Breast cancer is the most common cancer in women, with around 45,500 cases being diagnosed every year in the UK. It can develop in the milk-producing glands of the breast (lobular cancer) or the passages that carry the milk to the nipples (ductile cancer). Around one in nine women will develop breast cancer during their lifetime.
We asked consultant breast surgeon Clive Griffith what questions he would want to know the answers to about breast cancer.
What symptoms could indicate breast cancer?
If there’s any abnormality in the shape of the breast or if it doesn’t look the same as the other breast, we advise people to come and get it checked out.
The most common symptom of breast cancer is a breast lump that doesn’t go away with the menstrual period, which increases in size, or may be associated with deformity of the breast. Nipple discharge, particularly if it’s bloodstained, is another symptom.
About a third to half of all breast cancers in the UK are now picked up in the NHS Breast Screening Programme as an abnormality in a mammogram. The screening age (currently 50 to 70) will soon be extended to women between the ages of 47 and 73, so we're expecting to identify more and more women with cancer in the early stages.
What different types of treatment are available?
There are five treatments available:
- Surgery: treatment almost always involves surgical removal of the primary tumour either by lumpectomy (removal of the breast lump) or mastectomy (removal of the whole breast). The best treatment for any cancer is to remove the primary tumour along with some of the surrounding tissue.
- Radiotherapy: high-energy X-rays target the area in the breast where the tumour was or the armpit if the lymph glands are affected.
- Chemotherapy: anti-cancer drugs are given into the bloodstream. When we treat cancer, we treat it on a 'local' level, with surgery and radiotherapy. We also treat it on what’s called a systemic level, so that the treatment gets into the bloodstream. This is so that anywhere a cancer cell could go, the treatment will go.
- Hormone treatment: we know that most breast cancers are encouraged to grow by oestrogen. If the tumour is what we call oestrogen-receptor positive, we can give the patient an anti-oestrogen agent in combination with the other treatments.
- Herceptin: this is a monoclonal antibody (a protein produced by the immune system in response to substances that might threaten the body). It’s a specific chemical that targets a receptor on the cancer cell surface and stops the cancer cell from dividing.
A patient may well have all of these five treatments.
What are the surgical procedures?
Surgery can either be a lumpectomy, where we remove the tumour with some surrounding tissue and preserve the mound of breast tissue, or a mastectomy. A mastectomy involves removal of the whole area of breast tissue plus the skin over the breast, the nipple and the lymph glands that drain the breast.
There are various reasons why still need to do mastectomies, for example if the tumour is large or if the cancer is in lots of different areas in the breast.
If you have a lumpectomy, you would probably go home the day after surgery. The surgery will take an hour or so. If you have a mastectomy, you will probably be able to go home within three to four days.
What are the chances of recovery?
If your prognosis is good, your breast cancer is unlikely to come back. If your breast cancer was picked up early on the NHS Breast Screening Programme, you have a 98% chance of being alive 10 years after your breast cancer treatment.
If you come to a clinic with symptoms of breast cancer or a lump on the breast, the figure drops slightly, but 80% of women who come with a lump in the breast will still be alive 10 years after the breast cancer treatment.
Most recurrences (90%) are either local, where the tumour is in the chest wall, or distant, in another organ such as the lung or liver, and happen within the first five years after treatment. This means that we can tell patients five years after their treatment that the chances of the tumour coming back are now much lower.
Can you give any guidelines about how to lower your risk of breast cancer?
We’ve been able to show that breast cancer is related to lifestyle. Various things increase the risk of breast cancer. Apart from family history, the biggest risk is being overweight. Obesity increases your chance of getting breast cancer by a third.
Drinking excess alcohol increases the risk of breast cancer. This is not sociable drinking but drinking to excess.
