Breast cancer is a form of cancer that develops from breast tissue.
The female sex has a higher risk factor of developing breast cancer. Other risk factors may include :
- Older age
- Family history
- Obesity
- Ionizing radiation
- Drinking alcohol
- Lack of physical exercise
- Early age at first menstruation
- Having children late or not at all
- Hormone replacement therapy during menopause
Breast cancer can occur as a result of genes inherited from a patient’s parents. Research shows that 5-10% of cases can be the result of genes passed down from parents, the most common of this is BRCA 1 and BRCA 2.
Breast cancer may present itself in the form of a lump in the breast, a red scaly patch of skin, alteration in the shape of a breast, dimpling of the skin, or excretion of fluid from the nipple. In some patients, especially for those with experiencing a distant spread of the disease, bone pain, yellow skin, shortness of breath, and swollen lymph nodes may be observed.
Often, breast cancer develops in cells from the lining of milk ducts (known as ductal carcinomas) and also in the lobules supplying the ducts with milk (known as lobular carcinomas).
From case history of patients, there are more than 18 confirmed sub-types of breast cancer. Some cancers, such as ductal carcinoma in situ, develop from pre-invasive lesions.
How is breast cancer diagnosed?
Breast cancer is usually diagnosed in 2 settings.
Screening
It is recommended that asymptomatic women between the ages of 50-70 have screening mammography every 2 years. These mammograms are designed to detect breast cancers early, before the woman becomes symptomatic. In patients with dense breasts, an Automated Breast Ultrasound (ABUS) or MRI may be required.
Lump
When a woman detects a breast lump, this is investigated with a combination of clinical assessment, radiological imaging and biopsy. The doctor will clinically assess the risk of a lump being a cancer with a history and investigation. This will then be followed by a mammogram and ultrasound, and if there was a suspicion of breast cancer, a biopsy would be undertaken, either in the form of a needle or a minor operation.
Is there anything I can do to prevent breast cancer?
In general, for the woman with a normal risk of breast cancer, simple measures like a healthy lifestyle – good diet, weight control, minimising smoking, may be of benefit. If you’re on hormone replacement therapy (HRT), speak to your GP about using it only for as long as you need it.
For those at high risk of developing breast cancer, certain medications such as tamoxifen and raloxifene may be used to reduce the chances of occurrence. These carry their own risks and side-effects, so are used selectively. Surgically removing both breasts is also an option for high risk women who have a family history of the cancer.
What treatment can I expect if I’m diagnosed with breast cancer?
Treatment is tailored individually to suit the patient and may involve a combination of surgery, radiotherapy, chemotherapy, endocrine therapy and targeted immunotherapy.
Surgery involves removing the cancer from the breast and in most patients, breast conservation surgery is an option. There will also be a component of axillary surgery to assess and treat the possibility of cancer spreading to the lymph nodes in the axillary region (armpit).
In general, radiotherapy is offered to most patients having breast conservation surgery. Chemotherapy is usually included in the treatment plan if the benefits of the chemotherapy outweigh any risks and side effects that it may pose, usually in patients with more advance disease (Stage III and IV)
Endocrine treatment is based on depriving breast tissue of oestrogen, thereby reducing the risk of a cancer recurring or a new one emerging. Targeted immunotherapy, in Australia, is given in conjunction with chemotherapy.
What happens after?
Long term follow-up will usually be performed by the treating surgeon.
The risk of the cancer recurring is highest in the first 2 years, so the patient will be seen 6 monthly during that time. After this, an annual review is safe and sufficient.
As part of the review, a mammogram will be organise annually, to start a year after surgery.