Breast cancer

 Breast cancer

What are the facts about breast cancer in women?

 About 1 in 10 to 15 women (1 in 10 in Australia) develops breast cancer. Breast cancer is uncommon under the age of 30 but it then steadily increases to a maximum at the age of about 60 years, being most common over 50 years. 

Most cases start in the milk ducts and at first remain localised to the breast, where it is referred to as ‘cancer in situ’. If the tumour grows to about 25 mm, cells can break off and spread (metastasise) via the bloodstream and the lymphatic system to parts of the body such as the liver, lung and bones. 

Most breast cancers are found when they are ‘invasive’. Note: Very rarely breast cancer can develop in men. 

What are the symptoms? 

The majority of people with breast cancer present with a breast lump, most commonly in the upper, outer part towards the armpit. Other symptoms are: • a lump that is usually painless (16% are painful) • a hard and irregular lump • change in breast shape • puckering or dimpling of overlying skin • nipple changes: inverted (turned in) or discharge. It is unusual for the lump to be a noticeable bulge. Diagnosis is confirmed by a biopsy and imaging (ultrasound and mammography). 

What are the risk factors? 

• Increasing age (over 40 years) • Heredity—a strong family history • Caucasian race • Previous history of breast cancer • Hormone replacement therapy, especially longer than 5 years • Using the oral contraceptive pill • Increased alcohol intake • Obesity including heavy postmenopausal weight gain • Early age at first period • Later age at menopause (55 years or older) • Childlessness or having children after 30 • Ionising radiation exposure

 What are the hereditary factors? 

About 1 in 20 breast cancers are caused by specific genes (the BRCA 1 and 2 genes) that can be inherited. Those with a strong family history can be tested for the genes in a familial cancer clinic. 

What is the treatment?

 The treatment depends on several factors including the size, type and nature of the cancer and the age, health and personal preference of the patient. The options include surgery, chemotherapy, radiotherapy and hormone treatment, usually a combination of two or more of these. The first-line treatment is usually an operation to remove the cancer, surrounding breast tissue and possibly adjacent lymph glands. 

 The main surgical options are: 

• Breast-conserving surgery—‘lumpectomy’ or partial mastectomy—where a smaller operation for a smaller tumour removes the cancer and some of the surrounding breast tissue. 

• Mastectomy—removal of the entire breast with lymph glands from the armpit. This is the surgery of choice for a large tumour. 

Since the cancer cells first spread to the nearby lymph glands in the armpit, it is usual to remove these or at least have radiotherapy to this area. It is also standard to follow surgery for proven cancer with chemotherapy, radiotherapy or antihormone therapy (e.g. tamoxifen) depending on the pathology report and advice of the specialist. 

Breast implants and reconstruction

 Available options for cosmetic reasons include breast forms or prostheses to wear inside the bra, breast implants such as saline-filled devices and breast reconstruction using f laps of skin and muscle. These are often used following a mastectomy. 

What is the outlook?

 The results of treatment continue to improve. The 5-year survival rate is now just over 80%.

 Breast cancer screening

 It is recommended that women have screening mammography between 50 and 70 years, at least every 2 years. 

Key points

 • Breast cancer affects 1 in 10 Australian women.

 • The chances of cure are good. • Breast cancer support groups are helpful. • Treatment options include surgery (total or partial mastectomy), radiotherapy, chemotherapy and hormone therapy.