What is breast cancer?
Breast Cancer Screening
How is breast cancer diagnosed?
What's my prognosis?
How is breast cancer treated?
What about Male breast cancer?
In 2007, there were 2,463 new cases of breast cancer diagnosed in Ireland making it the most common invasive cancer in Irish women. An increase in the number of breast cancer cases was seen between 1994 and 2001 with a subsequent decrease from 2002 to 2006.
There are a number of factors behind these trends including the implementation of the National Breast Screening Programme. Advances in diagnosis and in treatment have seen an increase in survival from breast cancer for Irish women in recent years. In spite of this, breast cancer remains the biggest cause of death from cancer in women in Ireland.
What is breast cancer?
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
What are the risk factors for breast cancer?
Anything that increases your chances of getting a disease is known as a risk factor. Breast cancer is a complex disease with many factors contributing to its development. Some of the known risk factors for breast cancer include:
- Older age
- Menstruating at an early age
- Older age at first birth or never having given birth
- A personal history of breast cancer or benign (noncancer) breast disease
- Treatment with radiation therapy to the breast/chest
- Breast tissue that is dense on a mammogram
- Taking hormones such as estrogen and progesterone
- Drinking alcoholic beverages
- A mother or sister with breast cancer
Having one or more of these risk factors does not necessarily mean you will get breast cancer. If you are concerned as to how any of these risk factors may affect you, you should discuss it with your family doctor.
What changes in my breasts should I be on the look out for?
Women should know how their breasts normally look and feel and report any new breast changes to a family doctor as soon as they are found. These are the changes to look for and if you are in any doubt, visit your doctor:
- A lump or thickening which is different to the rest of the breast tissue
- Continuous pain in one part of the breast or armpit
- One breast becomes larger or lower
- A nipple becomes inverted or changes shape or position
- Skin changes including puckering or dimpling
- Swelling under the armpit or around the collarbone
- A rash on or around the nipple
- Discharge from one or both nipples
Additional information and advice on breast self examination can be found on the following websites:
http://www.cancer.org/docroot/cri/content/cri_2_6x_how_to_perform_a_breast_self_exam_5.asp
YouTube contains a number of videos illustrating the technique, simply enter breast self examination into the search box at http://www.youtube.com
Remember:
- Attend routine breast screening if you are aged 50 and over
- Know what is normal for you
- Look and feel
- Know what changes to look for
- Report any changes without delay
Breast Cancer Screening
BreastCheck is a Government-funded programme providing breast screening and invites women aged 50 to 64 for a free mammogram on an area-by-area basis every two years.
In 2000, BreastCheck began offering screening to women aged 50-64 in the eastern part of Ireland. Since then the programme has expanded and now offers screening on a national basis. Currently there are four permanent screening units:
- The Eccles Unit on the campus of the Mater Misericordiae University Hospital Dublin
- Merrion Unit at St. Vincent's University Hospital Dublin
- BreastCheck Southern Unit adjacent to the South Infirmary Victoria Hospital Cork
- BreastCheck Western Unit at the University College Hospital Galway
Mobile screening units attached to these clinical units offer screening in neighbouring areas. Full information of current screening is available from the BreastCheck website: http://www.breastcheck.ie. If you are aged between 50 and 64 you can also check the BreastCheck register to ensure your details are correct.
How is breast cancer diagnosed?
In addition to taking your history with regard to risk factors for breast cancer and examining your breasts your doctor may use a number of tests to help diagnose breast cancer including:
- Mammogram: a mammogram is an X-ray of the breast.
- Ultrasound: an ultrasound of the breast may be performed in addition to or instead of a mammogram, especially in younger women.
- Biopsy: If a lump is found on the breast on examination or on mammogram, a small piece of the lump will need to be removed to decide if cancer is present. A biopsy is performed using a needle to remove a part of the tissue which is then examined under the microscope.
What's my prognosis?
The chances of making a full recovery from breast cancer depends on a number of factors including:
- The type of breast cancer.
- How fast the tumour is growing.
