Before discussing breast cancer, it's important to be familiar with the anatomy of the breast. The normal breast consists of milk-producing glands that are connected to the surface of the skin at the nipple by narrow ducts. The glands and ducts are supported by connective tissue made up of fat and fibrous material. Blood vessels, nerves, and lymphatic channels to the lymph nodes make up most of the rest of the breast tissue. This breast anatomy sits under the skin and on top of the chest muscles.
As in all forms of cancer, the abnormal tissue that makes up breast cancer is the patient's own cells that have multiplied uncontrollably. Those cells may also travel to locations in the body where they are not normally found. When that happens, the cancer is called metastatic.
Breast Cancer develops in the breast tissue, primarily in the milk ducts (ductal carcinoma ) or glands (lobular carcinoma ). The cancer is still called and treated as breast cancer even if it is first discovered after the cells have travelled to other areas of the body. In those cases, the cancer is referred to as metastatic or advanced breast cancer.
Cells in the body normally divide (reproduce) only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumour. If the cells that are growing out of control are more normal cells, the tumour is called benign (not cancerous). If, however, the cells that are growing out of control are abnormal, don't function like the body's normal cells, and begin to invade other tissue, the tumour is called malignant (cancerous).
Cancers are typically named after the part of the body from which they originate. Breast Cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumours, a process called metastasis.
Every year nearly 60,000 people are diagnosed with breast cancer in the UK, that’s the equivalent of one person every 10 minutes 1 in 8 women in the UK will develop breast cancer in their lifetime
Breast cancer is the most common cancer in women in the UK
Nearly 12,000 people die from breast cancer in the UK every year,more than eight out of 10 (85%) people survive breast cancer beyond five years
Breast cancer also affects men, but it’s rare – around 340 men are diagnosed each year.
1. Gender - being a woman is the biggest risk factor for developing breast cancer.
2. Getting older - the older the person the higher the risk, more than 80% of breast cancers occur in women over the
age of 50. Most men who get breast cancer are over 60.
3. Significant family history – this isn’t common, around 5% of people diagnosed with breast cancer have inherited a faulty BRCA1 or BRCA2 gene.
There’s no right or wrong way to check your breasts for any changes. Try to get used to looking at and feeling your breasts regularly. You can do this in the bath or shower, when you use body lotion, or when you get dressed. There’s really no need to change your everyday routine. Just decide what you are comfortable with and what suits you best.
Remember to check all parts of your breast, your armpits and up to your collarbone.
Everyone’s breasts look and feel different.
Some people have lumpy breasts, or one breast larger than the other, or breasts that are different shapes. Some have one or both nipples pulled in (inverted), which can be there from birth or happen when the breasts are developing.
When you check your breasts, try to be aware of any changes that are different for you.>
Most breast changes are likely to be normal or due to a benign (not cancer) breast condition. Some benign breast conditions may cause problems and need treatment, but this is not always the case. However, if you notice any change that’s unusual for you, it is important to visit your GP.
Men can also develop benign breast conditions and the most common benign condition in men is gynaecomastia.
Mammography is useful for finding early changes in the breast, when it may be difficult to feel a lump. It isn't as helpful in younger women though. If you are under 35, your specialist is likely to suggest that you have an ultrasound instead of a mammogram. Mammography is possible in women who have had breast implants but may take a little longer.
Mammography can be uncomfortable because the breasts are put between two metal plates and a little pressure is applied. But most women describe this as mild to moderate discomfort. It only lasts a few minutes. The pressure doesn't harm the breasts.
Women who think they're too old to worry about mammograms may want to reconsider the age at which their breast cancer screening years are behind them, a new study suggests.
Based on an analysis of nearly 7 million mammograms over a seven-year period, "the benefit continues with increasing age up until 90," said study author Dr. Cindy Lee. She is an assistant professor in residence at the University of California, San Francisco.
The question of when to stop having mammograms has been widely debated. In 2009, the U.S. Preventive Services Task Force issued new guidelines, saying there wasn't enough evidence to assess the balance of benefits and harms of screening mammography in women aged 75 and older.
Lee and her colleagues looked at patient age, mammogram results, recall rates for more testing, biopsy referrals and biopsy results. The investigators also looked at the percentage of breast cancers found when a biopsy was recommended or performed. Ideally, Lee explained, screening should result in a higher cancer detection rate and a low recall rate.
In the analysis, which included data from 39 states from 2008 through 2014, nearly four breast cancers were found for every 1,000 patients screened. The recall rate was 10 percent.
