Ladies! The Arrival of the month of October, brings to our attention the tragedies of all those women who suffer from this deadly disease every year. So what do we need to about Breast Cancer?
The biggest risk factors for developing breast cancer are getting older, being female and, for a few, having a significant family history of the disease.
Just over 80% of breast cancers occur in women who are over the age of 50. Nearly half of all cases are diagnosed in people in the 50-69 age group.
Breast cancer starts when cells in the breast begin to divide and grow in an abnormal way. Breast cancer is not one single disease. There are several types of breast cancer. It can be diagnosed at different stages and can grow at different rates. This means that people can have different treatments, depending on what will work best for them.
Earlier detection and better treatments mean that survival rates after a diagnosis of breast cancer are improving. More than 8 out of 10 people survive breast cancer beyond five years. More than three quarters of people survive it beyond 10 years.
Estimated risk of developing breast cancer according to age
- Risk up to age 29, 1 in 2,000.
- Risk up to age 39, 1 in 215.
- Risk up to age 49, 1 in 50.
- Risk up to age 59, 1 in 22.
- Risk up to age 69, 1 in 13.
- Lifetime risk, 1 in 8.
What is breast screening?
Breast screening (mammography) is an x-ray examination of the breasts. It may help detect breast cancer before there are any signs or symptoms. The sooner breast cancer is diagnosed the more effective treatment may be.
Because breast cancer is more common in women who are over the age of 50, women aged 50 to 70 are invited for routine breast screening every three years. Also younger women’s breast tissue can be dense, which makes the mammogram image less clear so normal changes or benign (not cancer) breast conditions can be harder to identify.
Most cases of breast cancer don’t run in the family
Most cases of breast cancer happen by chance. Less than 10% of breast cancers are caused by inheriting a faulty gene.
Breast cancer can affect women, regardless of the size of their breasts
Breast cancer can affect women with small breasts, medium breasts, large breasts – any size breasts. Breast size is irrelevant.
Finding a lump in your breast doesn’t mean you have breast cancer
There are several benign (not cancer) conditions that can occur in the breast and may cause a lump. Also many women will experience lumpy breasts just before their period. This is a normal response to changing hormones and often the lump or lumpiness disappears after the period. However, if this doesn’t go away, it’s important to get it checked out by a doctor. Any new lump should always be assessed by a doctor, however old you are. Don’t be afraid that you’re wasting the doctor’s time.
The size of the breast cancer is usually measured in millimetres (mm) or centimetres (cm).
Although in general smaller cancers may have a better outcome, size doesn’t always give the whole picture about how fast the cancer is growing.
For example, a small cancer may grow very quickly or a larger cancer may have been growing slowly over a longer time. Sometimes there may be more than one area of breast cancer. In this case, each area is measured.
Multi-centric means there is more than one area of breast cancer in different quarters of the breast.
Multi-focal means more than one area has been seen but only in one quarter of the breast.
Breasts are made up of lobules (milk-producing glands) and ducts (tubes that carry milk to the nipple), which are surrounded by glandular, fibrous and fatty tissue. Breast cancer starts when the cells in the breast begin to divide and grow in an abnormal way.
There are different types of breast cancer and it is important that your doctors have an accurate diagnosis so they can plan the most appropriate treatment for you.
Types of primary breast cancer
Ductal carcinoma in situ (DCIS) is early breast cancer, sometimes described as intraductal or non-invasive cancer. This means that cancer cells have developed inside the milk ducts, but remain entirely in-situ (in their place of origin) because they have not yet developed the ability to spread outside of these ducts, either within the breast or elsewhere in the body. Both men and women can develop DCIS.
If DCIS is left untreated, the cells may become invasive and develop the ability to spread from the ducts into the surrounding breast tissue and beyond. The type, size and grade of the DCIS can help predict if it will become invasive but currently there is no way of knowing for certain in each individual case.
Invasive breast cancer
Invasive primary breast cancer is breast cancer that has the potential to spread from the breast to other parts of the body. The most common type of invasive breast cancer is invasive breast cancer of no special type (sometimes called invasive ductal cancer). This accounts for most breast cancer diagnoses, but there are many other less common special types.
Special type means when the cells are looked at under a microscope they have features that class them as a particular type of cancer. Some types of invasive breast cancer are outlined below.
Invasive ductal breast cancer/Invasive breast cancer of no special type
You may see no special type invasive breast cancer – written as NST or NOS (not otherwise specified). It’s also referred to as invasive ductal breast cancer. Invasive breast cancer of no special type is the most common breast cancer in both women and men and accounts for about 75% of all breast cancers.
