Breast Cancer

What is breast cancer?

Breast cancer occurs when cells in the breast begin to grow out of control. Most breast cancer is not considered terminal; however, Stage IV, or metastatic, breast cancer (MBC) is progressive and incurable. All breast cancers are a serious condition that require prompt, expert medical treatment. 

In 2012, 1.7 million people were diagnosed with breast cancer worldwide. As of 2012, the five-year survival rate of Stage I-II breast cancers (more on this below) is 80–90% in countries with advanced medical care. The median survival rate for people with MBC is around 3 years. 

Though there is no cure for breast cancer, some people are considered NED (no evidence of disease) after treatment and live a long healthy life. Some people may have recurrences, or new diagnoses of breast cancer after being NED. 

Breast cancer begins when abnormal cells group into a tumor in the milk ducts or lobules of the breast. If the cells stay in the ducts or lobules, they are called “in situ.” If they grow into the breast tissue, they are called “invasive.” 

Stages of breast cancer

Stages of breast cancer refer to the size and/or location of the breast cancer cells. “In situ” cancers are sometimes called Stage 0. Stage I means that an invasive cancer has formed, but that the tumor is small or only few cells have been found in nearby lymph nodes (glands that drain fluid). Stage II tumors are larger and/or more cancer cells have been found in lymph nodes. Stage III cancer means either even larger tumors with cancer in the lymph nodes, or cancer is found in many lymph nodes and/or has spread to the chest wall or skin. Stage IV, or metastatic breast cancer, is any breast cancer that has spread outside the breast and lymph areas. 

Types of breast cancer, like inflammatory, DCIS, LCIS, and ILC, refer to where in the breast the cancer begins, how it spreads, and the kinds of symptoms a person might experience. Subtypes like triple-negative (ER/PR -, HER2 -), hormone receptor (HR) positive (ER +/ PR +), HER2 +, refer to the presence or absence of different hormones and proteins in the breast cancer cells. 

Who’s most at risk?

Higher age, family history of the disease, long-term estrogen exposure, having had certain medical conditions or treatments, obesity, excessive alcohol use, and not having given birth or breastfed all increase risk. Ethnicity also has an impact: White women are at highest risk for developing breast cancer, but black women are at highest risk for dying of the disease. 

Understanding your risk for breast cancer should be done with the help of a medical professional. If you don’t yet know, you should find out if you have a family history of breast cancer. People with a family history of the disease are at a somewhat greater risk for breast cancer; women with a mutation in specific genes (called BRCA1, BRCA2, PALB2, and others that have been identified and can be tested for) are at much greater risk for breast cancer. Genetic testing can tell you whether you have this mutation; if you do, you should then talk to your doctor about whether to take preventative (prophylactic) measures. 

What are the symptoms of breast cancer?

Breast cancer symptoms include: 

  • Breast lumps 
  • Swelling under your arm 
  • Pain in your breast or nipple 
  • New dimples in the skin on your breast 
  • The skin on your breast becoming swollen, red, or hot 
  • Sudden changes in your breast size 
  • Changes in shape in only one of your breasts 
  • Having your nipple newly turn inward (invert) 
  • Non-milky liquid coming from your nipple

See your doctor if you notice any of these symptoms. Know your body so that you know what is unusual for you. 

‘I found a lump in my breast and it was tender to touch. I knew it wasn’t right’

response in 2018 HealthUnlocked breast cancer survey

Symptoms may intensify if the breast cancer is left untreated, but a high proportion of breast cancer is found through routine screening in women who don’t have any symptoms. When the breast cancer is detected, it is usually removed through surgery at the beginning of treatment. Symptoms of the disease stop with its removal, but treatment can present side effects that affect quality of life. 

What are the causes of breast cancer?  

Doctors do not know exactly what causes breast cancer. But some attributes increase your risk of getting breast cancer. They include: 

  • Gender – women are at greater risk than men (though men do get it)
  • Age – risk increases with age 
  • Genetics – specific gene mutations indicate higher risk 
  • Having a personal history of breast cancer 
  • Having had a previous breast cancer biopsy that revealed a precancerous lesion such as atypia (abnormal cells) or LCIS (lobular carcinoma in situ) 
  • A long window of estrogen exposure, such as with early onset of menstruation and/or late onset of menopause 
  • Previous radiation 
  • Ethnicity – white women have a higher risk of developing breast cancer than African-American women, but African-American women are more likely to die of the disease at a younger age. Asian, Native-American and Latina women have a lower risk of getting the disease and dying from it. These ethnic differences are similar in UK – white women are most likely to get breast cancer, but black women on average are diagnosed 12 years younger and have poorer outcomes 
  • Being overweight or obese (particularly important as you get older) 
  • Long term usage of post-menopausal hormone therapy (HRT) 
  • Excessive alcohol use, especially more than one drink per day 
  • Lack of physical activity or exercise 
  • Not having children or having children after the age of 35 
  • Not breastfeeding 

Diagnosing breast cancer  

It’s important to know the look and feel of your breasts so that you can tell if anything changes. Learn to do self-examination to check for lumps. If you experience any of the symptoms above, you should see a doctor. You could also speak to a doctor to assess your personal risk level and discuss screening. 

