Breast Cancer

Presentation by Dr Mafunga

Breast cancer in the UK

• Breast cancer is the second most common cancer in women.

• Around 1 in 9 women will develop breast cancer

• It most commonly affects women over the age of 50 years, rare before the age of 35

• 45,972 people were diagnosed with breast cancer in 2007, of whom over 99% were women

• 15,000 deaths per year

• one percent of all breast cancer occurs in men

What does a normal breast look like

•lobules – glandular tissue ( make milk after pregnancy)

•ducts - take milk from the lobules to the nipple.

•fatty tissue and supporting connective tissue.

•blood vessels, lymph channels and nerves

• Many women find that their breasts become more lumpy and tender before periods.

• Breasts also alter their size and shape with increasing age, pregnancy, and with marked weight changes.

• What is important is that you get to know your own breasts - how they look and feel - and report any changes promptly to a doctor

What is cancer?

Cancer is a disease of the cells in the body. Cancer cells are abnormal and multiply out of control.

A malignant tumour is a lump of cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage.

Malignant tumours may also spread to other parts of the body via the bloodstream or lymph nodes and form secondary tumours (metastases)

Invasive or in situ?

• Most breast cancers are diagnosed when a tumour has grown from

within a duct or lobule into the surrounding breast tissue. These are

called invasive breast cancers.

• Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. These are called carcinoma in situ, as no cancer cells have grown out from their original site.

• These are the most common of non invasive breast cancer and are easier to treat

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What causes breast cancer

• The exact reason why a cell becomes cancerous is unclear.

• It is thought that something damages or alters certain genes in the cell.

This makes the cell abnormal and multiply out of control.

Risk factors for breast cancer

• Age -risk doubles every 10 years of age

• Where you live- this may reflect genetic or environmental factors.

• Family history- close relatives who have or have had breast cancer < 50 years when diagnosed.

• If you have had a previous breast cancer.

• Being childless, or if you had your first child after the age of thirty.

• Not having breast-fed your children.

Risk factors for breast cancer

• Early age of starting periods.

• Chest being exposed to radiation.

• Having a menopause over the age of 55.

• Taking continuous combined hormone replacement therapy (HRT) for several years (in women over 50 years), leading to a slightly increased risk.

• Excess alcohol

Family history and genetic testing

• About 1 in 20 cases of breast cancer are caused by a faulty gene which can be inherited.

• The genes BRCA1 and BRCA2 are the most common faulty genes

• See your doctor if strong family history

What are the symptoms of breast cancer

• a painless lump in the breast Note: most breast lumps are not cancerous, mostly (cysts or

fibroadenomas (a clumping of glandular tissue) which are benign.

• Changes in the size or shape of a breast.

• Dimpling or thickening of some of the skin on a part of a breast.

• The nipple becoming inverted (turning in).

• A discharge occurring from a nipple (which may be bloodstained).

• A rare type of breast cancer, causing a rash around the nipple, which can look similar to a small patch of eczema.

• Pain in a breast. Note: pain is not a usual early symptom. Many women develop painful breasts (mastalgia) and this is not usually caused by cancer.

So what happens if find you lump

• Go to the doctor- (examination of breasts and armpits)

• You will normally be referred to a specialist. The following tests are usually done:

• Mammogram-This is a special X-ray of the breast tissue.

• Ultrasound sound of the breast.

• MRI scan of the breast. This is more commonly performed on younger women, who may have denser breast tissue.

• Biopsy- to confirm the diagnosis

• Staging to assess extent of disease

Treatment of breast cancer

• Surgery

• Chemotherapy

• Radiotherapy

• Hormone treatment

• Often a combination of two or more of these treatments is used.

Surgery

Radiotherapy

• Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.

For breast cancer, radiotherapy is mainly used in addition to surgery- adjuvant radiotherapy

Hormones

• Some types of breast cancer are affected by the female hormones oestrogen and progesterone.

• These hormones stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer. 

An example is

It works by blocking the oestrogen from working on cells. It is usually

taken for five years

Who has breast screening

• all women aged 50-70 years in the UK are offered a routine breast screening test every three years. (The government is planning to extend the age range for routine breast screening from age 47 to 73 by 2012.

• If you are under the age of 50 (or 47 from 2012), routine breast screening is not currently available unless:

-You have had breast cancer in the past.

-You have a first-degree relative (mother or sister) who has had breast cancer at a young age.

-You are known to have a gene which makes you more prone to breast cancer

How is breast screening done

Does breast screening save lives?

• Research studies have shown that breast screening has significantly reduced the number of deaths from breast cancer by 35% in women who are screened regularly with mammography. 

Statistics also show that the NHS Breast Screening Programme saves about 1,400 lives every year in England.

Take home message

• A lot of breast cancers are detected early by breast screening.

• However, a small number are not- check your breasts!

• All women of every age should still remain breast aware. That is, get to know how your breasts and nipples normally look and feel, and any changes that occur before and after your periods.

• See your GP if you notice any changes, lumps, or other abnormalities in your breasts or nipples. Don't just wait until your next screening mammography.

• Attend your breast screening appointments

• If you move area, ensure you tell GP so screening remains up to date

Further information

• NHS Breast Screening Programme• Web: www.cancerscreening.nhs.uk/breastscreen/

• Breast Cancer Care• 5-13 Great Suffolk Street, Southwark, London, SE1 0NS

Helpline: 0808 800 6000 Web: www.breastcancercare.org.ukProvides breast cancer information and support across the UK.

• Breakthrough Breast Cancer• Weston House, 246 High Holborn, London. WC1V 7EX

Information line: 08080 100 200 Web: www.breakthrough.org.ukA charity committed to fighting breast cancer through research and awareness

.• Macmillan Cancer Support• Tel (Helpline): 0808 808 0000 Web: www.macmillan.org.uk

Provide information and support to anyone affected by cancer.