May 302018

A friend of mine send me this email: “I found a lump…

“I awoke with a slight pain in my left breast 4 days ago. [At first] I thought nothing of it, … [but then] I found a very distinct pea-sized lump.” So I gathered some answers:

Q. How common is breast cancer?

A. There are over 212,000 cases of breast cancer diagnosed in the USA each year. In Canada the figure is 20,500, Australia 13,000 and in the UK the figure is 41,000. I could not find any statistics for Ethiopia, but overall, one woman in every nine will get breast cancer at some time in her life.

Q. Who is most at risk?

A. Breast cancer is overwhelmingly a female disease, but about 1% of cases occur in men (around 300 per year in the UK). Amongst women it becomes more common as age increases. More than 80% of cases occur in women over 50. Taking the contraceptive pill slightly increases the risk. Taking hormone replacement therapy significantly increases your risk somewhat more, but the health benefits derived from hormone replacement are better overall. Obesity and heavy drinking also significantly increase the risk.Breast Cancer

If one or more relatives have had breast cancer, this also increases your risk of developing it (see below).

Q. Does breast cancer run in families?

A. Having one close relative (mother or sister) with breast cancer doubles your risk of getting breast cancer, when compared to women with no cases in the family. Having two close relatives affected increases your risk further.

There are a very few families in which breast cancer is very common – ie four or more cases. Most of these families carry faulty versions of the ‘BRCA’ breast cancer genes.  Women with a faulty BRCA gene have a 50% to 80% chance of getting breast cancer. Testing for faulty BRCA genes is available on the NHS.

Q. Is the use of deodorants linked to breast cancer?

A. There has been a persistent internet rumour that underarm deodorants cause breast cancer and even one or two newspaper articles that suggested this was backed up by research findings.  However, there is no good evidence from cancer research to support this idea.   On the contrary: in a large study comparing breast cancer patients and healthy women, there was no difference found at all in their use of underarm deodorants.

Are there different types of breast cancer?

There are two main places in the breast where cancer can occur: the lobules (the milk-producing tissue) and the ducts (which carry the milk to the nipple).

  • Ductal carcinoma in situ means an early cancer in the milk ducts. It can be detected by mammograms and is normally easy to cure.
  • Invasive ductal carcinoma means a cancer that started in the milk ducts but has now spread beyond them.
  • Lobular carcinoma in situ is not considered to be cancer. It is a pre-cancerous condition. Most women with lobular carcinoma in situ do not get breast cancer, but they have an increased risk of getting it, so they are given frequent checkups.
  • Invasive lobular carcinoma is a cancer that starts in the lobules and has spread. These can be difficult to diagnose as they do not always form a lump or show up on mammograms.
What are the symptoms of Breast Cancer?

Screening for breast cancer by mammography (X-raying the breast) is offered every three years in the UK to all women between 50 and 64. The highest number of cases of breast cancer occurs in women between these ages.

Mammography can detect very early breast tumours, when they are too small to be felt. In fact, most of the breast cancers detected by screening are at this very early stage, when they are relatively easy to cure. Studies have shown that women who take part in screening are more likely to have breast cancer diagnosed early and more likely to have it cured and, as a result, are less likely to die from it, than women who do not take part in mammography screening.

Another method of screening available to all women is to feel the breasts for any lumps. A guide on how to do this properly can be obtained at any doctor’s surgery. Women should also check for the other main symptoms:

  • Change in the size or shape of a breast
  • Dimpling of the breast skin
  • The nipple becoming inverted
  • Swelling or a lump in the armpit
Diagnosis

The most important method used to diagnose breast cancer is by taking a biopsy (a tissue sample). A hollow needle is pushed into the breast lump to capture a tiny sample of the tissue. This is examined under a microscope. The shape and appearance of the cells in the tissue sample reveals whether the lump is benign, which is true of the vast majority, or if it is cancerous.

Q. How important is early detection?

A. We can currently cure six out of every seven patients who are diagnosed when their breast cancer is at the early stage. However, if they are diagnosed when it has become advanced, the cure rate falls to about one in seven. It is extremely important to catch breast cancer at an early stage.

Treatment

The main treatment for breast cancer is surgery. In most cases, conservative surgery is used, which preserves the shape and appearance of the breast. For very early breast cancer, only the lump and a small area of tissue around it is removed. For later stage breast cancer, much more tissue is removed but it is replaced with muscle to rebuild the breast. Since breast cancer cells usually spread first to the lymph node in the armpit, the surgeon will usually cut into it to check for any spread.

The surgery may be followed by a short course of radiotherapy or chemotherapy, depending on the type of tumour and how advanced it is. In most cases, the patient will be given a longer course of hormone therapy (eg tamoxifen) which reduces the risk of the cancer recurring.

The treatment for breast cancer has been improving for the last twenty years. In the early 1970’s, only half of all women diagnosed with the disease survived for five years. Now, over three quarters survive for that long and most of them will live for very much longer.


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