Breast cancer is caused by an abnormal and uncontrolled growth of cells in your breast tissue.
Your 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.
In the UK, around 53,000 women are diagnosed with breast cancer every 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 300 to 400 men are diagnosed each year in the UK.
There are different types of breast cancer. They are 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.
- 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 start to spread after a number of years.
- Invasive (or infiltrating) ductal carcinoma (IDC) is breast cancer that has spread outside the milk ducts into the breast tissue. It may start to spread to other organs of your body. This is the most common type of breast cancer.
- Invasive lobular carcinoma (ILC) is breast cancer that has developed in your breast lobules and has spread into the surrounding breast tissue. It also has the potential to spread to other organs of your body. Around 1 in 10 breast cancers diagnosed are this type.
Here are some of the most common symptoms of breast cancer. It's important to check the whole of your breast area. This includes both breasts, your armpits and up to your collarbone. The illustrations below show you what to look out for, but remember these symptoms might happen on a different part of the breast area than shown in the picture.
It’s possible that you might not have any symptoms of breast cancer, and it's only picked up if you've had a screening mammogram.
If you have any of the symptoms above, you should see your GP. These symptoms don't necessarily mean you have cancer. They can often be caused by other less serious conditions, which can easily be treated. But if it turns out that you do have breast cancer, the sooner you’re diagnosed and start treatment, the more successful it’s likely to be.
Breast self referral
If you are experiencing the symptoms of suspected breast cancer and have Bupa health insurance, there is usually no need for a GP referral. Call our team to speak to a specialist advisor or nurse.
Excludes some company schemes. Subject to member’s underwriting terms and any pre-existing conditions. Eligibility checks are required for pre-authorisation.
Seeing your GP
If you see your GP because you're worried about breast symptoms, they'll want to examine you. Your GP will usually examine both your breasts for lumps and for other possible signs, such as changes to your skin or nipples. They will also ask you whether you have any family history of breast cancer.
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 will 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.
Breast cancer is diagnosed by a process called triple assessment. There are three stages to this.
- Clinical examination. A doctor or nurse will ask about your medical history, before doing 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 asked to have either a mammogram (an X-ray of your breasts), an ultrasound, or both. Which you're offered depends on how old you are, and which test your doctor thinks will give the most accurate images of your breasts.
- Biopsy. If your doctor has seen any areas for concern on 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 is cancerous or non-cancerous (benign). There are different types of biopsy, but the most common type is called a core or needle biopsy. This uses a needle about the same size as the lead in a pencil. Read our information on having a breast biopsy for more information.
The results of the triple assessment can help your doctor decide if you need any more investigations or treatment.
It's likely that you'll also be asked to have an ultrasound scan of your lymph nodes in your armpit. 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. Your doctor may also want to take a sample of cells from your lymph node for testing. If you’re diagnosed with breast cancer, you may also need to have other tests to find out if the cancer has spread and how big it is. This process is known as staging. The tests may include a chest X-ray, bone scan, ultrasounds, MRI and CT scans.
If you're diagnosed with cancer, you'll be put under the care of a multidisciplinary team. This includes the various health professionals who will be involved in your care – such as surgeons, doctors specialising in cancer treatments, and doctors who are experts at diagnosing cancer. 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 treatments may be suitable for you. This will depend on a number of things, such as the type of cancer you have, whether or not it's spread outside your breast, and if your cancer is sensitive to certain drugs. Your doctors will also look at your general health and your age.
You'll be given time to think about your options, and will be able to say if you have a preference for a certain treatment. 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 is a lot to take in and think about when you're first diagnosed.
The main treatment options for breast cancer are listed below.
Surgery is usually the first type of treatment you'll be offered if your cancer is early stage or hasn’t spread beyond your breast. This normally involves surgery in both your breast and your armpit.
There are two main types of breast surgery that you may have. 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. This means that you don’t have your whole breast removed. It can range from removing the lump (called a lumpectomy or wide local excision) to removing a larger part of your breast, and remodelling your breast shape. If you’re just having the lump removed, your surgeon will usually need to remove a small margin of healthy tissue at the same time.
- Mastectomy. In a mastectomy, your surgeon will remove the whole of your affected breast. If you have a mastectomy, you should also be offered surgery to have your breast reconstructed afterwards. You can have your breast reconstructed straight after the mastectomy, or you can decide to have it done 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 taking a sample of the lymph nodes in your armpit to check to see if they are cancerous. 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 – and so 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 remove these during your operation (this is called axillary clearance). Sometimes, you may need a separate operation to do this, or your doctor may recommend you have radiotherapy to your armpit instead.
Radiotherapy is a treatment to destroy cancer cells with radiation. You may be offered it after surgery to destroy any remaining cancer cells, and reduce the risk of your cancer coming back. If you're having radiotherapy, it will normally start within a month of your surgery.
