Breast Cancer

Breast cancer occurs when a lump or tumour forms in your breast, because cells have begun to grow in an abnormal way.

Breast cancer and how to treat it, is understood better than ever before and treatment is tailored to the person as well as the type of breast cancer.

There are several different types of breast cancer:

Pre-invasive breast cancer/Ductal Carcinoma in Situ – when the cancer cells have not spread outside the lining of the ducts and into the surrounding tissue
Invasive breast cancer – when the cancer cells have spread outside the lining of the ducts into the surrounding breast tissue
Triple negative breast cancer – when the cancer cells don’t have receptors for oestrogen, progesterone and HER2
HER-2 positive breast cancer – is a breast cancer that tests positive for a protein called Her2 in the breast which facilitates the growth of the cancer cells
Breast sarcoma – develops from the soft tissue and is rare
Metaplastic carcinoma – when two types of cancer cells (often carcinoma and sarcoma) occur
Lobular carcinoma in situ (LCIS) – changes to the cells lining in the lobes within the breast and is not a cancer. With LCIS there is a slightly increased risk of developing breast cancer in later life.
Invasive lobular breast cancer – begins in the breast lobules and is a breast cancer
Inflammatory breast cancer – grows along the lymph vessels in the skin of the breast
Invasive ductal carcinoma – occurs in the lining of the breast ducts and has spread into surrounding breast tissue.
Paget’s disease – a rare condition which affects the nipple

Breast cancer can be detected with a routine screening, or when a woman notices changes in the appearance, feel or shape of her breasts. Changes to look for include:

• An unusual lump or swelling in your breast or under your arm
• A change in the shape or size of one or both of your breasts
• A thickened area in either breast or armpit
• Discharge from either of your nipples
• Dimpling of the skin of your breasts
• Nipple rash or scabbing
• A change in the appearance of one of your nipples (e.g. it has become inverted)

Many breast changes are not cancerous. There’s a very good chance of complete recovery if breast cancer is detected early.  For this reason, it’s vital that women to be breast aware.

Get to know your breasts a little more by understanding how your breasts feel at different times of the month. For example some women have tender, lumpy breasts around the time of their period.

• Become familiar with the way they move
• Know what’s normal for you
• Do they look any different in shape, size or texture?

It isn’t fully known what causes breast cancer, but some potential risk factors may include:

• Age – About 8 out of 10 cases of breast cancer occur in women over 50
• Getting pregnant at an older age, or having no children
• Family history
• Previous breast cancer or lump
• Dense breast tissue
• Being overweight or obese
• Benign diseases of the breast
• Hormones and hormone medicine
• Hormone replacement therapy (HRT) – if you take HRT for longer than 1 year, you have more chance of getting breast cancer than women who don’t use it
• Contraceptive pill –women who take the contraceptive pill have an increased risk of getting breast cancer
• Gene mutations
• Exposure to radiation

If you notice any symptoms of breast cancer, see a doctor as soon as possible. To make a diagnosis, your doctor will examine you. If you have suspected breast cancer, they’ll refer you to a specialist breast cancer clinic to undergo further tests:

• Mammogram – this creates several X-ray images of your breasts, which your doctor can review
• Breast ultrasound – this creates an image of the inside of your breast
• Biopsy – cells from your breast are tested to see if its cancerous
• Needle aspiration – a smaller needle is inserted into your breast to extract cells for testing
• Needle biopsy – a larger needle is used to take tissue from a lump in your breast
• Guided needle biopsy – ultrasound, X-ray or sometimes MRI are used to obtain a more accurate diagnosis of cancer
• Vacuum-assisted biopsy – a needle is attached to a suction tube to get a sample and clear any bleeding from your breast

If you have breast cancer, your doctor will refer you to a multidisciplinary team (MDT), which is a team of specialists who agree the best personalised treatment and care for you, along with your Consultant

The main treatments for breast cancer are:

• Surgery – is performed to remove an area of cancer within the breast or a mastectomy (often with reconstruction) with a sentinel lymph node biopsy, magtrace of axillary lymph node dissection
• Chemotherapy – different combinations of chemotherapy to prevent any remaining cancer cells from spreading, administered either before surgery (neo-adjuvant) or after surgery (adjuvant)
• Immunotherapy/Chemotherapy – is given neo-adjuvantly paired together and (immunotherapy only) may be continued after surgery for additional treatment, for those who are diagnosed with a breast cancer without expression of oestrogen and Her2 receptors.
• Radiotherapy – targeted X-ray radiation directed at the chest to destroy any cancer cells and prevent them from growing and spreading
• Hormone therapy – drugs block or remove hormones such as oestrogen
• Targeted therapy – a range of targeted treatments to help shrink cancer and to reduce the risk of cancer returning

You may have one of these treatments, or a combination depending on the type of cancer you have and it’s stage.

The Breast Clinical Nurse Specialists are here to empower you regarding your diagnosis and individualised treatment plan, to talk through choices and options and to provide you and your family with holistic support at every step of the way.

This content has been checked and approved by Amelia Cook, Breast Unit Manager at King Edward VII’s Hospital.