing. If the results show that the cells around your cancer are all healthy (known as a 'clear margin'), you probably won’t need any further surgery. If the margin isn’t clear, you may need another operation. You may also need to have lymph nodes removed from your armpit during your operation (sentinel node biopsy).

    Most patients with invasive breast cancer will be recommended to have radiotherapy after a lumpectomy. This is to prevent new cancers growing within your remaining breast tissue. If you have early breast cancer, a lumpectomy followed by radiotherapy is as effective at treating breast cancer as a mastectomy.

    Any type of surgery to remove a breast lump will leave a scar and may affect how your breast looks. The scar will probably be quite small if you’ve had a lumpectomy. Talk to your surgeon about what to expect about the appearance of your breast after your surgery.

  • Lymphoedema is swelling in your arm, caused by your lymph fluid not draining away properly. This can happen after you have breast cancer surgery to remove lymph nodes or radiotherapy on your lymph nodes.

    As soon as you notice any swelling in your arm, you should see your doctor or breast care nurse. At first, you might just notice your clothes or jewellery (such as your watch or rings) getting tighter on that arm. Your doctor may want to carry out some tests to make sure there’s no other problem causing your symptoms. You may be able to see a specialist in lymphoedema, who will be able to suggest ways to manage your symptoms. These may include:

    • massage to stimulate the flow of fluid and reduce your swelling
    • wearing bandages or a compression sleeve to move fluid out of your arm
    • doing exercises designed to activate muscles in your arm to improve lymph drainage

    There are some things that can make lymphoedema worse. These include heavy lifting and repetitive exercises, so it’s best to avoid these.

    If you don’t get treatment for lymphoedema, the swelling is likely to get worse, become painful, and make it difficult to move your arm. Getting help as quickly as you can will help you to manage your symptoms.

  • The TNM staging system is a way for doctors to assess your cancer and understand how big it is and far it has spread. Staging is important to help decide what your treatments options are.

    Your doctor will use information from tests such as ultrasound and biopsies to help stage your breast cancer. Sometimes though, your doctor might not be able to tell your exact stage until you have surgery.

    The TNM staging is one of the most common systems used by doctors. TNM stands for ‘tumour, nodes, metastasis’.

    • T refers to the size of your tumour. Tumour is another word for the area or lump of cancer. A T stage of ‘Tis’ means the tumour is only in the milk ducts (ductal carcinoma in situ or DCIS). Tumours that have spread into the breast tissue have a T value between 1 and 4, with 1 being the smallest and 4 being the largest.
    • N refers to whether or not the cancer has spread to your lymph nodes. It can have a value between 0 (no spread) and 3 (where lots of your lymph nodes are affected).
    • M refers to whether or not the cancer has spread to another part of your body (metastasized). It has a value of either 0 (the cancer hasn’t spread) or 1 (the cancer has spread).

    These categories can be subdivided even further depending on exactly how big the tumour is or how far it has spread.

    Sometimes doctors use number stages instead of the TNM system to describe how big the cancer is and how far its spread. There are four number stages: stage 1 is the earliest, smallest breast cancer and stage 4 means the cancer has spread to another part of the body.

    If you need more information about the stage of your cancer or what it means, ask your doctor or surgeon.


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  • Reviewed by Pippa Coulter, Freelance Health Editor, January 2019
    Expert reviewer, Mr Giles Davies, Consultant Breast Surgeon
    Next review due January 2022



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