Female Breast Cancer

Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should also see a GP if you notice any of these symptoms:

  • a change in the size or shape of one or both breasts
  • discharge from either of your nipples, which may be streaked with blood
  • a lump or swelling in either of your armpits
  • dimpling on the skin of your breasts
  • a rash on or around your nipple
  • a change in the appearance of your nipple, such as becoming sunken into your breast

Breast pain is not usually a symptom of breast cancer.

Causes of breast cancer

The exact causes of breast cancer are not fully understood. However, there are certain factors known to increase the risk of breast cancer.

These include:

  • age – the risk increases as you get older
  • a family history of breast cancer
  • a previous diagnosis of breast cancer
  • a previous non-cancerous (benign) breast lump
  • being tall, overweight or obese
  • drinking alcohol

Diagnosing breast cancer

After examining your breasts, a GP may refer you to a specialist breast cancer clinic for further tests. This might include breast screening (mammography) or taking a small sample of breast tissue to be examined under a microscope (a biopsy).

Types of breast cancer

There are several different types of breast cancer, which develop in different parts of the breast.

Breast cancer is often divided into either:

  • non-invasive breast cancer (carcinoma in situ) – found in the ducts of the breast (ductal carcinoma in situ, or DCIS) which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
  • invasive breast cancer – where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.

Other, less common types of breast cancer include:

  • invasive (and pre-invasive) lobular breast cancer
  • inflammatory breast cancer
  • Paget’s disease of the breast

It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland.

If this happens, it’s known as secondary, or metastatic, breast cancer.

Breast cancer screening

Mammographic screening, where X-ray images of the breast are taken, is the most commonly available way of finding a change in your breast tissue (lesion) at an early stage.

However, you should be aware that a mammogram might fail to detect some breast cancers.

It might also increase your chances of having extra tests and interventions, including surgery, even if you’re not affected by breast cancer.

Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50 to 70 years old are invited for breast cancer screening every 3 years.

Women over the age of 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47 to 73.

Treating breast cancer

If cancer is detected at an early stage, it can be treated before it spreads to other parts of the body.

Breast cancer is treated using a combination of:

  • surgery
  • chemotherapy
  • radiotherapy

Surgery is usually the first type of treatment you’ll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatments.

The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor should discuss the best treatment plan with you.

In a small proportion of women, breast cancer is discovered after it’s spread to other parts of the body (metastatic breast cancer).

Secondary cancer, also called advanced or metastatic cancer, is not curable, so the aim of treatment is to relieve symptoms.

Living with breast cancer

Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.

How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.

Forms of support may include:

  • family and friends, who can be a powerful support system
  • communicating with other people in the same situation
  • finding out as much as possible about your condition
  • not trying to do too much or overexerting yourself
  • making time for yourself

Preventing breast cancer

As the causes of breast cancer are not fully understood, at the moment it’s not possible to know if it can be prevented.

If you have an increased risk of developing the condition, some treatments are available to reduce your risk.

Studies have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who:

  • maintain a healthy weight
  • exercise regularly
  • have a low intake of saturated fat
  • do not drink alcohol

It’s been suggested that regular exercise can reduce your risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer. 

If you’ve been through the menopause, it’s particularly important that you try to get to, and maintain, a healthy weight.

This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should see a GP if you notice any of the following:a new lump or area of thickened tissue in either breast that was not there beforea change in the size or shape of one or both breastsa discharge of fluid from either of your nipples, a lump or swelling in either of your armpits a change in the look or feel of your skin, such as puckering or dimpling, a rash or rednessa rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple, a change in the appearance of your nipple, such as becoming sunken into your breast.

Breast pain is not usually a symptom of breast cancer.

The causes of breast cancer are not fully understood, making it difficult to say why one woman may develop breast cancer and another may not.However, there are risk factors known to affect your likelihood of developing breast cancer. Some of these you cannot do anything about, but there are some you can change.

Age

The risk of developing breast cancer increases with age. The condition is most common in women over age 50 who have been through the menopause.

About 8 out of 10 cases of breast cancer happen in women over 50.All women who are 50 to 70 years of age should be screened for breast cancer every 3 years as part of the NHS Breast Screening Programme.

Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit.Find out more about breast screening.

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer.However, because breast cancer is the most common cancer in women, it’s possible for it to occur in more than one family member by chance.

Most cases of breast cancer do not run in families, but genes known as BRCA1 and BRCA2 can increase your risk of developing both breast and ovarian cancer. It’s possible for these genes to be passed on from a parent to their child. The genes TP53 and CHEK2, are also associated with an increased risk of breast cancer.

