Breast Cancer

Breast cancer affects millions of women around the world. Although its exact causes remain unclear, various factors are known to increase the likelihood of developing the disease.

Understand the symptoms of breast cancer, factors that may increase the risk of developing the disease and treatment that may be needed.

What is Breast Cancer?

Breast cancer is a type of cancer that forms in the cells of the breast tissue. It can occur in both men and women, although it is much more common in women. Breast cancer usually begins in the milk ducts (ductal carcinoma) or the lobules (lobular carcinoma) of the breast but can also occur in other areas of the breast tissue. Breast cancer is the most common cancer among women worldwide and is the second leading cause of cancer-related deaths among women.

Causes

The exact cause of breast cancer is not known, but several factors may increase the risk of developing the disease:

• Age: The risk of breast cancer increases with age, with the majority of cases diagnosed in women over the age of 50. However, breast cancer can occur at any age, including in younger women.
• Family History: A family history of breast cancer, particularly in first-degree relatives (such as mother, sister, or daughter), increases the risk of developing the disease. Certain genetic mutations, such as mutations in the BRCA1 or BRCA2 genes, are associated with an increased risk of breast cancer.
• Inherited Genetic Mutations: Inherited genetic mutations, such as mutations in the BRCA1 or BRCA2 genes, increase the risk of breast cancer. These mutations are also associated with an increased risk of ovarian cancer and other cancers.
• Personal History of Breast Cancer: Women who have had breast cancer in one breast are at increased risk of developing a new cancer in the other breast or a recurrence of the original cancer.
• Reproductive Factors: Factors that affect a woman’s reproductive history, such as early menstruation (before age 12), late menopause (after age 55), never having been pregnant, or having a first child at an older age, may increase the risk of breast cancer.
• Hormone Replacement Therapy (HRT): Long-term use of hormone replacement therapy (HRT), particularly oestrogen-progestin combination therapy, may slightly increase the risk of breast cancer. However, the benefits of HRT in managing menopausal symptoms often outweigh the risks for most women.
• Exposure to Radiation: Previous exposure to radiation therapy to the chest area, such as for the treatment of Hodgkin lymphoma or other cancers, increases the risk of breast cancer later in life.
• Obesity: Obesity, particularly in postmenopausal women, is associated with an increased risk of breast cancer. Excess body weight may lead to hormonal changes, inflammation, and other factors that promote cancer development.
• Alcohol Consumption: Regular or excessive alcohol consumption is associated with an increased risk of breast cancer. The risk of breast cancer increases with the amount of alcohol consumed.
• Physical Inactivity: Lack of regular physical activity or sedentary behaviour is associated with an increased risk of breast cancer. Exercise helps maintain a healthy weight, reduces inflammation, and may have other protective effects against breast cancer.

Symptoms

Breast cancer may cause symptoms, but they are often not noticeable in the early stages of the disease. Common symptoms of breast cancer may include:

• Lump or Mass: A painless lump or mass in the breast or underarm area, which may feel hard, irregular in shape, or different from surrounding breast tissue.
• Changes in Breast Size or Shape: Changes in breast size, shape, or contour, such as asymmetry between the breasts or noticeable swelling or distortion.
• Changes in Skin Texture: Changes in the texture or appearance of the skin on the breast, such as dimpling, puckering, redness, thickening, or indentation.
• Changes in Nipple Appearance: Changes in the appearance of the nipple, such as inversion (turning inward), flattening, or retraction (pulling inward), or discharge from the nipple, especially if it is bloody or occurs without squeezing.
• Breast Pain or Discomfort: Persistent or unexplained pain, tenderness, or discomfort in the breast or nipple area.
• Swelling or Enlargement: Swelling or enlargement of one breast or a portion of the breast, which may be accompanied by warmth, redness, or inflammation.
• Skin Rash or Eczema: Persistent rash, eczema, or irritation on the breast skin, particularly in the nipple or areola area.
• Lymph Node Enlargement: Enlarged lymph nodes in the armpit (axilla) or collarbone area, which may be felt as firm, swollen, or tender.

It is important to note that these symptoms can also be caused by other conditions, such as benign breast changes, cysts, or infections, and experiencing one or more of these symptoms does not necessarily mean that a person has breast cancer. However, if symptoms persist or worsen over time, it is important to see a doctor for evaluation and diagnosis.