- The woman's age and whether or not she has gone through the menopause.
- The size of the tumour.
- Whether or not the tumour has spread to the lymph nodes under the arm.
- The presence or not of a number of proteins namely the estrogen receptor, the progesterone receptor and human epidermal growth factor type 2 receptor. Tests to determine the presence or absence of these receptors will be performed on the tumour when it is removed or on the biopsy specimen.
How is breast cancer treated?
There are four broad categories of treatment for breast cancer and depending on the type of breast cancer, a combination of these may be used.
- Surgery
- Radiotherapy
- Chemotherapy
- Hormonal therapy
1. Surgery
Most patients with breast cancer will undergo an operation to remove the tumour from the breast. Depending on the size and location of the cancer within the breast, the surgeon will perform one of two types of operation:Lumpectomy
In a lumpectomy the part of the breast that has cancer and a small area of surrounding normal tissue is removed. In a small number of cases further surgery may be required if the tumour has extended to the margin of excision.
Mastectomy
The whole breast that has cancer is removed during a mastectomy. For patients who will require a mastectomy, consideration can be given to having breast reconstruction surgery whereby after the mastectomy, surgery is used to re-build the shape of the breast using either implants or tissue from the patients body. This reconstruction surgery may occur at the same operation as the mastectomy or at a later date.Surgery for breast cancer also involves taking a sample of lymph nodes from under the arm. Lymph nodes are small pea sized glands located throughout the body. It is important to determine if any of the cancer cells from the breast have spread to these glands as this will affect the type of treatment after surgery. Often, one or two nodes are removed at the initial operation for breast cancer by a technique known as sentinel lymph node biopsy. If cancer cells are identified in these glands when examined under a microscope, further surgery will be required to remove all of the glands from under
the arm.
Lymph nodes help drain excess fluids out of the arm. Removing them can, in some cases,
lead to lymphoedema, a condition which causes the arm to swell painfully. This is why surgeons usually check for cancer spread before removing lymph nodes.After the tumour is removed, it will be examined under a microscope to determine exactly the type and size of the tumour. The results of these tests are normally available within 2-3 weeks of surgery. Depending on these results, a range of other treatments may be used.
Further information on aspects of surgery for breast cancer is available at the following websites:
Reconstruction surgery:
Breast Cancer Care UK:
http://www.breastcancercare.org.uk/breast-cancer-breast-health/treatment-side-effects/surgery/reconstruction/
American Cancer Society: http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Breast_Reconstruction_After_Mastectomy_5.asp
Lymphoedema Support Network
http://www.lymphoedema.org/lsn/index.html
2. Radiotherapy
Radiotherapy or radiation therapy, uses X-ray beams to kill cancer cells. This treatment is used for almost all women who have had only part of their breast removed and in some patients who have undergone mastectomy. It is carried out in specialist hospitals over a period of time for optimal effect to reduce the chances of cancer recurring.In most cases, radiotherapy is given five days a week for between 3 and 6 weeks with each session lasting only a few minutes. Side effects of radiotherapy are often mild and include skin reactions, fatigue and lymphoedema (swelling of the arm)
Further detailed information on radiotherapy for breast cancer is available from the Action Breast Cancer website: http://www.cancer.ie/action/radiotherapy.php
3. Chemotherapy
Chemotherapy refers to the use of drugs that kill cancer cells. The decision as to whether
chemotherapy is required in the treatment of your breast cancer will be taken in conjunction with your doctor and will consider many aspects of the type of breast cancer that you have. Chemotherapy may be given before surgery in an attempt to shrink the size of your tumour before the operation or it may be given after surgery with the aim of reducing the risk of the cancer coming back in the future.
