Breast Cancer Awareness Month

Breast cancer is the name for cancers that start in the breast. It is the most common cancer in the UK.

Around 50,000 women are diagnosed with breast cancer each year in the UK, including around 4,600 in Scotland. Breast cancer survival is improving, yet there are still around 1,000 UK women who die of breast cancer every month.

Breast cancer in men is rare, with around 350 men diagnosed each year in the UK. However, it’s still important that it is caught early and there are signs and symptoms that men can look out for.

What is Breast Cancer?

Breast tissue is found in the breast, upper chest and the armpit. Each breast contains 15-20 glands called lobes, where milk is produced in women who are breastfeeding. These lobes are connected to the nipple by tubes called ducts. The structure of the lobes and ducts is a bit like the branches of a tree. Breast cancer usually begins within smaller structures of the lobes.

Much of the rest of the breast is fatty tissue. The breast and armpit also contain lymph nodes and vessels carrying lymph fluid, which are part of the immune system. Breast cancer can spread to other areas of the body through this lymph system or blood vessels.

Symptoms:
Everyone’s breasts are different, and your breasts can change with age and at different times of the month. It’s important to get to know how your breasts normally look and feel so it will be easier to spot if there are any unusual changes for you.

If you do spot any unusual changes to your breasts you should get them checked out by your doctor.

Finding out about breast cancer signs and symptoms can help you understand what breast changes to look out for.

Lumps are vital to look out for, and for many women the first sign or symptom of breast cancer is a lump in their breast. But many women have breast lumps and most of them are benign (not cancerous), and there are other important signs and symptoms too.

When Checking:
Lump- may not be seen but might be felt.
Can you feel a lump either in the breast, upper chest or armpit?
Is there a lumpy area or unusual thickening of the breast tissue
that doesn’t go away?
Is there any unusual pain either in part of the breast or the armpit?

Skin texture E.G dimpling or puckering
Any change in size or shape? For example, one breast might become larger or lower than the other.
Any change in colour? E.g. the breast may look red or inflamed.
Any change in skin texture Such as puckering or dimpling of the skin of the breast?

Appearance or direction of the nipple
What about the appearance or the direction of the nipple?
E.g. one might become inverted (turned in) when it normally points out.

Nipple Discharge
Any unusual discharge? One or both nipples might have a discharge.

Rash or Crusting
Any rash or crusting of the nipple or surrounding area.

It’s as simple as TLC
TOUCH your breasts. Can you feel anything unusual?
LOOK for changes. Is there any change in shape or texture?CHECK anything unusual with your doctor.

How is Breast Cancer diagnosed?

The first thing to do if you feel a lump or notice any unusual change in your breast is to see your GP, who will examine you and discuss your general health with you.

Most women with unusual breast changes find they do not have cancer. However, it’s important to get any unusual changes checked out by your doctor as soon as possible.

The earlier breast cancer is found, the better the chances of beating it.

Treatment:
Surgery:
For most people with breast cancer, surgery happens before any other treatment, although some women will have other treatments beforehand. During surgery, cancerous tissue in the breast is removed. Surgeons also look to see whether lymph nodes (glands) in the armpit have been affected. If they have, these are removed too.

Many women have a process called breast conserving surgery (also called wide local excision or lumpectomy). This is where only the breast cancer and a small margin of healthy tissue is removed, but surrounding healthy breast tissue is not removed.

Some women, however, will need to have the whole breast removed in an operation known as amastectomy. Women who are offered a mastectomy should also be offered breast construction (plastic surgery to rebuild the breast).

Women who do not have immediate reconstruction, or who choose not to have reconstruction at all, should be offered an appointment with a prosthesis fitting service (breast prostheses are artificial breasts).

Side effects of surgery may include:

  • pain and discomfort
  • infection
  • the collection of fluid in the wound area, causing swelling (seroma)
  • long-term swelling of your arm or nearby areas (lymphoedema)

Treatments are available to help relieve or reduce these side effects.

Your surgeon will explain to you the best approach to surgery in your case, and will help you to make any decisions you may have.

Radiotherapy:

Radiotherapy is treatment with radiation (high energy X-rays). It is usually given after surgery and aims to destroy any cancer cells remaining after surgery.