"We are finding more cancers with increasing age," Lee said, which makes sense because the risk rises with age. "We are doing better at catching them," she said. And, "we have decreased the recall rate. We are calling back fewer women for additional testing, but are finding more cancers."
The study authors concluded that "there is no clear age cut-off point" to determine when to stop screening.
Ultrasound scans use sound waves to make a picture of the inside of the body. Breast ultrasound is painless and takes just a few minutes. It is usually used for women under 35 whose breasts are too dense or solid to give a clear picture with mammograms. You may also have an ultrasound if you have a lump in the breast that doesn't show up on the mammogram.
Ultrasound can also show if a breast lump is solid, or if it contains fluid. A fluid filled lump is called a cyst.
A biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn't normal.
Doctors may call an area of abnormal tissue a lesion, a tumour, or a mass. These are general words used to emphasise the unknown nature of the tissue. The suspicious area may be noticed during a physical examination or internally on an imaging test.
Biopsies are most often done to look for cancer. But biopsies can help identify many other conditions.
A biopsy might be recommended whenever there is an important medical question the biopsy could help answer. Here are just a few examples:
In some cases, a biopsy of normal-appearing tissue may be done. This can help check for cancer spread or rejection of a transplanted organ.
In most cases, a biopsy is done to diagnose a problem or to help determine the best therapy option.
There are many different kinds of biopsies. Nearly all of them involve using a sharp tool to remove a small amount of tissue. If the biopsy will be on the skin or other sensitive area, numbing medicine is applied first.
Needle biopsy is also called a core biopsy or Tru Cut biopsy. You usually have this test under a local anaesthetic. The anaesthetic numbs the area and allows the doctor to take a core of tissue from the lump using a needle that is the same thickness as a pencil lead. In this type of biopsy the pathologist can see the cells in place within the piece of breast tissue that has been removed. So it is possible to tell a non invasive cancer (DCIS) from invasive breast cancer with this test. It can also show how abnormal the cancer cells are (the grade) and whether they have receptors for hormones or particular treatments.
Sometimes you may have this test while lying on your front or during a mammogram.
After giving you a local anaesthetic, the surgeon makes a small cut in your breast tissue. Guided by an ultrasound or X-ray, the surgeon uses a small vacuum assisted probe to take a biopsy from the suspicious area. This type of biopsy removes a slightly larger sample of breast tissue than a needle biopsy. It can sometimes cause quite a lot of bruising. It is sometimes called Mammotome biopsy or or MIBB, which stands for Minimally Invasive Breast Biopsy.
A punch biopsy is when the doctor removes a small circle of skin tissue to biopsy. You might have this type of biopsy if your doctor thinks you could have inflammatory breast cancer or Paget's disease of the nipple.
Excision biopsy is also called a surgical biopsy. In this biopsy, you have a minor operation to remove the whole lump under local anaesthetic or general anaesthetic. Many hospitals do this type of biopsy as a day case. In others, you may need to stay in hospital overnight.
A wire guided biopsy is also called a wire localisation. Doctors usually use this technique if you have calcium specks showing up on your mammogram, but no clear lump. In these cases, the surgeon can't really see or feel which area needs to be removed. So during a mammogram or ultrasound, the doctor puts a fine wire into the area containing the calcium specks. The doctor makes sure the tip of the wire is right in the centre of the abnormal area and then secures the wire firmly.
The wire stays in until you have your biopsy, which is usually the same day but may be the next day. Your surgeon knows that where the wire ends is where they need to take a biopsy of the tissue.
The tests used to diagnose your cancer give information about its stage and grade. Knowing the stage and grade is important for helping the doctors decide which treatments you need. The stage of your breast cancer means how big it is and whether it has spread. Grade means what the cancer cells look like under the microscope.
Breast cancers can be:
Low grade cancers tend to grow more slowly than high grade. High grade cancers are more likely to come back after they have first been treated. But the grade can only give a guide to how any individual cancer will behave and individual cancers may behave differentSTAGE 1
Find out about stage 1 breast cancer and the treatment options.
Stage 1 breast cancer means that the cancer is small and only in the breast tissue or it might be found in lymph nodes close to the breast.
It is an early stage breast cancer.
Stage 1 breast cancer has 2 groups.
Stage 1A means that the tumour is 2 centimetres (cm) or smaller and has not spread outside the breast
Stage 1B means that small areas of breast cancer cells are found in the lymph nodes close to the breast and that:
The TNM staging system stands for Tumour, Node, Metastasis.