Speak to a GP if breast or ovarian cancer runs in your family and you’re worried you may get it too. They may refer you for an NHS genetic test, which will tell you if you have inherited one of the cancer-risk genes.

Find out more about predictive genetic tests for cancer-risk genes.

Previous breast cancer or lump, If you have previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast.

A benign breast lump does not mean you have breast cancer, but certain types of breast lumps may slightly increase your risk of developing cancer. Some benign changes in your breast tissue, such as cells growing abnormally in ducts (atypical ductal hyperplasia), or abnormal cells inside your breast lobes (lobular carcinoma in situ), can make getting breast cancer more likely.

Dense breast tissue

Your breasts are made up of thousands of tiny glands (lobules) that produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser.

Women with dense breast tissue may have a higher risk of developing breast cancer as there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) difficult to read, as any lumps or areas of abnormal tissue are harder to see.Younger women tend to have denser breasts.

As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.Hormones and hormone medicine.

Exposure to oestrogen.

The female hormone oestrogen can sometimes stimulate breast cancer cells and cause them to grow.The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty, to regulate your periods.Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to.For example, if you started having periods at a young age and experienced the menopause later than average, you will have been exposed to oestrogen over a longer period of time.In the same way, not having children or having children later in life may slightly increase your risk of developing breast cancer because your exposure to oestrogen is not interrupted by pregnancy.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with an increased risk of developing breast cancer.All types of HRT can increase the risk of breast cancer, except for vaginal oestrogen.There is no increased risk of breast cancer if you take HRT for less than 1 year.But if you take HRT for longer than 1 year, you have a higher risk of breast cancer than women who never use HRT.The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.Find out more about the risks of HRT.

Contraceptive pill

Research shows that women who take the contraceptive pill have a slightly increased risk of developing breast cancer.However, the risk starts to decrease once you stop taking the pill, and your risk of breast cancer is back to normal 10 years after stopping.

Lifestyle factors

Being overweight or obeseIf you have experienced the menopause and are overweight or obese, you may be more at risk of developing breast cancer.This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Alcohol

Drinking alcohol increases the risk of getting breast cancer.People who drink even small amounts of alcohol on a regular basis have a greater risk of getting breast cancer than people who do not drink alcohol at all. The more alcohol you drink, the more your risk of getting breast cancer increases.

Radiation

Certain medical procedures that use radiation, such as X-rays and CT scans, may slightly increase your risk of developing breast cancer.If you had radiotherapy to your chest area for Hodgkin lymphoma you should have already received a letter from the Department of Health and Social Care inviting you for a consultation with a specialist to discuss your increased risk of developing breast cancer.See your GP if you were not contacted or if you did not attend a consultation. You’re usually entitled to have your breast checked with an MRI scan.If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

You may be diagnosed with breast cancer after routine breast screening, or you may have symptoms that you’ve seen your GP about.

Seeing a GP

See a GP as soon as possible if you notice any symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts.The GP will examine you. If they think your symptoms need further assessment, they’ll refer you to a specialist breast cancer clinic.

Tests at a breast cancer clinic

If you have suspected breast cancer, either because of your symptoms or because a mammogram has shown an abnormality, you’ll be referred to a specialist breast cancer clinic for further tests

Mammogram and breast ultrasound

If you have symptoms and have been referred to a specialist breast unit by a GP, you’ll probably be invited to have a mammogram, which is an X-ray of your breasts. You may also need an ultrasound scan.If cancer was detected through the NHS Breast Screening Programme, you may need another mammogram or ultrasound scan.Your doctor may suggest that you only have a breast ultrasound scan if you’re under the age of 35. This is because younger women have denser breasts, which means a mammogram is not as effective as ultrasound in detecting cancer.Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities.Your breast specialist may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Biopsy

A biopsy is where a sample of cells is taken from your breast and tested to see if it’s cancerous.You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected.Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition. 

Needle aspiration

Needle aspiration may be used to test a sample of your breast cells for cancer or drain a small fluid-filled lump (benign cyst).Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

Needle biopsy

Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle.You may have a local anaesthetic, which means you’ll be awake during the procedure, but your breast will be numb.Your doctor may suggest that you have a guided needle biopsy, usually guided by ultrasound or X-ray, or sometimes MRI, to obtain a more precise and reliable diagnosis of cancer.This can also distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS).

Vacuum-assisted biopsy

Vacuum-assisted biopsy, also known as mammotome biopsy, is another type of biopsy.During the procedure, a needle is attached to a gentle suction tube, which helps to obtain the sample and clear any bleeding from the area.

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