This section provides information about Breast Cancer
This includes its causes, risk factors, symptoms, how it is diagnosed and the different types breast cancer treatments available.
About breast cancer
Breast cancer is the most common type of cancer found in women in the UK. Although it mainly affects older women, it can occur at a younger age. Men can also develop breast cancer. Breast cancers occur when cells in the breast start to grow and multiply abnormally to form a tumour.
Whatever age you are, it’s important that you get to know what’s normal for youa nd your breasts. If you notice any changes in how they look or feel, you should see your doctor as soon as possible. It is also important to go to your Breast Cancer Screening (mammogram) appointments as these can pick up cancers that you may not be able to feel.Here you can find out more about the different types of breast cancer, risk factors,what causes it and how it’s treated.
Facts about breast cancer
- Breast cancer is the most common cancer in the UK
- It affects around 48,000 women in Britain every year
- Breast screening saves around 1,300 lives a year in the UK
NHS Choices, Breast cancer (female), Introduction http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Introduction.aspx
Cancer Research UK, Mammograms in breast screening http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/screening/mammograms-in-breast-screening
NHS Choices screening information https://www.nhs.uk/conditions/breast-cancer-screening/
Types of breast cancer
The breast is composed of lobules and ducts. Breast cancer can develop in either of these parts of the breast. They can also be defined as either invasive or non-invasive (also known as in-situ cancer).
Non-invasive breast cancer means the cancer cells are confined to the breast lobules and ducts. This does not always present as a lump and is most commonly found on a mammogram. If non-invasive breast cancer isn’t treated, it can develop into invasive breast cancer. The most common form of non-invasive breast cancer develops from the ducts and is called ductal carcinoma in situ(DCIS). Less commonly, a condition called lobular carcinoma in situ (LCIS) may develop from the breast lobules.
Invasive breast cancer (usually just called breast cancer) means the cancer cells have spread to breast tissue surrounding the ducts and lobules. It can also spread to the lymph glands under your arm. Sometimes invasive cancer cell scan spread to other parts of your body through your lymph glands or bloodstream. Around nine in ten invasive cancers are ductal cancers, and one inten is a lobular cancer. Breast cancers are also classified according to whether they contain receptors for the hormone oestrogen (which is found in both women and men).Cancers with this change are called oestrogen receptor (ER) positive breast cancers, and those without are known as ER negative. Cancers are also classified by another change called HER2 positivity, where too much of a normal protein in the body is present on the surface of the cells. Invasive breast cancers are routinely tested for these changes, as this affects the choice of treatment.
Cancer Research UK – about breast cancer https://www.cancerresearchuk.org/about-cancer/breast-cancer/about
Breast cancer symptoms
Most women notice a lump in their breast before any other symptom of breast cancer. Lumps in your breasts are usually normal, and nine out of ten are not cancerous. It’s still important to get any lumps in your breasts checked by a doctor – the sooner you identify a problem, the easier it is to treat.
Other symptoms which you should report to your doctor are:
- a change in the size or shape of your breast
- dimpled skin on your breasts
- a difference in how your nipple looks
- discharge or blood coming from your nipples
- a rash around your nipples
- a lump or swelling in your armpit
- painful breasts or armpits.
What’s normal for you?
It’s important that you learn what’s normal for you and your breasts throughout the month. For example, some women find that they have normal breast painr elated to their period. Learning what’s normal for you at different stages in your life and as your breasts naturally change will make it much easier for you to spot anything unusual. It is usually best to check your breasts just after your period. If you notice anything unusual, particularly if one breast feels different to the other, get a doctor to check as soon as possible.
Risk factors for breast cancer
While the exact cause of breast cancer isn’t known, there are somethings we know definitely increase the risk.
Around four out of five breast cancer cases are diagnosed in women over 50,which is why the NHS recommend you have breast screening every three years between the ages of 50 and 70 through the NHS Breast Screening Programme. After the age of 70 you can ask your GP or local screening service if you wish to continue screening mammograms.