Invasive lobular breast cancer
Invasive lobular breast cancer is the second most common invasive breast cancer accounting for about 10-15% of all breast cancers. It occurs when the cancer cells spread outside the lobules and into the breast tissue around them.
Cribriform breast cancer
About 4% of invasive breast cancers have a cribriform part. It’s often mixed with tubular breast cancer. Under the microscope there are distinct holes between the cancer cells, making it look a bit like a sieve.
Inflammatory breast cancer
Inflammatory breast cancer is a fast growing type of breast cancer which accounts for between 1-4% of all breast cancers. The symptoms of inflammatory breast cancer are also common symptoms of breast infections.
Inflammatory breast cancer gets its name because the skin of the breast develops a red inflamed appearance and may feel warm and tender to the touch. The skin may also appear pitted like the skin of an orange. The redness and swelling (oedema) is caused by cancer cells blocking tiny channels called lymph channels in the breast tissue.
Malignant phyllodes tumour
Malignant phyllodes tumours account for less than 1% of all breast cancers. There are two other types of phyllodes tumour called benign(not cancer) and borderline malignant. They are put into these three categories, according to what they look like under a microscope.
Medullary breast cancer
Medullary breast cancer accounts for around 3-5% of all breast cancers. This type of breast cancer usually has a clear, well defined border between the cancer and the surrounding breast tissue – a feature which pathologists use to help distinguish it from other types of breast cancer. It’s more common in women who inherit a faulty copy of the BRCA1 gene.
Metaplastic breast cancer
Metaplastic breast cancer accounts for about 1% of invasive breast cancers. In this type of breast cancer the cells have changed (transformed) from one cell type into another.
Metaplastic breast cancer is treated in the same way as other types of invasive breast cancer although is more likely to be triple negative.
Mucinous breast cancer
Mucinous (also known as colloid) breast cancer is so called because when it is looked at under a microscope, the cells look like they are surrounded by mucous. It’s common to see mucinous cancer mixed with other types of breast cancer, such as invasive breast cancer of no special type. Pure mucinous breast cancer (when no other type of breast cancer is present) accounts for about 2% of all breast cancers.
Paget’s disease of the breast
Paget’s disease is an uncommon condition which is often noticed by changes to the nipple such as a red, scaly rash which can feel itchy or painful. The nipple may also become inverted. It occurs in less than 5% of all people with breast cancer.
Approximately half of people with Paget’s disease will have an underlying breast lump, which is likely to be an invasive breast cancer. Where there is no lump, most people will have non-invasive or in-situ cancer known as ductal carcinoma in situ (DCIS) somewhere in the breast.
Papillary breast cancer
This type of breast cancer accounts for less than 2% of all breast cancers. Under the microscope the breast cancer cells are in a pattern that looks a bit like the shape of a fern. It is common to see DCIS alongside papillary breast cancer.
Tubular breast cancer
Tubular breast cancer accounts for around 2% of all breast cancers. It is called tubular breast cancer because the cells look tube-like when they are examined under a microscope.
Triple negative breast cancer
Some breast cancers are referred to as triple negative. This means the breast cancer is oestrogen receptor negative, progesterone receptor negative and HER2 receptor negative which is why it’s called ‘triple negative’ breast cancer. Around 15-20% of people with breast cancer test negative for all three of these receptors. Special and non-special types of breast cancer can be triple negative.
Second primary diagnosis
Anyone who has had breast cancer in one breast is at slightly higher risk of developing a new primary breast cancer. This may happen either in the same breast after breast-conserving surgery or, more commonly, in the opposite (contralateral) breast and is called a second primary diagnosis.
People who have developed breast cancer due to a faulty gene also have an increased risk of developing a new cancer.
When doctors perform tests on the cancer, they are usually able to tell if it is a new cancer or a recurrence of the original cancer. A second primary diagnosis is not a recurrence. A second primary breast cancer is considered a new cancer episode and may not behave in the same way as your first breast cancer. An example of this could be your first breast cancer being oestrogen receptor positive but your new primary breast cancer being oestrogen receptor negative.
Cancers are graded according to how different they are to normal breast cells and how quickly they are growing.
In your pathology report this may be called differentiation.
There are three grades of invasive breast cancer:
- grade 1 (well differentiated) the cancer cells look most like normal cells – for example, they are of similar size and shape to normal cells – and are usually slow-growing
- grade 2 (moderately differentiated) the cancer cells look less like normal cells – they are often larger and show variation in size and shape – and are growing faster
- grade 3 (poorly differentiated) the cancer cells look most changed and are usually fast-growing.
