Hello. My name is Clive Griffith.
I'm a consultant breast surgeon in Newcastle upon Tyne.
Breast cancer is the commonest cancer to affect females.
Basically, a breast cancer will either arise
from the milk ducts,
which are the tubes that conduct the milk to the nipple,
or alternatively the lobules,
which are the parts of the breast that actually make the milk.
Lobular breast cancer accounts for about 20 per cent of breast cancer,
whereas ductal cancer is about 80 per cent.
About 42,000 women a year get breast cancer in the UK,
so the lifetime risk of any patient in this country
is about one in nine, and we think that the incidence is rising.
The commonest symptom of any patient with breast cancer
is a breast lump, a lump that doesn't go away with your menstrual period,
a lump that increases in size,
a lump that may be associated
with deformity of the skin of the breast over it
or a dimple in the skin.
Nipple discharge, particularly if it's bloodstained, is worrying.
And if there's any abnormality in the shape of the breast,
if it doesn't look the same as the other breast,
we advise people to get it checked out.
Basically, we know that about ten per cent of breast cancer patients
have what's called familial breast cancer,
because of an abnormal gene being passed down through the generations.
If they're in the high risk group, they will be screened regularly
in a family history clinic from the age of 35 onwards.
I have to say that about a third to a half of all breast cancers in the UK
are now picked up in the national breast cancer screening programme.
At the moment the screening age is from 50 to 70,
but shortly it will be dropped to 47 up to 73.
So we're expecting more and more women to be picked up
with much earlier cancers.
There's five treatments: surgery, ie, removal of the primary tumour
either by lumpectomy or mastectomy.
Chemotherapy, which are anticancer drugs given into the bloodstream.
Radiotherapy is using high-energy X-rays
to actually target where the tumour was in the breast,
or to target the armpit in cases where the lymph glands are involved.
The other two treatments are hormone treatment.
We know that most breast cancers are driven by oestrogen,
and if the tumour is oestrogen-receptor positive,
then as a treatment we can give the patient an anti-oestrogen.
So it may well be that a patient will have all of these five treatments.
For a lumpectomy, we try and remove less than ten per cent of the breast volume.
If we can do that, then the cosmetic results are very acceptable.
There are now techniques where if a woman's had a problem
after a lumpectomy with a dimple or a dint in the breast
that the tissue can be replaced
either with a muscle flap or with fat cells.
For a conventional mastectomy,
the patient will be left with a scar on the chest wall,
usually transverse, sometimes oblique,
so that a lot of women think that when they wake up
they're going to look like a boy, with the nipple,
but for a conventional mastectomy the nipple has to be removed
and the patient will be left with a fine scar on the chest wall.
Most breast units in the country
will discuss each patient before they have the surgery,
and one of the questions we ask if a woman is to have a mastectomy,
whether she can have an immediate reconstruction.
Now, the priority in breast cancer treatment
is to treat the cancer.
If we can achieve cosmesis at the same time, that's great,
but it's not always possible,
so sometimes we have to say, "You can have a breast reconstruction
but it will have to be delayed."
But there are an increasing number of patients
where because of the fact that the cancer's been picked up early,
they can have a mastectomy and breast reconstruction at the same time.
But it has to be decided by a panel of experts.
It's got to be an informed decision
so that we're not putting the patient at risk from doing cosmetic surgery
which might delay their cancer treatment.