You'll need to go into hospital for your radiotherapy sessions. This will normally be every day for three to five weeks. There are a number of different ways of having radiotherapy, depending on the type of cancer you have and what surgery you've had.
You may also have radiotherapy to treat advanced cancer that has spread to other areas of your body. Read our information on radiotherapy to find out more.
Chemotherapy uses medicines to destroy cancer cells. You may need one or more different chemotherapy medicines as part of your treatment. You may have chemotherapy before surgery, to shrink your tumour and make it easier to remove. Or you may have it after surgery, to destroy any remaining cancer cells in your body. You may also be offered chemotherapy if you have breast cancer that has spread outside your breast.
Find out more in our information on chemotherapy.
Hormone, or endocrine, therapy may be a treatment option for you if you have breast cancer that's sensitive to the female hormones, oestrogen and progesterone. This means these hormones can stimulate the cancer to grow. You may also hear it called hormone-receptor positive breast cancer.
Hormone therapy includes tamoxifen and aromatase inhibitors. These medicines work by blocking the effects of oestrogen and progesterone on your cancer. If you have this type of breast cancer, you may be offered hormone therapy to take after surgery and 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.
If you have hormone-receptor positive cancer that's spread outside your breast, hormone therapy is one of the first treatments you'll be offered.
Some breast cancers are stimulated to grow by a substance called HER2. Biological therapy uses specific antibodies that have been grown in a laboratory (monoclonal antibodies) to block the action of HER2. You may be offered treatment with the monoclonal antibody trastuzumab (Herceptin) after surgery if your cancer is sensitive to HER2. Trastuzumab is given via a drip into your arm, and you’ll generally need to have it every three weeks for a year. You may need to go into hospital to have this treatment, or it may be possible to have it at home.
After treatment for breast cancer, you'll have regular check-ups with your doctor. 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. Your breast cancer nurse will be able to offer any support and advice you need as you recover from your breast cancer and treatment.
If your cancer has spread to other areas of your body, some of the treatments listed above, such as hormone therapy, chemotherapy and biological therapy may help to keep your cancer under control. There are various other treatments available to help with any symptoms you may have, such as pain, bone pain, anaemia and breathing problems. Specialist doctors and nurses are trained in helping people with advanced cancer. They will be able to support you and advise you on the best ways to manage your symptoms.
It's not possible to say exactly what causes some people to develop breast cancer. But 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 family history of breast cancer or ovarian cancer
- started your periods early or the menopause late
- don’t have children or didn't have children until you were older
- 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
- regularly smoke or drink alcohol
There are some risk factors for breast cancer that you can't change, such as 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, more than 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 members of your family have had breast cancer and you're concerned about your risk, talk to your GP. Your GP may refer you to a 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. 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. You may also 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.
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.
Organisations and support groups that specialise in breast cancer, such as those listed in the Other helpful websites section, can be a great source of information and support.
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. 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 to try to reduce the risk of the cancer coming back or leaving any cancerous cells 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'll usually need 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 have a lumpectomy. Talk to your surgeon about what to expect about the appearance of your breast after any type of surgery.
Lymphoedema is when you have swelling in your arm or occasionally in your breast. It means the lymph nodes in your armpit are blocked and aren’t draining fluid properly. This can happen after you have breast cancer surgery or radiotherapy, or if you have advanced cancer that has blocked your lymph nodes. There isn’t a cure, but treatments are available to help manage your symptoms.
You can get lymphoedema months or years after you've had breast cancer treatment. You normally get it in the arm on the same side as you had breast cancer.
As soon as you notice any swelling in your arm, you should see a doctor or nurse. At first, you might just notice your clothes or jewellery (eg 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. There isn’t a cure for lymphoedema but your doctor or nurse 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 and compression garments to move fluid out of your arm
- doing exercises designed to activate muscles in your arm to improve lymph drainage
The TNM staging system is a way for doctors to assess your cancer and understand how 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 stage your breast cancer. This is called TNM staging. TNM stands for ‘tumour, nodes, metastasis’. Metastasis means the spread of cancer. The TNM system can help your doctor understand how big your breast cancer tumour is and whether it has spread.
- T refers to the size of the cancer; it can have a value between 1 and 4. T1 is small (less than 2cm), whereas T4 means the cancer involves the muscles of your chest wall and/or your skin.
- 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. It has a value of either 0 (the cancer hasn’t spread) or 1 (the cancer has spread).
This code will be written on your test forms and in your medical records. It will help your doctors try to predict how your cancer will develop and to plan your treatment.
If you need more information about the stage of your cancer or what it means, ask your doctor or surgeon.
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- Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published June 2013
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Peer reviewed by Miss Rachel M Bright–Thomas, Consultant Breast Surgeon
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