Different medical authorities have different guidelines for who should get mammograms, when, and how often; there are merits and risks to each of their recommendations. Your body and personal risk level should be considered when deciding on screening. In the UK, all women aged 50-70 are offered screening and in some areas this has been widened to include women aged 47-73.

Mammograms catch some breast cancers but not all. There are other screening procedures, like molecular breast imaging and 3D tomosynthesis, that are more appropriate for some women. 

To screen for breast cancer, doctors may use mammograms, sonograms, MRIs, molecular breast imaging, or 3D tomosynthesis. To diagnose breast cancer, doctors will use a biopsy. 

To determine what kind of breast cancer it is, doctors will use tests such as Oncotype DX and MammaPrint that check “biomarkers” in the tissue removed in the biopsy to determine the cancer’s subtype. 

Treatment​​ ​for​ breast cancer  

Different types and subtypes of breast cancer are treated with different procedures and medications. Many people will have surgery, radiotherapy, chemotherapy, hormone therapy, or targeted therapy, or some combination of these. You may have several treatment options available for your subtype. If so, you should talk to your oncologist about your priorities during treatment. Ask about the potential side effects and their impact on quality of life, so that you and your doctor can come to a decision together. You could also choose to join a clinical trial, which might give access to cutting-edge new treatments. 

‘Try to be strong. There are so many new treatments on offer that if found early the chances of survival are excellent.’

2018 HealthUnlocked breast cancer survey response.

Because breast cancer uses a different combination of treatments for each person, the side effects of treatments will vary. Side effects of radiation can be skin reactions, fatigue, pain, and sometimes lymphedema. Side effects of chemotherapy vary but major effects include hair loss, nausea, “chemo-brain” or forgetfulness, and a nerve disorder called neuropathy which can cause numbness or tingling, pain and weakness. 

There are at least seven drugs used for hormone therapy, all of which can produce different side effects ranging from osteoporosis to loss of libido; ask your doctor to review which hormone therapy drugs will be most effective for you and help you maintain the most important aspects of your life. 

Targeted therapies are specifically designed to minimize side effects. They target specific characteristics of the cancer cells, rather than killing many healthy cells along with the cancer or working on your body’s hormones.   

Living​ ​with​ ​breast cancer  

Here are some tips from women who have been through breast cancer themselves:

  • Try to keep perspective; expect setbacks during treatment 
  • Treat your side effects with anti-nausea and anti-inflammatory drugs
  • Learn to say “no” to others when necessary
  • Bring a friend with you to appointments and treatment sessions
  • Complementary therapies can be helpful in alleviating anxiety and even pain 
  • Write down your symptoms, questions, and notes from appointments
  • Consider clinical trials 

‘Share your diagnosis with family, friends and health professionals like Macmillan. You will gain huge support and understanding.’

2018 HealthUnlocked breast cancer survey response.

Try to be open with your doctors about any questions or concerns. Identify your treatment priorities (such as keeping your hair, or keeping travel costs down) and discuss these with your doctor. If you don’t feel like you’re being heard, or you disagree with their conclusions, feel entitled to seek a second opinion. 

Note that some breast cancer risk factors are under your control. You may be able to lower your risk by doing these things: 

  • Try to have fewer than 3-4 alcoholic drinks a week 
  • Exercise moderately for 3-4 hours a week 
  • Avoid hormone replacement therapy after menopause 
  • Keep a healthy body weight 
  • If you have a new baby and are able, choose to breastfeed 

‘Exercise and healthy eating are key. Try to live your life as normally as possible. It’s helpful for your mental state’

2018 HealthUnlocked breast cancer survey response.

Research has not proven that any particular food can prevent, treat, or cure breast cancer. Some research suggests that vitamin D can support normal cell division, and that people with low vitamin D levels are more likely to develop breast cancer; however, more research is needed. Research on soy’s impact on breast cancer is also mixed, but in general, it is safe to eat moderate amounts of soy as part of a balanced diet. 

After being diagnosed, some people take supplements to support their health. It is critically important to tell your doctor if you want to take supplements of any kind, even ‘natural’ ones, during treatment. Your doctor needs to know what you are taking to make sure there are no harmful interactions.

Support

Connecting with people who know what you’re going through can help you cope with the challenges of breast cancer. You may have supportive friends and family, but they may not know what to say or understand your experience. There’s nothing like the support of someone who’s been there, so consider joining a community of people who have been through breast cancer as well. 

You can join an online community, such as Breast Cancer Haven at HealthUnlocked.  Most large cancer charities also run online communities, for example Breastcancer.org

‘Join a recognised support forum and read as much as you can about your condition.’

2018 HealthUnlocked breast cancer survey response.

Local face-to-face support groups where you can meet others and chat, hear talks, help organise events and so on, are also popular.

Your doctor or hospital may also be able to recommend a local group you could join.

Apps

There’s a range of free and low-cost smartphone apps that some people find helpful in managing their breast cancer. You can find them by searching for ‘breast cancer’ in your device’s app store.

Main resources consulted in preparing this information

All sources mentioned here were accessed during January 2018.

·         National Institute of Health and Care Excellence

·         US National Library of Medicine

·         Cancer Research UK

·         NHS.UK

·         National Breast Cancer Foundation

·         Centers for Disease Control and Prevention

·         Breast Cancer Care

·         Macmillan

·         American Cancer Society

·         World Health Organization

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