With ductal carcinoma in situ (DCIS) there also three grades, but these are usually called low, intermediate and high instead of 1, 2 or 3.
Being diagnosed with breast cancer during pregnancy
If you develop breast cancer during pregnancy the treatment you are offered will depend on the type and extent of your breast cancer, the trimester of your pregnancy when the cancer is diagnosed and your individual circumstances. Each trimester of pregnancy represents a number of weeks.
- First trimester – from conception to 12 weeks.
- Second trimester – 13-28 weeks.
- Third trimester – from 28 weeks to delivery.
Effective treatment for breast cancer can be given during pregnancy without affecting the baby. You cannot pass cancer on to your baby and there is no evidence that having breast cancer during pregnancy affects your baby’s development in any way. Your treatment team will include your obstetrician as well as your breast cancer specialist.
Breast cancer is normally diagnosed by a method known as triple assessment carried out at a specialist breast clinic.
You are more likely to have chemotherapy if your breast cancer is larger than 2cm (about three quarters of an inch), but this will also depend on other factors and the results from the pathology report.
This is because larger cancers may have been there for longer before being found so may have had more chance to spread.
The size and position of the cancer in relation to your breast size may also affect what surgical options you are offered. For example, with smaller cancers it may be possible to have breast-conserving surgery, where only the cancer and a small area of healthy tissue surrounding it are removed (also called wide local excision or lumpectomy).
If you have a larger cancer (in relation to your breast size), you may be recommended to have a mastectomy or you may be offered the option of having chemotherapy before surgery (called neo-adjuvant or primary chemotherapy). This is given with the aim of shrinking the cancer, which may mean less tissue needs to be removed during surgery.
People with grade 3 invasive breast cancers are more likely to be offered chemotherapy to help destroy any cancer cells that may have spread as a result of the cancer being faster growing.
Treatment during pregnancy and after delivery
The following are treatments that you may be given depending on your trimester and whether you have delivered your baby. If you are near to the end of your pregnancy, your specialist may delay your treatment until after the birth. If you are breastfeeding you will be advised to stop before receiving any treatment.
Many women with breast cancer are given a choice between mastectomy (removal of the breast including the nipple area) and breast-conserving surgery (usually referred to as wide local excision or lumpectomy, the removal of the cancer with a margin (border) of normal breast tissue around it).
During pregnancy you are more likely to be offered a mastectomy. This is because after breast-conserving surgery, radiotherapy is needed whereas not all women who have a mastectomy need radiotherapy and this is not recommended while you are pregnant.
If you are diagnosed in your second trimester and will be having chemotherapy after your surgery, you may also be able to have breast-conserving surgery (if appropriate) instead of a mastectomy. This is because radiotherapy will not usually be given until after your chemotherapy has finished, and after your baby has been born.
Immediate breast reconstruction is generally not offered due to the changes in the breast during pregnancy and to avoid a long time under anaesthetic.
Your doctor will also want to check the lymph nodes under your arm (you may already have had a lymph node biopsy at the time of your diagnosis).They are likely to recommend an operation to remove either some (a lymph node sample or biopsy) or all of them (a lymph node clearance).
Sentinel lymph node biopsy is widely used for people with breast cancer whose tests before surgery show no evidence of the lymph nodes containing cancer cells. This procedure identifies whether or not the first lymph node (or nodes) is clear of cancer cells. If it is, this usually means the other nodes are clear too, so no more will need to be removed.
If the results of the sentinel lymph node biopsy show that the first node (or nodes) are affected it may be recommended you have further surgery to remove some or all of the remaining lymph nodes. This procedure may not be suitable if tests before your operation show that your lymph nodes contain cancer cells. In this case it is likely that your surgeon will recommend a lymph node clearance.
This process uses a radioisotope which does not affect the pregnancy. However, the blue dye that is used alongside the radioisotope to identify the sentinel node is not recommended during pregnancy. Your surgeon will discuss whether sentinel node biopsy is a suitable option for you.
Whichever type of surgery you have, it will involve having a general anaesthetic. This is generally considered safe during pregnancy, but there may be a slightly increased risk of miscarriage, especially early on in the pregnancy.
Certain combinations of chemotherapy can be given during pregnancy. However, chemotherapy should be avoided during the first trimester as it may cause harm to the unborn baby or cause miscarriage. Generally, chemotherapy during the second and third trimesters is safe.
Radiotherapy is not usually recommended at any stage of pregnancy as, even a very low dose, it may carry a risk to the baby. It can be given after the birth.
Source : Breast Cancer Care