What is breast cancer?

People tend to think a sign of breast cancer is a lump in your breast – and it can be - but there are other things to look out for too:

•  You might have some thickening or dimpling in an area of your breast.
•  You might notice a change in the size or shape of your breast, or both breasts.
• There might be something different about your nipple. It could have a discharge or become sunken into your breast.
• You may have a lump or swelling in your armpit, or both.
• You might have a rash on or around your nipple.

If you check your breasts regularly, you’ll know how they usually feel and be able to spot something different quickly.

 

There aren’t any specific causes of breast cancer, but there are things that increase your risk, including:

• Your age – the risk increases as you get older.
• If you’ve had breast cancer before.
•  If you’ve had a non-cancerous breast lump before.
• Being overweight.
• Smoking and drinking alcohol.
• A family history of breast or ovarian cancer.
• Certain gene mutations such as BRCA2, BRCA1 and CHEK2 -these can be passed from parents to children and can be identified through a blood test.
• Taking HRT (hormone replacement therapy). The risk increases the older you are and the longer that you take it. However, after stopping HRT, this increased risk lowers over time.

There are two main types of breast cancer. Non-invasive breast cancer develops within the milk ducts or lobules. Invasive breast cancer is cancer that has spread from the ducts or lobules into adjacent breast tissue. This is the most common type of breast cancer.

Doctors often use stages to help them explain how large the cancer is and how far it has spread.

Stage 1

In Stage 1, the cancer is still quite small and hasn't spread outside the breast. Finding it this early often means the cancer can be treated more easily.

Stage 2

By Stage 2, the cancer has grown a bit larger, or it might have spread to nearby lymph nodes (the small glands that help your body fight off illnesses). But it's still mainly in the breast area.

Stage 3

Stage 3 means the cancer is bigger and has spread into surrounding tissues or more lymph nodes close to the breast. This stage shows the cancer is more serious and needs stronger treatment.

Stage 4

Stage 4 breast cancer has spread to other parts of the body, such as the bones, lungs, liver, or brain. This is also called advanced or metastatic breast cancer. Treating it is harder, but there are still ways to help manage the disease and keep symptoms under control.

 

If you feel a lump in your breast or notice any other changes in the breast area, you should see your GP and get checked over, so they can consider referring you to a Breast Clinic, where a breast surgeon will examine your breasts and arrange for you to have a mammogram and/or ultrasound. A mammogram is an x-ray screening of your breast and an ultrasound uses high-frequency sound waves to produce an image of the inside of your breast. Sometimes they may request an MRI scan as well.

The doctor will discuss the results with you on the day and will need to take a fine needle aspiration biopsy. This involves using a small needle to sample some cells from the lump in your breast  for examination  under a microscope. Depending on the results, they may also need to take another biopsy at a later date.

Breast screening

Mammograms are offered routinely on the NHS every 3 years to women aged 50 to 70. You’ll get a letter in the post inviting you. If anything abnormal is detected , you’ll be referred to the Breast Clinic.

 

Breast cancer is much rarer in men as they have less breast tissue and less lifetime exposure to the hormone oestrogen.

Around 400 men in the UK are diagnosed with breast cancer every year, and these are mostly older men, diagnosed between the age of 60 and 70.^{Footnote [3]}

Genetics, family history and ageing can also contribute to causing breast cancer in men. Both men and women can lower the risk by:

• Maintaining a heathly weight.
• Eating a healthy balanced diet.
• Reducing alcohol intake.
• Being more active.

The signs and symptoms are the same as in women and you should check your chest regularly. Don’t feel self-conscious, if you think something isn’t right – go and see your doctor and get it checked out.

If your doctor thinks you need further examination, you’ll be sent to a Breast Clinic for tests.

 

Your treatment will depend on the type of cancer you have and if has spread other parts of your body. If so, it’s called secondary or metastatic cancer while it may not be curable, treatment may be offered to slow further progression and relieve your symptoms.

You’ll be looked after by a group of breast cancer specialists called a multidisciplinary team (MDT), who will work together to agree the most suitable treatment and care. 

Surgery

This is often the first treatment offered and there are two types:

Breast-conserving surgery

This is where the tumour and the surrounding tissue is removed, but not all of your breast. It can range from a small lumpectomy to a wider section of breast tissue being removed.

This depends on factors such as the type of cancer you have, the position and size of the tumour, and the amount of surrounding tissue that needs to be removed.

The healthy tissue surrounding the tumour that’s been removed will be tested to see if there’s any traces of cancer in it. If there is, more tissue may need to be removed from your breast.

Mastectomy

Having a mastectomy involves removal of the whole breast, including the nipple. The operation is carried out under general anaesthesia and takes about 90 minutes. ^{Footnote [4]}  You’ll usually be ready to go home the following day.

In some cases, your skin, or nipple may be saved, depending on the cancer and where it is.

If you’ve got any cancer in your armpit lymph nodes, these are also likely to be removed.

Reconstruction

If you need a mastectomy, you’ll be offered a reconstruction, either at the same time, or at a later date. This is where your breast will be reconstructed to look as similar as possible to your old breast. Doctors may use an implant or some of your own tissue to create the shape.

Chemotherapy

Chemotherapy is drug treatment to destroy cancer cells in the body by stopping them dividing and growing.

It can be used before surgery, to allow breast conservation, but is more frequently given after surgery for tumours with a high risk of recurrence.

Chemotherapy is usually given as an outpatient treatment, where you attend hospital for a few hours each time. The treatment plan will be planned by your medical team: the number of sessions and type of medicine will be informed by the type and stage of breast cancer you have.

You may receive a combination of medicines through an intravenous drip into a vein in your hand or arm. Sometimes you may be given tablets to take at home.

Chemotherapy does have side effects and your medical team will tell you what to expect. These can include sickness and diarrhoea, hair loss, blood clots, a sore mouth and tiredness.

Your doctor may prescribe some medicines to help ease these side effects.

Targeted therapies

Targeted therapies use drugs that help to stop cancer from growing and spreading. They’re less likely to harm normal, healthy cells than other treatments. You might be given this treatment as a pill, an injection, or a drip.

One common targeted therapy approach targets the proteins in cancer cells, slowing their growth. Another method helps your immune system to fight the cancer better.

These therapies are often used alongside other treatments and will be chosen based on the type of breast cancer you have.

Radiotherapy

After surgery you may be given radiotherapy to kill any cancer cells that have been left in your breast or to reduce the risk of the breast cancer coming back. It’s also sometimes given after chemotherapy.

Doctors will make this decision based on the location, grade, size, and stage of your cancer. It won’t start immediately after your surgery or chemotherapy, as your body needs a chance to recover.

Radiotherapy is a treatment that’s given regularly, sometimes over a few weeks. It’s divided up into doses (called fractions) and is often given daily with a break at weekends.

Hormone treatment

You might be offered hormone therapy if you have the type of breast cancer that’s stimulated to grow by oestrogen and progesterone. These hormones are found naturally in your body.

Hormone treatment lowers their levels and therefore could help stop the tumour(s) from growing and even shrink them.

This treatment is usually given after surgery and chemotherapy, but can also be given if your general health stops you from having other treatments.

This treatment is usually given for five years, or more. You may get Tamoxifen, or an aromatase inhibitor such as Anastrozole, Exemestane and Letrozole. These are taken as a tablet, or liquid, once a day.