Following on from last month’s focus on prostate cancer, this time around we delve into one of the most common forms of cancer for women in the UK; breast cancer. We take a look at the symptoms and treatments with further expertise from Hove’s Montefiore Hospital
2014 UK statistics show that there were 55,222 new cases of invasive breast cancer, and 141,433 deaths from the illness. Meanwhile, the same statistics show that there was a 27% prevention rate during this same year, and between the years 2010 and 2011, 78% of females survived breast cancer for 10 or more years. These statistics really are quite shocking, yet many people still shy away from the C-word. As with any kind of illness or disease, catching it in the early stages is important and allows easier control over the issue. This is the reason why having knowledge on such problems is so important. It’s clear to see that breast cancer is among the most common illnesses for women in the UK and while it might be heard of all too often, do people really know the signs and symptoms to look out for?
Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out, but over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.
Not all tumours are dangerous; benign tumors are not considered cancerous and their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Regardless, it’s always better to be cautious and to know exactly what you should be looking for. Breast cancer refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts however less commonly, breast cancer can begin in the stromal tissues.
Most people are under the impression that getting cancer is down to either genes or just incredibly bad luck, however scientific research has shown that our risk of developing such a condition depends largely on a combination of things – our environment and lifestyle included in this. In the UK, more than 1 in 2 people will develop cancer at some point in their lives. Every year, more than 350,000 people are diagnosed with the disease, but experts estimate that more than 4 in 10 cancer cases could be prevented, largely through lifestyle changes, such as not smoking, maintaining a healthy body weight, eating a balanced diet, cutting back on levels of alcohol consumption and keeping active.
People who work in certain jobs may have higher risks of cancer because of exposures to some chemicals, radiation, or other aspects of their work. Scientists estimate that occupational exposure to health hazards is responsible for nearly 4% of cancer cases in the UK. However, these exposures are not too much of problem now due to the fact that a large amount of them have been banned, and employers are now under a legal obligation to control exposure to such chemicals.
The signs and symptoms of breast cancer can vary, and some of which can occur due to regular breast changes or a benign breast condition. Some people think that having breast cancer will cause other symptoms apart from a breast change, such as feeling tired, having less energy or weight loss, but this is not always the case. The most common symptoms of cancer of this kind include; a change in breast size or shape, a lump or area that feels thicker than the rest of the breast, a change in skin texture such as puckering or dimpling, redness or rash on the skin and/or around the nipple, liquid (sometimes called discharge) that comes from the nipple without squeezing, constant pain in your breast or your armpit or swelling in your armpit or around your collarbone.
The key message is to be breast aware and to be familiar with your own body. Some ladies, particularly younger women, have firm glandular tissue, so it is even more important to be aware of changes as it can be difficult otherwise to detect lumps. This can get worse just before a period due to increased hormonal stimulation, leading to congestion of the breast tissue. This symptom gets better once a period starts so it is always worth waiting until after your period to see if an area of lumpiness persists before consulting your GP.
How to examine your breasts
The best time for self-examination is around a week after a period as this would be the time of least hormonal stimulation. Never use two hands and fold breast tissue between them, as this would give the impression of lumpiness. Stand in front of a mirror and raise your arms above your head. Look carefully at the shape of each breast. Then lie down and with your fingers flat; feel over the whole surface of both breasts for anything which is different from the last time. This is easier in a bath when the skin surface is soft and slippery to allow the flat of your hand to glide more easily.
Never squeeze the nipples to check for discharge, however, do seek advice from your GP if the nipples discharge spontaneously. A wide range of conditions, most of which are harmless or easily treated, can cause nipple discharge. Discharge that is ‘toothpaste-like’ in consistency, and greenish/yellow is usually due to inflammation of the ducts and not cancer.
Leaflets on breast self-examination are available from most breast cancer charities in the UK. Although most lumps aren’t breast cancer, any unusual changes to the breasts should be checked by a GP as soon as possible. If your GP finds a lump on examination, they will routinely refer you to be seen by a hospital specialist.
A GP will do an urgent referral so that you will be seen by a local breast unit within two week, although the vast majority of ladies referred don’t have a diagnosis of breast cancer. Tests to diagnose cancer include mammography (an x-ray of the breast) an ultrasound scan, or a needle biopsy in which a thin needle is used to remove a small amount of cells.
This is a common symptom in many ladies and is usually due to hormones just before a period. This is normal and your GP could advice you on simple measures to help with this. Post-menopausal ladies can still get breast pain often caused by spurts of oestrogen secretion which stimulate the breasts, creating congestion and sometimes cysts. This creates pain in patchy areas of one or both breasts. It is not a sign of cancer on its own, however it is advisable to see your GP.
Some ladies have some degree of nipple inversion and this is of no concern. If nipple inversion is a new symptom, particularly if the nipple cannot be retracted out easily by gentle stimulation, consult your GP. Some cancers can pull onto the nipple as they grow, although nipple inversion is not always a sign of cancer and can occur during the menopause. New scaliness of the nipple, particularly if you don’t suffer from eczema and affecting only one side, requires attention. Do not apply any topical steroids as this may mask important symptoms and delay a diagnosis. If it is itchy, don’t scratch, and apply a simple lubricating ointment until you see your GP.
Treatments for breast cancer
Most patients with early stage breast cancer undergo a lumpectomy to surgically remove the tumour. This is usually followed by a combination of other treatments such radiotherapy, anti-hormonal treatment or chemotherapy.
A new development in early low stage breast cancer is intra-operative radiotherapy or IORT. During the lumpectomy, a single high dose of radiation is administered to the site of the tumour which means the patient wakes up having received a full treatment and is able to return to their daily routine much more quickly. The Montefiore Hospital was one of the first in the country to offer this treatment to appropriate stage 1 and 2 breast cancer patients.
All treatment will depend on the stage and grade of your cancer – how big it is and how far it has spread. Each cancer is unique and treatment is tailored to the individual’s needs. You will be supported by a team of surgeons, specialised nurses and oncologists to help you make appropriate decisions about your treatment.