In the TNM staging system stage 1A breast cancer is the same as:
Stage 1B is the same as:
Find out what stage 2 breast cancer means and about treatment options.
Stage 2 breast cancer means that the cancer is either in the breast or in the nearby lymph nodes or both.
It is an early stage breast cancer.
Stage 2 breast cancer has two groups.
Stage 2A means one of the following:
Stage 2B means one of the following:
Find out what stage 3 breast cancer is and about treatment options.
Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.
It is also called locally advanced breast cancer.
Stage 3 breast cancer is divided into 3 groups.
Stage 3A means one of the following:
Stage 3B means:
1. The tumour has spread to the skin of the breast or the chest wall (the structures surrounding and protecting the lungs, such as the ribs, muscles, skin or connective tissues). It has made the skin break down (an ulcer) or caused swelling.
Stage 3C means:
1. The tumour can be any size, or there may be no tumour, but there is cancer in the skin of the breast causing swelling or an ulcer and it has spread to the chest wall.
It has also spread to:
Find out what stage 4 breast cancer means and about treatment options.
Stage 4 breast cancer means that the cancer has spread to other parts of the body.
It is also called advanced cancer, secondary breast cancer or metastatic breast cancer.
In stage 4 breast cancer:
Your specialist in the breast clinic or your breast surgeon will send your breast cancer cells for tests to see if they have hormone receptors or biological therapy receptors. They call this receptor status.
Oestrogen is a female sex hormone. It stimulates some breast cancers to grow by triggering particular proteins (receptors) in the cancer cells. If your breast cancer cells have oestrogen receptors, the cancer is said to be ER positive.
About two thirds of women with breast cancer have hormone positive cancers. Hormone therapies that can stop oestrogen from stimulating the cells to divide and grow work well for ER positive breast cancers. Your doctor may recommend hormone therapy to shrink a tumour before surgery.
More often they will recommend hormone therapy after surgery, to reduce the chance of the cancer coming back.
Testing for particular proteins can help to show whether biological therapies may work as a treatment for your breast cancer. For example, the drug trastuzumab (Herceptin) is only likely to work if your breast cancer cells have a lot of Her2 protein.
You may see this written as HER2neu or erbB2. Her2 protein is on the cell surface of up to 1 in 4 early breast cancers.
Herceptin attaches to the Her2 protein. If your breast cancer cells don't have this protein, Herceptin won't work.
Most people begin their breast cancer treatment with surgery. There are different types of surgery for breast cancer. Your doctor may offer you a choice about your treatment.
Depending on the size and position of the tumour, you may be able to have just the cancerous lump removed with a border of normal breast tissue (a wide local excision or lumpectomy) plus several weeks of radiotherapy to the rest of the breast. Or you may prefer to have the whole breast removed (mastectomy) and perhaps have a breast reconstruction. To help you decide, you may want to consider:
There are no right and wrong answers to most treatment decisions. Women each feel very differently. Some women want to keep their breast if at all possible, so they choose a lumpectomy (wide local excision) and radiotherapy. Other women feel that once they have breast cancer they would rather have the whole breast removed and they may then have a new breast made.
Some women feel strongly that they don't want radiotherapy. Others welcome it if it means keeping their breast. The most important thing is to take time to find out how you feel and make the right decision for you.
For some women the position of the cancer within the breast or its size may mean that they don't have a choice of treatment. If the cancer is quite big, or right in the centre of the breast, the only option may be to remove the whole breast. But reconstruction is usually possible.
The type and timing of reconstruction may depend on the need for further treatment such as chemotherapy or radiotherapy.
Remember that you don't have to make a decision about treatment straight away. You can say to your specialist that you need some time to think over your options. You can then discuss the issues with family or friends, or reflect on your own about how you feel. Before making a decision you can also ask your specialist or breast cancer nurse more questions about the different treatments if you need to.
There is detailed information about these treatments in the sections about surgery for breast cancer and radiotherapy for breast cancer.
Breast reconstruction is an operation to make a new breast shape after having a breast removed.
Or it can be an operation to fill in an area where a large lump was removed from the breast.
If you have a mastectomy, you can usually choose whether you would like breast reconstruction at the time of the mastectomy or during a later operation (delayed reconstruction).
You may have chemotherapy or hormone therapy before or after your surgery and radiotherapy.
Cancer treatment before surgery is called neo adjuvant treatment. You may have chemotherapy or hormone therapy before surgery for large tumours or locally advanced breast cancer to try to make the cancer smaller and easier to remove.