The female hormone oestrogen can stimulate the growth of breast cancer cells.The more oestrogen you’re exposed to, the greater your risk of developing breast cancer. Things like starting your period early and entering menopause late,taking HRT or the pill, not having children or having them later in life mean your body’s been exposed to oestrogen for a longer time frame or in a greater quantity.
Weight also has an effect on your risk of breast cancer, especially for women who are overweight or obese after the menopause.
Drinking alcohol or smoking
Both smoking and alcohol intake increase your risk of breast cancer.
Your family history
If a close relative has had breast cancer or ovarian cancer, you might be at greater risk of developing breast cancer too. As breast cancer is the most common type of cancer in women, it’s possible for more than one case in a family to be coincidental. Most breast cancer cases don’t run in the family,although some genes can increase your risk. Depending on your family history you may be referred to a clinical geneticist to discuss genetic testing.
If you’ve had breast cancer before
You have a greater risk of getting breast cancer in either the same breast or your other breast if you’ve had breast cancer before.
There are other factors that have been linked to the chance of getting breast cancer too. Things like exposure to radiation and the density of your breasts can also increase your risk of breast cancer.
NHS Choices – Causes and risk factors https://www.nhs.uk/conditions/breast-cancer/causes/
The stages and grades of breast cancer
When you are diagnosed with breast cancer, your consultant may describe its “stage”. This is a way of categorising the size of the tumour, whether it has spread to your lymph nodes and if the cancer cells have spread to any other part of your body.
The stage of your breast cancer will help to inform the decisions you and your consultant make about your treatment options. There most common staging system is known as TNM staging and describes the size of the tumour (T), the number and location of lymph nodes involved (N) and whether the cancer has spread to become metastatic (M). Cancer may also be described as stage 1 to 4, based on the same criteria. This system is described below.
- Stage 0 | Ductal carcinoma in situ (DCIS) is sometimes called stage 0 (may also be known as Tis).
- Stage 1 | The tumour is less than 2cm and has not spread to any lymph nodes under the arm. There may be very small deposits in the nodes, called micrometastases.
- Stage 2 | The cancer may be larger or have affected some of the lymph nodes under the arm.
- Stage 3 | The tumour may either be attached to skin or other tissues or may have spread to more of the lymph nodes in areas close to the breast. This stage is also used to describe larger tumours with any degree of lymph node involvement.
- Stage 4 | The tumour has spread to other areas of your body. This is called metastasis.
You may also hear the term “grade”. This refers to how the cells look under a microscope. The cancer will be grade from 1 to 3, with 1 being the slowest growing and 3 the more rapidly dividing and abnormal cells. Both stage and grade are used to determine the treatment for your cancer.
Treatment for breast cancer
If you have been diagnosed with breast cancer, there are several treatment options for you to consider. You might need one or a combination of different treatments, which your consultant and breast care nurse will talk you through.
Your treatment options
Treatments may include:
- breast cancer surgery
- hormone therapy
- targeted therapy
As everyone is different, your consultant breast surgeon and oncologist will take a number of things about you into account when deciding which treatment would suit you best. They will consider factors including:
- the type of breast cancer you have
- what stage and grade of your breast cancer and cancer cells
- whether you have gone through the menopause
- your overall health.
Breast cancer surgery
For most people, surgery is the first step in their breast cancer treatment. There are different types of surgery for breast cancer. Your consultant breast surgeon will talk to you about your options and help you to decide on the right treatment for you. For many women, breast conserving surgery may be an option,where the cancer and surrounding tissue are removed, leaving the breast intact.For some women and for men with breast cancer, a mastectomy (removal of the breast) may be offered. The decision depends on the size, position and number of tumours as well as your wishes.For invasive cancers or for larger areas of DCIS, a sentinel node biopsy may be undertaken, where a small number of nodes is removed from under the arm to look for cancerous cells. If the breast cancer is already known to have spread to the nodes then an axillary clearance may be recommended. This is where all of the nodes from under the arm are removed.