Diagnosis and Evaluation

If breast cancer is suspected based on symptoms, physical examination, or imaging findings, diagnostic tests and evaluations may be performed, which may include:

• Clinical Breast Examination: A clinical breast examination may be performed by a doctor to assess the size, shape, and texture of the breasts and to check for any abnormalities, lumps, or changes.
• Mammography: Mammography is a screening test that uses X-rays to create images of the breast tissue and detect abnormalities, such as tumours, calcifications, or masses, that may indicate the presence of breast cancer. Mammography is the most effective screening tool for breast cancer and is recommended for women starting at age 40 (earlier for women at increased risk) as part of routine breast cancer screening.
• Breast Ultrasound: Breast ultrasound uses sound waves to create images of the breast tissue and may be used in conjunction with mammography to further evaluate suspicious findings or to distinguish between solid masses and fluid-filled cysts.
• Breast Magnetic Resonance Imaging (MRI): Breast MRI is an imaging test that uses magnetic fields and radio waves to create detailed images of the breast tissue. Breast MRI may be used in certain situations, such as for high-risk women with dense breast tissue or to assess the extent of the disease in newly diagnosed breast cancer patients.
• Breast Biopsy: If breast cancer is suspected based on imaging studies or clinical findings, a biopsy may be performed to obtain tissue samples from the breast for microscopic examination. Biopsy is the definitive diagnostic test for breast cancer and helps determine the type, grade, hormone receptor status, and HER2/neu status of the tumour.

Staging and Evaluation

Once a diagnosis of breast cancer is confirmed, further staging and evaluation may be performed to determine the extent of the disease and guide treatment decisions. Staging may include:

• Pathologic Evaluation: Pathologic examination of biopsy specimens or surgical specimens provides information about the histologic type, grade, hormone receptor status, HER2/neu status, and presence of lymphovascular invasion or metastases, which are important factors for determining prognosis and treatment planning.
• Imaging Studies: Additional imaging studies such as CT scan, MRI, bone scan, or PET scan may be ordered to evaluate for metastases, detect involvement of distant organs or tissues, or assess treatment response.
• Lymph Node Evaluation: Assessment of lymph node involvement is an important part of breast cancer staging. Lymph nodes in the axilla (armpit) are often evaluated using physical examination, imaging studies, or sentinel lymph node biopsy to determine if cancer has spread to nearby lymph nodes.

Treatment and Management

Treatment for breast cancer depends on various factors, including the stage, grade, histologic type, hormone receptor status, HER2/neu status, extent of the disease, and the patient’s age, overall health, and preferences. Treatment options may include:

• Surgery: Surgical removal of the tumour and surrounding tissues (lumpectomy or mastectomy) is the primary treatment for breast cancer. The choice of surgical procedure depends on the size, location, and extent of the tumour, as well as other factors such as tumour characteristics, breast size, and patient preferences.
• Radiation Therapy: Radiation therapy uses high-energy beams of radiation to destroy cancer cells or shrink tumours and may be used after surgery (adjuvant radiation therapy) to reduce the risk of local recurrence or as part of the primary treatment for certain types of breast cancer. Radiation therapy may also be used to relieve symptoms or palliate metastatic disease.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or inhibit their growth and may be used as adjuvant therapy (after surgery) or neoadjuvant therapy (before surgery) to reduce the risk of recurrence, shrink tumours, or improve treatment outcomes. Chemotherapy may be administered intravenously or orally and may be combined with other treatments such as surgery or radiation therapy.
• Hormonal Therapy: Hormonal therapy, also known as endocrine therapy or anti-oestrogen therapy, may be used to block the effects of oestrogen or progesterone on hormone-sensitive breast cancers. Hormonal therapy drugs may include selective oestrogen receptor modulators (SERMs), aromatase inhibitors, or gonadotropin-releasing hormone (GnRH) agonists.
• Targeted Therapy: Targeted therapy drugs that target specific molecular pathways or genetic mutations involved in breast cancer growth and progression may be used to block tumour growth, prevent angiogenesis (formation of new blood vessels), or overcome resistance to chemotherapy. Targeted therapy drugs may include HER2/neu inhibitors, CDK4/6 inhibitors, or PI3K inhibitors.
• Immunotherapy: Immunotherapy drugs such as immune checkpoint inhibitors or monoclonal antibodies may be used to stimulate the immune system to recognize and attack cancer cells. Immunotherapy may be used in certain cases of breast cancer to enhance treatment response, improve survival, or induce durable remissions.
• Breast Reconstruction: Breast reconstruction surgery may be performed after mastectomy to restore the shape, size, and appearance of the breast. Reconstruction options may include implant-based reconstruction, autologous tissue reconstruction (flap reconstruction), or a combination of techniques.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments, experimental therapies, or investigational drugs that are being evaluated for safety and efficacy in the treatment of breast cancer. Clinical trials help advance scientific knowledge and may provide potential benefits to participants.

