What is breast cancer?
Breast cancer is the most common cancer in women worldwide. As breast health specialists we diagnose about 50,000 women with breast cancer every year in the UK alone. About 1 in 8 women can develop breast cancer during the course of their lifetime. Contrary to popular belief, only a minority of breast cancers are caused by a genetic fault (such as the BRCA gene). According to evidence and experience, almost all breast cancers (about 95% of all cases) happen without a very clear or specific reason. This is called sporadic breast cancer (as opposed to inherited breast cancer which happens because of a genetic fault that runs in the family).
Prevention and breast awareness (to know your breasts) help to diagnose a breast cancer at its early stages and achieve complete treatment (cure). When diagnosed with breast cancer, the first reaction is that of a shock and this is completely understandable and natural. If you are a breast cancer patient, you must bond with your treating consultant and put confidence in expert hands with a team-based and compassionate approach. There is evidence showing that experts who treat a lot of patients with breast cancer every year are more likely to achieve better outcomes.
How does breast cancer develop?
The breast consists of fat and glandular tissue comprised of ducts and lobules. Fat and glandular tissue exist in different proportions and depend on age, hormonal replacement therapy, parity (having had children or not) and breastfeeding. Breast cancer develops when some cells in the ducts or lobules of the breast become aggressive enough to start multiplying without control. The next stage is commonly a symptom called a “lump”. A lump usually forms because a group of abnormal cells come together to develop a mass or a bump in the breast that can be felt during breast examination or self-checking. Less commonly, breast cancer can manifest as skin retraction, nipple inversion (nipple indrawing), skin redness, nipple discharge (fluid coming out of the nipple) or as a lump under the armpit. It is therefore crucial to remain breast-aware and regular self-examine. Whenever you notice any of the above breast changes you should immediately seek a breast health specialist referral.
How common is breast cancer?
Breast cancer is the most common cancer in women worldwide. As breast health specialists we diagnose about 50,000 women with breast cancer every year in the UK alone. About 1 in 8 women can develop breast cancer during their lifetimes. Contrary to popular belief, only a minority of breast cancers are caused by a genetic fault (such as the BRCA gene). According to evidence and experience, almost all breast cancers (about 95%) happen without a very clear or specific reason. What we also know however is that prevention and breast awareness are crucial in order to pick up a breast cancer at the earliest possible stage and cure it completely.
How does breast cancer get diagnosed
Breast cancer is most commonly diagnosed during a visit to the breast health specialist. If you have patient symptoms or signs suspicious for breast cancer will have your medical and family history taken and a full clinical examination performed by Mr Charalampoudis, followed by a mammogram (usually in women above the age of 40 or earlier if suspicion is high), an ultrasound and a biopsy. A mammogram is a special X-ray of the breast, which obtains a detailed picture of your breast tissue. Lumps, masses, distortions, densities or calcifications (deposits of calcium within the breast gland) will show up on mammogram and/or ultrasound (a gel scan) of the breast. When a biopsy is recommended to obtain tissue and establish a diagnosis, a specialist radiologist will insert a biopsy needle through the breast skin under local anaesthetic and will take a tiny amount of breast tissue away. This tissue is then sent to the lab to find out whether there is breast cancer or not. Sometimes, particularly in younger women or women with “dense” breasts, we may need to undertake a special mammogram called MRI of the breast (Magnetic Resonance Imaging). The process of finding out about what causes the breast symptoms through clinical examination, mammogram and ultrasound/biopsy is called “triple assessment".
Another way of diagnosing breast cancer is by further investigating a routine “screening” mammogram for women aged usually 50 to 70 years of age. Although the NHS offers screening mammograms in women aged 50 to 70, there is evidence to suggest that screening mammogram may be useful in women between the ages 40-50 as well as in women above 70, particularly those with a personal or family history of breast cancer.
What types of breast cancer are there?
Once the breast biopsy has been performed, Mr Charalampoudis and a dedicated Breast Care Nurse will inform you of the breast cancer type you have. In terms of the breast cancer’s ability to invade neighbouring structures such as the lymph nodes in the armpit, a breast cancer can be termed invasive or non-invasive. Non-invasive breast cancer is otherwise known as DCIS and usually manifests in the form of calcifications in the breast. These calcifications are usually picked up on screening mammograms and cannot be felt on clinical examination.
In terms of breast cancer types, we largely divide breast cancer into ductal and lobular breast cancer, depending on the source of the abnormal cells forming the breast cancer. The ductal type is the most common whereas the lobular type is less common and may require different treatment. In patients with lobular breast cancer, Mr Charalampoudis may request an MRI of the breasts on top of the regular mammogram and ultrasound in order to best inform the diagnosis.
Another very important part of the diagnosis of breast cancer is whether your breast cancer is sensitive to hormones or not. You will commonly hear Mr Charalampoudis saying that your breast cancer is oestrogen-sensitive (ER positive) or oestrogen-insensitive (ER negative). Apart from the oestrogen receptor, Mr Charalampoudis will also find out about another important and special receptor, called the Her2 receptor. Finding out about these receptors is crucial for tailoring your systemic therapy for breast cancer as there are specific targeted treatments that individualize cure and specifically fight against the expression of receptors on the breast cancer cells.
Patients with oestrogen-sensitive breast cancer will usually be recommended hormonal tablets for five to ten years after surgery, whereas in patients with oestrogen-insensitive breast cancers we may more commonly recommend chemotherapy to achieve cure on top of surgery.
How is breast cancer treated?
Breast cancer is treated in a multidisciplinary fashion. There is no “one size fits all” rule for the treatment of breast cancer. Each patient is highly individualized, and the treatment plan that Mr Charalampoudis and his Team recommend is highly tailored to meet every patient’s unique needs. Breast cancer treatment involves surgery, chemotherapy, biological therapy, radiotherapy and hormonal tablets (endocrine treatment). In the majority of cases, surgery is offered as first treatment, and this can be a lumpectomy or a mastectomy with or without reconstruction of the breast. Mr Charalampoudis will discuss in much detail your reconstructive options in the clinic. Not all patients require chemotherapy, radiotherapy or tablets after surgery for breast cancer. The selection of treatments after surgery highly depends on the type of breast cancer you have.