Radiotherapy is usually recommended for women who have undergone a lumpectomy or sometimes a mastectomy. It is usually given to the affected breast or the area behind where the breast was removed. The lymph glands in the armpit and above the collarbone are also sometimes treated.

Before you have radiotherapy, your oncologist will work out exactly where to point the X-ray’s beams and what dose to use so that cancer cells are destroyed with minimum damage to normal tissues. A typical course of radiotherapy for breast cancer is given five days a week for three weeks. Each session lasts a few minutes.

Side effects of radiotherapy are generally short-lived. They may include:

  • Reddening of the skin treated
  • Possible burning (like a strong sunburn) to the area treated
  • Tiredness

Few women experience long-term side effects. These can, however, include:

  • Changes to the skin, bone, lung or heart near the area treated
  • Long-term swelling of your arm or nearby areas (lymphoedema)

Chemotherapy:
Chemotherapy is treatment with one or more anti-cancer (cytotoxic) drugs. It aims to prevent the breast cancer spreading or coming back. Chemotherapy drugs are usually given directly into your bloodstream – either by injection directly into a vein or through a drip into a vein over a period of minutes or hours (an infusion). Chemotherapy is usually given after surgery, although some women have it before surgery.

Whether or not you are recommended to have chemotherapy will depend on a number of factors, including the grade of your breast cancer. There are several different chemotherapy drugs and a course of treatment generally combines two or three of these. A chemotherapy course is made up of repeated cycles of treatment, usually a few weeks apart, over several months.

Chemotherapy drugs circulate throughout the body. As well as cancer cells, they affect healthy body cells too – this causes side effects.

Most women suffer some short-term side-effects with chemotherapy treatment, although these vary a great deal.

Common side effects of chemotherapy include:

  • tiredness
  • nausea
  • vomiting
  • a sore mouth
  • mouth ulcers
  • muscle and joint aches
  • diarrhoea
  • hair loss (anything from slight to complete)
  • weight gain
  • menopausal symptoms

Remember, though, that a lot can be done to help relieve side effects, so if you do experience any of these, tell your oncologist or breast care nurse.

Hormone therapies:
Hormones are naturally occurring substances that control the growth and activity of cells in the body. However, the female hormones oestrogen and progesterone can also promote the growth of some breast cancers. Around three out of four breast cancers are sensitive to hormones in this way – these are known as hormone positive breast cancers.

Hormone therapies are tablets that block the production of female hormones or reduce the ability of breast cancer cells to respond to the hormones. They aim to prevent the breast cancer spreading or coming back.

They are only effective in treating breast cancers that are hormone positive (shown using receptor tests). All patients with hormone positive breast cancer should be offered hormone therapy, unless there is a reason this would be unsuitable.

The two types of hormone therapy are:

  • Aromatase inhibitors, for example anastrazole (Arimidex), exemestane (Aromasin) andletrozole (Femara) – this is for women who have been through the menopause
  • Tamoxifen – this is for women before or after the menopause

The exact treatment will vary from person to person, and is typically five or more years in length.

Tamoxifen and aromatase inhibitors can cause menopausal symptoms. Aromatase inhibitors can also cause pain and stiffness and osteoporosis.

Targeted (biological) therapy:
Targeted therapies attack cancer cells directly (ie target them). They do not usually affect healthy tissues and so do not cause side effects such as sickness and hair loss.

Herceptin (also known as trastuzumab) is the targeted therapy available to treat early breast cancer. It aims to prevent the breast cancer spreading or coming back.

Herceptin targets breast cancers that express high levels of a protein called HER2. These breast cancers are known as HER2 positive breast cancers (shown using receptor tests) and account for around one in five breast cancers. Patients with HER2 negative cancers (those with low levels of HER2) do not benefit from Herceptin.

Women taking Herceptin may experience some side-effects including flu-like symptoms, and it can lead to heart problems. Due to this risk, Herceptin may not be a suitable treatment for everyone and all patients should have their heart function assessed before and during treatment.

What can cause Breast Cancer:

Alcohol:
Regularly drinking alcohol increases your risk of developing breast cancer. The more drinks that you have each day, the greater your risk of breast cancer will be. If you want to reduce your risk of breast cancer, we recommend you limit the amount of alcohol you regularly drink throughout your life.