There are many different chemotherapy drugs and a course of chemotherapy often combines two or three of these drugs. Chemotherapy works by targeting cells that are dividing quickly. Some drugs are given as an injection into the bloodstream and others are available as a tablet. If required to be given into a vein, most patients attend a day ward at their hospital where the treatment is administered. You are usually at the hospital for a few hours because you have to have blood tests before your treatment and will have to wait for the results of the tests to come through.As chemotherapy targets rapidly dividing cells in the body, some normal cells, in addition to the cancer cells can be damaged by these drugs. Different drugs cause different side effects and not everyone will experience all side effects. It is important that you discuss potential side effects of your specific treatment drugs with your doctor or nurse. Some of the common side effects of chemotherapy include:
- Nausea and vomiting
- Diarrhoea
- Hair loss
- Mouth ulcers
- Tiredness which may get worse through treatment and may continue for a period after treatment.
Effect on blood cells: chemotherapy may stop the bone marrow from producing blood cells with a risk of developing infections or bruising. It is important to let your hospital treatment team know urgently if you have any signs of infection.
The Cancer Research UK website has a section providing very useful information on chemotherapy: http://www.cancerhelp.org.uk/about-cancer/treatment/chemotherapy/index.htm
4. Hormonal therapy
Hormones are substances that occur naturally in the body and control the growth and activity of normal cells. The female hormone oestrogen can stimulate the growth of breast cancer cells. These cancers are oestrogen receptor positive tumours and account for approximately 70% of breast cancers. Your cancer specialist will discuss this with you if your cancer is of this type. Hormonal therapy is used to either stop production of these hormones or block their actions. Hormonal therapies are taken in tablet form for a prolonged period, normally for five years following your diagnosis and in some cases for even longer periods. There are two main classes of drugs available:Tamoxifen:
Tamoxifen is one of the most common therapies used for breast cancer. The most common side effects of tamoxifen are similar to menopausal symptoms, such as hot flushes, night sweats, vaginal dryness or discharge, irregular periods, lighter periods or stoppage of periods. Tamoxifen can also affect the lining of the womb (endometrium), which may become thickened. If you experience anyunexpected bleeding contact your doctor.
Aromatase inhibitors:
This class of drug is used in women who have been through the menopause. The medications include anastrozole (Arimidex ), exemestane (Aromasin ) and letrozole (Femara ). Most common side effects include aching or pain in the muscles or joints. Menopausal symptoms such as hot flushes, vaginal dryness and tiredness can arise from taking aromatase inhibitors. Other symptoms such as
feeling sick and headaches can occur.
What about Male breast cancer?
Although the vast majority of breast cancers occur in women, around 20 men develop breast cancer in Ireland each year. If you are in any way concerned about male breast cancer you should contact your family doctor.
What are the causes of Male Breast Cancer?
As with breast cancer in women, the causes of male breast cancer are not known. However, we do know about some risk factors, the most important being increasing age. In rare circumstances high oestrogen levels, Klinefelter's syndrome, exposure to radiation or a family history/genetic link may play a small part.
Age
As in female breast cancer, increasing age is the main risk factor. Most men who get breast cancer are over 60, although younger men can be affected.
Obesity
Although not fully understood,being very overweight or obese seems to increase the risk of male breast cancer especially over 35 years of age, this may be related to a higher oestrogen level in the body.
High oestrogen levels
High oestrogen levels can occur as a result of chronic liver damage, obesity and some genetic conditions.
Klinefelter's syndrome
This is a rare genetic condition where a man is born with an extra female chromosome. For men who have this syndrome the risk of breast cancer is 20 times greater than average.
Radiation
Men who have had repeated and prolonged exposure to radiation, i.e. radiotherapy treatment to the chest wall (particularly when young), are thought to be at increased risk of developing breast cancer.
Family history/Genetic link
An increased risk of breast cancer is seen in men with a family history of female breast cancer. This includes mother or sister, particularly if the relative was under 40 when diagnosed.
Approximately 5% of all breast cancers in women are thought to have a genetic link. A genetic link in men seems to be more common, approximately 10-20%. The gene that is most commonly associated with male breast cancer is known as the BRCA2 gene, which can be passed on to both male and female children. Genetic testing is now available for people who may be carrying a faulty gene. You may want to discuss this issue with your specialist, who can refer you to a genetic clinic if necessary.