Chemotherapy or hormone therapy can often help to shrink the cancer in the breast. Hormone therapy is only used if you have oestrogen receptor positive breast cancer. It will usually be obvious how well the treatment is going to work within 6 to 12 weeks of starting it.
Chemotherapy or hormone therapy after surgery is called adjuvant treatment. It helps to lower the chance of the cancer coming back. The type of treatment you have depends on:
Current national guidelines for early breast cancer treatment recommend that you should have hormone therapy after surgery if your breast cancer has oestrogen receptors (ER positive). Younger women who are ER positive may have chemotherapy as well as hormone therapy.
Women who have a small cancer with a low risk of it coming back might not need to have chemotherapy.
It depends on how much the chemotherapy is likely to help and the person's general health.
When you are first diagnosed
Cancer treatment can sometimes seem very complicated. As there are quite a few different ways of treating breast cancer. And it can seem even more confusing if other people you meet are having different treatments.
It is important to remember that other people will have different circumstances to you, they may:
Don’t be afraid to ask your doctor or nurse if something is puzzling you. It can help to take notes when you talk to people about your treatment. Or you can ask to record the conversation so that you don't forget what your doctor or specialist nurse says.
If you still don't understand, do ask again. No one will think it strange that you want to ask a lot of questions about your treatment.>
Your reaction can be affected by many things such as where you are at the time, how much you know about breast cancer, who tells you and how prepared you are for the news. Your partner’s reaction to being diagnosed can also influence your feelings.
However you react, actually hearing that your partner has breast cancer can be very tough to deal with. You may not feel prepared for their response, or your own, and be worried about what to say or how to comfort them.
Many people talk about feeling shock, disbelief, anger and fear. You may feel you are in emotional turmoil, with all sorts of questions running through your mind about what will happen to your partner and what impact their breast cancer will have on your life.
For many people, the immediate response is to put on a brave face and be strong for your partner. This shows to the outside world that you are loyal, but it can also mean that you avoid facing your own feelings. Although you may believe that you are taking control of the situation, your own emotions and needs can be ignored.
Focusing all your attention on your partner may also lead them to feel over-protected and stifled. Allowing yourself and your partner space when it’s needed can help you both gather your thoughts and be better prepared as they go through treatment.
Understanding your partner’s reaction to their diagnosis may help the way you both cope. Like you, your partner may have days when they feel positive and others feeling devastated and frightened. You may both experience very similar emotions, but not necessarily at the same time.
Sometimes your partner may seem filled with negative feelings about their diagnosis and worry about how it will affect your relationship. They may seem unable to focus on you or anyone else and you may feel for a while that your own needs are being neglected. Underneath, however, your partner may fear your rejection, but find it easier to withdraw than risk being hurt.
The ability to talk and listen to each other in a meaningful way is an important part of any successful relationship. You may feel that after finding out your partner has breast cancer, the things you talked about before start to seem irrelevant or less important, and everyday conversation changes.
Often being able to talk comes down to finding the time and space to do so. It can help to set aside an hour or so when you are both able to talk undisturbed in a place you both feel at ease. Don’t be afraid to open the conversation and try to gauge how much your partner wants to talk. There may be questions you want to ask about how they are feeling and what you can do to help. You may find that you can open up and talk to each other comfortably. However, if you sense that your partner is tense, don’t bombard them with questions. Instead ease them gently into the conversation. Remember it’s very hard to discuss everything at one time so try to be patient.
You may feel there is also a time not to talk. Talking with a friend may help you to get your thoughts clearer, making it easier to talk to your partner.
Talking openly can be difficult. If you and your partner want to seek relationship counselling either together or separately, you can contact an organisation like Relate(link is external).
Although you may feel like you need to have all the perfect responses for your partner, simply offering to listen can be just as supportive and reassuring. It can be distressing to listen to your partner when they are feeling very low, and you may be tempted to move the conversation on to something lighter. However, really listening to your partner can be good for both of you. Try not to feel the pressure to ‘fix the problem’ – you may not be able to. If your partner feels that they are able to talk freely, they will be more open to listening and this can help you both to talk and listen to each other.
There are other ways to show your partner that you care. Physical affection, for example a kiss or a hug, can offer a great deal of comfort and give you both a real sense of togetherness, with reassurance that you are there for each other. Going away together for a weekend and enjoying each other’s company in different surroundings can also strengthen the bond between you. Even simple gestures such as tidying the house, washing up or making breakfast can speak volumes without using words.>
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