Hormone replacement therapy (HRT):
Taking HRT to treat menopausal symptoms increases your risk of breast cancer; this risk increases the longer you use HRT. The good news is that the increase in breast cancer risk begins to fall as soon as you stop taking HRT, no matter how many years you’ve taken it. If you are considering taking, or stopping taking, HRT you should speak to your doctor.

The Pill:
Taking the pill (combined contraceptive pill) slightly increases your risk of breast cancer. Ten years after stopping the pill this increased risk will have disappeared and your chance of developing breast cancer will be about the same as that of a woman who has never taken the pill. Remember, breast cancer is rare in women under the age of 40, regardless of whether or not they use the pill.

Pregnancy:
Having children affects breast cancer risk in three different ways:

  • In the long term, having children decreases your risk of breast cancer.
  • The earlier a woman begins her family, the lower her risk of breast cancer is.
  • In the short term, your risk of breast cancer may slightly increase after you give birth, regardless of your age. This increase is temporary.

Weight:
There are three known links between weight and breast cancer:

  • Putting on weight in adulthood (after the age of 18) increases your risk of developing breast cancer after the menopause.
  • Being overweight or obese before the menopause slightly reduces your risk of developing breast cancer before the menopause.
  • Being overweight or obese after the menopause increases your risk of breast cancer.

For the following factors, there is some scientific evidence that suggests they may affect the chances of developing breast cancer. More research is needed before we can be sure whether or not they are definitely linked to the disease.

Healthy Diet:
Maintaining a healthy diet might help to reduce your risk of breast cancer, as well as other cancers. However, we still aren’t sure whether any specific dietary factors influence the chance of developing the disease. It is unlikely that phyto-oestrogens (found in soya and some other foods) increase your risk of developing breast cancer.

Aspirin and Ibuprofen:
Taking aspirin or ibuprofen might slightly reduce the risk of breast cancer, but we don’t recommend that women take these drugs solely to lower their risk of breast cancer.

In Vitro Fertilisation Treatment (IVF):
It is unclear whether IVF treatment affects the risk of breast cancer because only a very small number of studies have looked into this. If you are worried about IVF treatment and breast cancer risk you should discuss your concerns with your doctor or fertility specialist.

Smoking:
Smoking may increase your risk of developing breast cancer but there is not enough evidence for us to be sure. Recently, some studies have shown that smoking increases the risk of breast cancer; however, some older studies did not find a link.

Age:
As you get older, your risk of breast cancer increases. At least four out of five of all breast cancer cases in the UK are in women over the age of 50. The disease is uncommon in women under the age of 40.

Being Female:
Women are much more likely to get breast cancer than men, so simply being a woman means you are at higher risk of developing the disease.

Being Taller:
For women, being taller slightly increases the risk of developing breast cancer. Conversely, being shorter slightly decreases risk.

Early Puberty:
Women who started their periods at an early age have a slightly increased risk of breast cancer. The earlier you began your periods, the higher your risk, but this effect is small and gradual.

Genetics:
In a small number of cases, breast cancer runs in the family. Of all women who develop breast cancer, up to 15% has a significant family history of the disease and about one in 20 has inherited a fault in a gene linked to breast cancer. If you have concerns about any cancers in your family then you should see your doctor.

High Breast Density:
The amount of tissue compared to fat in your breasts is known as ‘breast density’. Having high breast density (a low proportion of fat) is one of the biggest risk factors for breast cancer. Unfortunately, most women will not know their breast density and there are no established ways to reduce it.

Late Menopause:
Women who go through the menopause later have a slightly increased risk of breast cancer. The later you go through menopause, the higher your risk, but this effect is small and gradual.

Other Breast Conditions (proliferative benign breast disease):
There are many types of benign (non-cancerous) breast conditions and most do not affect the risk of developing breast cancer. However, if you have a benign breast condition where the breast cells are described as ‘proliferative’ (meaning the cells are growing too quickly) then your risk of breast cancer will be increased.

Ethnicity:
Your ethnic background affects your risk of developing breast cancer. In England, a white woman is more likely to develop breast cancer than a black, Asian, Chinese or mixed-race woman.

 

 

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