Follow-Up and Monitoring

After treatment for breast cancer, regular follow-up visits with your doctor, breast surgeon, medical oncologist, or radiation oncologist are essential to monitor treatment response, assess disease recurrence, and address any complications or side effects. Monitoring may include:

• Clinical Breast Examination: Regular clinical breast examinations may be performed to assess for signs of recurrence, detect new masses or abnormalities, or evaluate the health of the breasts and axilla.
• Mammography: Follow-up mammography may be recommended at regular intervals to screen for recurrence, assess treatment response, or detect new breast abnormalities.
• Imaging Studies: Additional imaging studies such as breast ultrasound, MRI, CT scan, bone scan, or PET scan may be ordered to evaluate for recurrence, detect metastases, or assess treatment response.
• Hormonal Therapy: If hormonal therapy is part of the treatment plan, periodic monitoring of hormone receptor status, tumour markers, or other blood tests may be performed to assess treatment response and disease progression.
• Bone Health: Women receiving hormonal therapy or certain types of chemotherapy may be at increased risk of bone loss or osteoporosis. Bone density testing (DEXA scan) and preventive measures such as calcium and vitamin D supplementation or bisphosphonate therapy may be recommended to maintain bone health.

Prevention and Risk Reduction

While the exact cause of breast cancer is not fully understood, several strategies may help reduce the risk of developing the disease:

• Breast Cancer Screening: Regular breast cancer screening with mammography, clinical breast examination, and breast self-examination can help detect breast cancer at an early stage when it is most treatable. Breast cancer screening recommendations may vary based on age, risk factors, and personal preferences.
• Healthy Lifestyle Habits: Adopting a healthy lifestyle that includes regular physical activity, maintaining a healthy weight, avoiding smoking, limiting alcohol consumption, and eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins may help reduce the risk of breast cancer.
• Breastfeeding: Breastfeeding may reduce the risk of breast cancer, particularly if breastfeeding is prolonged or exclusive. Breastfeeding has been associated with hormonal changes that may protect against breast cancer development.
• Hormonal Therapy: Limiting the duration and dosage of hormone replacement therapy (HRT) for menopausal symptoms may help reduce the risk of breast cancer. Women considering HRT should discuss the risks and benefits with their doctor and use the lowest effective dose for the shortest duration possible.
• Genetic Counselling and Testing: Genetic counselling and testing may be recommended for individuals with a family history of breast cancer, ovarian cancer, or certain genetic mutations (such as BRCA1 and BRCA2) to assess their risk of developing the disease and guide personalized screening and preventive strategies.

Conclusion

Breast cancer is a complex and heterogeneous disease that affects millions of women worldwide.

While the exact cause of breast cancer is not fully understood, several factors may increase the risk of developing the disease, including age, family history, genetic mutations, hormonal factors, and lifestyle habits.

Breast cancer often presents with subtle or nonspecific symptoms, highlighting the importance of breast cancer screening and early detection.

If diagnosed with breast cancer, treatment options may include surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy, immunotherapy, or participation in clinical trials.

Prevention strategies such as regular breast cancer screening, healthy lifestyle habits, and risk reduction measures can help reduce the risk of breast cancer and improve outcomes.

By working closely with doctors, staying informed about risk factors and screening recommendations, and adopting healthy behaviours, individuals can take proactive steps to protect their breast health and well-being.

Arranging To Visit A Private GP

To discuss any symptoms that could be an indication of breast cancer make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

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