Breasts are made up of connective tissue, fat and glandular tissue (divided into lobes).
It is common for a woman’s breast to be a different size and shape to the other. They may also feel different at different times of the month and may feel tender and lumpy around her period.
Facts and figures
Breast cancer can be diagnosed at different stages of development. It is not one single disease; there are several types of breast cancer and it can grow at different rates. Its complexity can make it difficult to predict what course it will take in each person.
- Breast cancer is the most common form of cancer for women in the UK
- There have been huge advances in the treatment of breast cancer over the last fifty years and around 80% of patients developing early breast cancer will now be cured of their disease
- There are an estimated 570,000 people who have been diagnosed with breast cancer living in the UK today
- Around 53,000 women and 400 men are diagnosed with breast cancer each year
- Women over the age of 50 account for 80% of breast cancer occurrences, almost half of all cases are diagnosed in people who are in aged between 50 and 69
- Multiple tumours can occur in around 10% of breast cancer cases
Signs and symptoms
Detecting cancer early is important because the earlier a breast cancer is diagnosed the easier it is likely to be to treat it and the better the chance of cure.
The most common way for women to notice something is not right is to find a painless lump while bathing or showering.
Other symptoms include:
- Change in shape or size of the breast
- Change in the appearance or feel of the skin on the breast
- Rash on the nipple or the surrounding area
- Discharge from the nipple
- Inverted nipple (turned in nipple)
- Lump or swelling in the armpit
If symptoms are suspicious a GP will refer a patient to a specialist breast clinic or consultant. At this stage careful examination is used to establish the size, location and character of a potential tumour, together with any potential evidence of spread (metastases) in the lymph nodes in the armpit and other areas around the breast.
A triple assessment will be undertaken. This usually involves:
- An ultra sound scan or mammogram
- A physical breast examination (including both breasts and armpits)
- A needle core biopsy or a fine needle aspiration to remove an extremely small amount of breast tissue to test and see whether the cells are cancerous.
Investigations required to fully assess early breast cancer may include:
- a blood count
- liver function tests
- chest x-ray/mammography
- a bone scan
Other types of scanning may be requested if abnormalities are found in an examination or there are symptoms that suggest the disease may have spread.
Metastases occurs when cancer cells break off and spread through the lymphatic channels or blood vessels to settle in other parts of the body. With breast cancer it usually spreads through the lymph nodes in the axilla (armpit). Secondary tumours can form in the bone, liver, lung and, less frequently, the brain.
The increased awareness of breast cancer has led to more women seeing their doctors at an early stage which makes treatment much easier.
Treatments for breast cancer include: surgery, chemotherapy, radiotherapy, hormone treatment or targeted therapy. These can be given alone or in any combination or order and are always discussed with patients who form part of the decision making process.
Surgery is usually the first treatment and is used to remove cancerous tissue from the breast. Mastectomy (removal of the breast) is no longer the primary surgical approach to breast cancer. Today, it is more likely that just the tumour is removed. This approach gives a better cosmetic result with no evidence of an increased rate of local recurrence or poorer survival when compared with more aggressive surgical procedures.
However, if there is a large tumour in a small breast and its removal would result in a poor cosmetic appearance, or if there are several tumours in the breast, a mastectomy may be necessary.
Chemotherapy may be used following successful removal of the tumour by surgery and radiotherapy to treat any potential small areas of spreading cells. This is known as adjuvant treatment.
Chemotherapy is also offered where breast cancer has recurred. It often takes two to three months to check if the tumour is disappearing in response to chemotherapy.
Targeted therapy is the name for a group of drugs, the most well-known being Herceptin, that block the growth and spread of cancer by interfering with the specific processes in the cells that cause cancer to grow.
Hormone treatment like chemotherapy, is used in both adjuvant and metastatic situations. The female hormone oestrogen can play a part in stimulating some breast cancers to grow and a variety of drugs are available that suppress it.
Radiotherapy is used in conjunction with surgery to prevent disease returning. It may also be used if breast cancer recurs outside the previously treated area and hasn’t spread.
Standard radiotherapy can lead to fibrosis and other late side effects as a result of damage to the normal tissue surrounding the tumour. Image guided radiotherapy (IGRT) combined with intensity modulated radiotherapy (IMRT) precisely targets the tumour to avoid damage to the healthy tissue. (Radiotherapy may also be used to treat metastases)
If cancer is in the left breast, where suitable, techniques such as deep inspiration breath-hold (DIBH) can be used during radiotherapy to help lift the breast away from the heart during treatment.