Breast cancer today

Breast cancer today is not what it was 20 years ago. Survival rates are climbing, thanks to greater awareness, more early detection, and advances in treatment. For the 46,000 women in the UK who are diagnosed with breast cancer each year, there are plenty of reasons to be hopeful.

Breast cancer symptoms

There are often no symptoms of breast cancer, but sometimes women may discover a breast problem on their own. Signs and symptoms to be aware of may include:

• A painless lump in the breast.
• Changes in breast size or shape.
• Swelling in the armpit.
• Nipple changes or discharge.

Breast pain can also be a symptom of cancer, but this is not common.

Signs of inflammatory breast cancer

Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red and may look pitted - like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.

Breast cancer & mammograms

The earlier breast cancer is found, the easier it is to treat. And mammograms, X-rays of the breast, can detect tumours before they are large enough to feel. Under the NHS Breast Screening Programme, women aged between 50 and 70 who are registered with a GP, are invited for screening every three years. That's being extended to women aged between 47 and 73 in 2012.

Breast ultrasound and MRI

Besides a mammogram, your doctor may order additional imaging with breast ultrasound. An ultrasound can help determine the presence of cysts, fluid-filled sacs that are not cancer. An MRI may be arranged along with a mammogram for routine screening in certain women who have a higher risk of breast cancer.

Breast self-examination

The NHS advises women to be "breast aware":

• Know what's normal for you
• Look at your breasts and feel them
• Know what changes to look for
• Seek medical advice without delay if there are any changes
• Always attend screening appointments

What if you find a lump?

First, don’t panic. Most breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it’s found the better. And if it’s not, testing can give you peace of mind. 

Breast biopsy

The only sure way to determine whether a lump is cancer is to do a biopsy. This involves taking a tissue sample for further examination in the laboratory. Sometimes this is done through a small needle, in other cases surgery is done to take part of or the entire lump for testing. The results will show whether the lump is cancer, and if so, what type. There are several forms of breast cancer and treatments are carefully matched to the type of cancer.

Hormone-sensitive breast cancer

Some types of breast cancer are stimulated to grow by the hormone oestrogen. A biopsy can reveal whether a tumour has receptors for oestrogen (ER-positive). About two out of three breast cancers are hormone sensitive. There are several medications that keep the hormones from promoting further cancer growth.

The image shows a molecular model of an oestrogen receptor.

HER2-positive breast cancer

In about 20-25% of patients, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive, and it tends to spread faster than other forms of breast cancer. It’s important to determine whether a tumour is HER2-positive, because there are special treatments for this form of cancer.

A HER2-positive breast cancer cell is illustrated here, with abnormal growth signals shown in green.

Breast cancer stages

Once breast cancer has been diagnosed, the next step is to determine how big the tumour is and how far the cancer has spread. This process is called staging. Doctors use Stages 0-4 to describe whether cancer is localised to the breast, has invaded nearby lymph nodes, or has spread to other organs, such as the lungs. Knowing the stage and type of breast cancer will help your health care team formulate a treatment plan.

Breast cancer survival rates

The odds of surviving breast cancer are strongly tied to how early it is found. Around 82% of women in the UK with breast cancer live at least five years – and many women in this group remain cancer-free for good.  The more advanced the cancer, the lower this figure becomes, but these rates can improve as more effective treatments are found.

Breast cancer surgery

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conservation surgery) to removing the entire breast (mastectomy.) It’s best to discuss the pros and cons of each of these procedures with your doctor before deciding what’s right for you.

Radiotherapy for breast cancer

Radiotherapy uses high-energy rays to kill cancer cells. It may be used after breast cancer surgery to wipe out any cancer cells that remain. It can also be used along with chemotherapy for treatment of cancer that has spread to other parts of the body. Side effects can include fatigue and swelling or a sunburn-like feeling in the treated area.

Chemotherapy for breast cancer

Chemotherapy uses drugs to kill cancer cells anywhere in the body. The drugs are often given by IV (drip), but are sometimes taken orally or by injection. Chemotherapy may be done after surgery to lower the odds of the cancer coming back. In women with advanced breast cancer, chemotherapy can help control the cancer’s growth. Side effects may include hair loss, nausea, fatigue and a higher risk of infection.

Hormone therapy for breast cancer

Hormone therapy is an effective treatment for women with ER-positive breast cancer. These are cancers that grow more rapidly in response to the hormone oestrogen. Hormone therapy can block this effect. It is often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to reduce the chance of breast cancer developing in women who are at high risk.

Targeted drugs for breast cancer

Targeted therapies are newer drugs that target specific properties within cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from promoting the growth of cancer cells. These drugs are often used in combination with chemotherapy. They tend to have milder side effects compared to chemotherapy.

Life after diagnosis

There’s no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work or social outings. This can lead to feelings of isolation. It’s vital to reach out to friends and family for support. They may be able to go with you to treatments, help out or just remind you that you are not alone. Many people choose to join a support group - either locally or online.

Breast reconstruction

Many women who have a breast removed choose to undergo reconstructive surgery. This replaces the skin, nipple and breast tissue that are lost during a mastectomy. Reconstruction can be done with a breast implant or with tissue from somewhere else in your body, such as the tummy. Some women opt to begin reconstruction at the same time as their mastectomy, but it is also possible to have reconstructive surgery months or years later.

Breast prosthesis

An alternative to breast reconstruction is to be fitted for a breast-shaped prosthesis that fits inside your bra. This allows you to have a balanced look when you are dressed - without undergoing additional surgery.

Breast cancer: Why me?

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is much more common in women. There are around 300 new cases of male breast cancer in the UK each year. Other risk factors for breast cancer include being over 50, having a close relative who has had the disease, being overweight or obese and excessive alcohol consumption.

Breast cancer genes

Some women have a very high risk of breast cancer because they inherited changes in certain genes. The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have a 50-80% risk of getting breast cancer at some point in their lifetime. Other genes may be linked to breast cancer risk as well.

Risk factors in your control

Being overweight (after menopause) and drinking more than one alcoholic beverage per day can increase the risk of developing breast cancer. Contraceptive pills and some forms of postmenopausal hormone therapy (HRT) can also increase your risk. However, the risk goes back to normal a number of years after these medications are stopped. Among survivors, good lifestyle choices may be helpful. Studies suggest that physical activity may help lower the risk of breast cancer and it's also a proven mood-booster.

Breast cancer research

Doctors continue to search for more effective and tolerable treatments for breast cancer. The funding for this research comes from many sources, including charities and groups throughout the UK. Many breast cancer survivors and their families choose to take part in charity walks and fundraising events. This links each individual fight against cancer into a common effort for progress.

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