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Breast cancer is the most common cancer in women in the UK, affecting one in nine women at some point in their life.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Damage to the DNA of these cells results in uncontrolled cell division and growth, and, eventually, sufficient cells accumulate to form a lump.

The cells invade normal surrounding breast tissue and can break off from the primary lump to spread in lymph channels or the blood stream to other organs where secondary lumps (metastases) may form.

The breast is divided into ducts and lobules. The most common form of breast cancer arises from the ducts and is known as invasive ductal carcinoma. Cancers arising from the lobules (invasive lobular carcinomas) are less common.

As with most cancers, the key to successful treatment is early diagnosis before the cancer has had the chance to spread to other organs.

Causes/Risk Factors

The exact causes of breast cancer have not been clearly identified, but certain risk factors have been identified:

• Getting older – 80 per cent of breast cancer cases are in postmenopausal women – it’s relatively unusual in younger women
• Having a significant family history of breast cancer, which may be associated with inherited gene mutations (see below)
• Having no children or children late in life
• Starting your periods early or going through the menopause late
• Taking hormone replacement therapy (HRT) for a prolonged period
• Being overweight
• Drinking alcohol in excess

A genetic link

Fewer than one in 20 cases of breast cancer is inherited. About one person in 1,000 carries the genes responsible, so if a relative has breast cancer it’s most likely to be by chance. However, you should be more wary if you have:

• A relative who was diagnosed under the age of 40
• A close relative with cancer in both breasts
• A male relative with breast cancer
• Two close relatives on the same side of the family diagnosed with breast cancer under 60 or with ovarian cancer
• Three close relatives diagnosed with breast or ovarian cancer at any age

It may be worth writing out a family health history record, to help you work out patterns of disease that run in the family.

If you’re worried, talk to your GP. You may want to think about genetic screening.

SymptomsBreast cancer may be diagnosed before any symptoms occur through screening. The NHS National Breast Screening Programme provides free screening for breast cancer for all women over the age of 50. If you’re between 50 and 70 you should be routinely invited for a mammogram every three years. Women over 70 are encouraged to make their own appointment.

Otherwise, breast cancer may be diagnosed when a woman develops symptoms that alert her to seek medical advice. All women should practise breast awareness. This involves getting to know what’s normal for your breasts in terms of look and texture, so you can spot any changes and get them checked as soon as possible.

In particular you should look for:

• Lumps or thickening of the tissue
• Discharge from the nipple
• ‘Tethering’ of the skin, as if it’s being pulled from the inside
• Any unusual appearance, sensation or pain

 

Remember, most lumps are harmless, especially if you’re young. But you should still get them checked by a doctor as soon as possible.

How’s the diagnosis confirmed?All patients suspected of having breast cancer must be seen by a hospital specialist within two weeks of an urgent referral by their GP.

Some hospitals run ‘one-stop shops’ for rapid assessment of breast lumps where all the examinations can be done on the spot, often with the results available on the same day.

To make an accurate diagnosis, doctors need to carry out a thorough examination. They’ll take a careful look at the lump itself, possibly using an ultrasound and mammogram.

They may take a sample of tissue using needle aspiration and/or needle biopsy. This is then analysed by a pathologist to assess whether malignant cells are present and confirm the diagnosis of cancer.

The cells may be tested to see if they carry certain receptors, which may influence the treatments offered. If they carry hormone receptors, it suggests they’re sensitive to female sex hormones and hormone therapies are likely to be used in their treatment.

Cells carrying the Her2 receptor may respond to the drug trastuzumab (herceptin), which may be used in the treatment of some Her2 positive cancers.

Treatment/RecoveryThere’s no quick cure for breast cancer – if anyone tries to tell you otherwise, be extremely sceptical. However, there are many effective treatments and the death rate from breast cancer in the UK has been falling for a number of years.

Once a diagnosis of breast cancer is confirmed, the exact treatment used, how soon it’s given and how long it takes all depends on several factors, including:

• The stage of the tumour (how far it has spread) and whether there is secondary cancer
• The receptor status of the breast cancer
• The general fitness of the patient
• The menopausal status of the patient
• The woman’s own wishes

Management of breast cancer is a team effort and a number of specialists may be involved including surgeons, oncologists and breast care nurses.

Other investigations, such as blood tests, chest x-rays and CT scans, may also be done.