Breast reconstruction replaces tissue that is removed during your breast cancer surgery to help recover some of your breast’s shape, and may be performed directly after a partial breast removal (mastectomy) or some time later. If you are likely to require radiotherapy there may be some benefits to delaying there construction, but this is an individual decision to discuss with your surgeon.
After surgery you are likely to be offered other treatments to reduce the risk of the cancer coming back. The treatment you have next depends on the type of breast cancer that you have.
Chemotherapy is commonly given after surgery to reduce the risk of thecancer returning anywhere in the body. It is also used for metastatic disease(that has spread away from the breast and is not curable) to control thecancer. This is termed palliative chemotherapy. Chemotherapy is usually giventhrough a vein and is delivered on the day unit, although some treatments maybe given in tablet form. You will need a consultation with your consultant orspecialist nurse before each treatment where your blood results will be checkedand any side effects discussed. Theexact treatment will depend on the type and stage of the breast cancer. Sometimes chemotherapy is used before surgery. This may be done if thecancer is too large to remove or if shrinking the cancer would allow for lessextensive surgery. It may also be offered for some specific types of breastcancer to reduce the risk of spread to other parts of the body.
Radiotherapy uses high energy x-rays to reduce the risk of cancer coming back in the breast and sometimes the lymph node areas around the breast. It is a local treatment which means that most of its effect is in the treated area.Radiotherapy treatment is delivered in a course of treatment lasting between one and five weeks. It can be also used on other parts of the body if cancer has spread.
Hormone (endocrine) therapy
This is used for cancers that are hormone or oestrogen (ER) positive. You will usually be offered a tablet to take once daily for five to ten years to reduce the risk of cancer recurrence. Hormone treatment may also be used to treat metastatic disease, or if surgery is felt to be too high risk due to other medical problems. Sometimes your consultant may recommend an injection to stop your ovaries working in addition to giving hormone treatment.
Targeted therapy uses either antibodies or other drugs to treat specific types of breast cancer. For HER2 positive breast cancers the drugs trastuzumab and pertuzumab are commonly used in combination with chemotherapy.Other targeted therapies work together with hormone treatments for ER positive breast cancers and are taken in tablet form.
Bisphosphonates and Denosumab
Bisphosphonates are used either to reduce the risk of cancer spreading to the bone, or for cancer that has already spread. Denosumab is an alternative drug for cancer in the bone.
This is a relatively newer form of treatment for some types of breast cancer, known as triple negative breast cancers. If your consultant thinks you may benefit from this treatment, they will request special tests on a sample of the cancer to see if it is likely to be effective.
Follow up treatment
After your breast cancer treatment, you will have regular check-ups and annual mammograms. Your follow up will be determined by your individual needs.
Specialising in Breast Cancer Treatments
Consultant Medical Oncologist
Dr Matthew Winter
Consultant Medical Oncologist
MBChB MSc MD FRCP
Breast cancer and gestational trophoblastic disease.
Dr Winter joined Weston Park Cancer Centre in 2011 as a consultant after completing his specialist training in medical oncology in Sheffield including a doctor of medicine clinical and translational research degree in breast cancer.
He specialises in breast cancer and gestational trophoblastic disease.
He is also the Deputy Director of the Sheffield Trophoblastic Disease Centre, which is based at Weston Park Cancer Centre, and since 2018 has also been a member of the Executive Committee of the European Organisation for the Treatment of Trophoblastic Disease.
He has a keen interest in clinical trials and has published in a number of peer reviewed journals in both breast cancer and gestational trophoblastic disease.
In 2018 he was appointed to Honorary Reader in the Department of Oncology and Metabolism, University of Sheffield.
Consultant Clinical Oncologist
Consultant Clinical Oncologist