Breast Cancer: What to look out for

Breast cancer is the most common cancer to affect women in the UK – around 1 in 8 women will develop the disease at some stage in their lifetime.

Despite its prevalence, breast cancer is very treatable due to huge advances in medicine over the years. This has drastically improved patients’ survival rates and quality of life.

We spoke to Ms Mahwash Babar, a Consultant Oncoplastic Breast Surgeon, to find out more about breast cancer, what women should look out for, and what treatment options are available.

How often should women check their breasts and what should they look out for?

The biggest risks for developing breast cancer are being a woman and having ovaries. As women grow older, their risk will also increase, so if you’re approaching 50 it’s a good idea to check your breasts regularly.

How to check your breasts

You can check your breasts once a month. If you have periods, the best time to do this is a few days after your last period ends.

Most breasts will feel a bit lumpy, and they won’t always look or feel the same – this is normal, so don’t worry!

When you check your breasts, start by just looking at them. Look at them with your arms by your side first, and then with your arms above your head.

Once you’ve done this, check your breasts by feeling. Use the flat of one hand, and make sure you examine both breasts in their entirety, all the way up to your collarbone, as well as under your armpits.

Things to look out for are:

• Changes in shape, size or symmetry
• Puckering, dimples or ridges
• Sores or rashes
• One or both of your nipples suddenly being inverted instead of sticking out or pointing in a different direction
• A new lump, swelling, thickening, or bumpy area
• Any discomfort or pain

Whilst looking for lumps is important, you should also look out for nipple discharge and soreness, and remember that the lumps may not be in your breasts around 5-8% of people will present with a lump in the arm. Anything new or different, get it checked out.

Can your lifestyle increase your risk of breast cancer?

If you drink too much alcohol, or if you smoke, you’ll have a higher risk of developing breast cancer and your body may respond slightly less to treatment. Having a high BMI can also increase your risk of post-menopausal cancer.

The oral contraceptive isn’t a significant factor but it does slightly increase your risk.

Twenty years ago, there was a lot of emphasis on the risks of hormone replacement therapy (HRT)  for menopausal women. Now we know HRT is more like a propagator for breast cancer rather than the initiator of breast cancer. If you’re considering going on HRT, make sure you fully research it, so you can make an informed decision, and attend regular mammograms. If you develop breast cancer whilst on HRT, I would advise you to stop HRT because it can accelerate the process.

How much drinking is considered too much?

For most women, half a glass of wine a day is generally fine. Drinking 2 to 3 glasses of wine a day will significantly increase your risk though.

Can men get breast cancer?

Men can get breast cancer but it’s pretty rare. I see about one case of male breast cancer a year. In the last 40 years, the risk of breast cancer in females has risen by a 6th, whereas the risk in men has remained the same.

How treatable is breast cancer?

Breast cancer is one of the most curable cancers. Thanks to research, awareness, accurate data collection and new advances in medicine, chances of survival have massively increased. Cancer Research UK has reported that 98% of women survive when they get an early diagnosis and can expect a good quality of life once they recover.

If you are diagnosed with breast cancer, is it likely to come back?

Recurrence is the term used for the likelihood of cancer coming back. It can be local or distant. Both of these depend on the original biology and stage of the cancer.

For most early cancers, the recurrence rate is quite low. After full treatment and surveillance for five years with favourable biology, the recurrence risk could even be lower than a new incident cancer risk, which is quite amazing!

Your oncologist can also provide a quantitative score for recurrence, adjusting for biology and tailored treatment.

What does ‘early’ and ‘advanced’ mean?

These terms refer to size, grade and nodal status. Early is usually small, palpable and detected through mammography.

Advanced presentation is with a larger palpable lump, which has usually been apparent for months and involves spread to the local lymph nodes under the armpit. If the cancer has spread to other parts of the body, it is called metastatic breast cancer. This type of cancer is still treatable but not curable.

How is breast cancer treated?

Treatment is via a mix of different methods, of which surgery remains the mainstay. At the Breast Clinic, we focus on diagnosis and surgery, so we would refer you to another hospital for radiotherapy or chemo. Much of the surgery I do is breast-conserving surgery, which is curative as well as cosmetic. If a mastectomy is planned, then we can also offer reconstructive surgery. Over the last 15 years, reconstructive surgery has evolved and the emphasis has shifted to women choosing and leading the decisions in their cancer treatment.

Reconstructive surgery can also be offered as an immediate procedure. This means that patients having a mastectomy will wake up with a reconstructed breast. They could choose implant-based reconstruction, which involves placing a silicon prosthesis under the skin. This involves a stay of one or two nights and a relatively speedy recovery, especially in younger women. Or, some women choose to have a reconstruction using their body tissue, which will be taken from the abdomen, back, or thighs. It’s a relatively longer operation but it can done at the same time as the mastectomy.

Radiotherapy

The second aspect of treatment is radiotherapy after surgery, which is given for 5 – 21 days. Radiotherapy is local X-ray treatment given to the symptomatic breast with a specialised machine, and it doesn’t have systemic side effects like chemotherapy. The theory is that after getting radiotherapy, the other cells lose their ability to transform into cancer cells. That’s why the recurrence rate is much lower.

Molecular treatment for breast cancer

Molecular biology and treatment of breast cancer is an important aspect. Individual cells have surface markers, such as oestrogen, progesterone and HER-2. These are analysed and assessed, and then tailored treatment is provided accordingly.

Most breast cancer cells express oestrogen, which allows us to use anti-oestrogen treatment. HER-2 is a growth marker on the cancer cell. Targeted treatment against these markers has revolutionised breast cancer treatment.

Chemotherapy

Chemotherapy may be used in advanced cancers or if the cancer has spread to the lymph nodes or other parts of the body. In some early cancers, it is used to destroy single cells in the circulation that may have escaped and can’t be picked up with any scan.

Are there any side effects to these treatments?

There are surgical side effects, such as scarring, breast shape-changing, or losing the breast. If women are going through menopause, anti-oestrogen treatment will make hot flashes and night sweats worse, as well as affecting bone health.

Breast cancer treatment aims to cover all those aspects. It’s important to remember that recovery is a journey, and we are here to support people through this journey.

What is the recovery process like for breast cancer?

Within two weeks, most people I treat for breast cancer are feeling better. Often they’ll be back at work and will be able to drive and do housework. I also encourage all people I treat to have arm and shoulder physiotherapy to help improve functionality and get back to normal life faster.

Radiotherapy can make people tired and the side-effects of chemotherapy can be tough. However, many patients are still able to work through it. It’s important to remember that life doesn’t end with a cancer diagnosis – treatments nowadays are very successful and survivors can expect a good quality of life once they’ve recovered.

The Breast Clinic at St John and St Elizabeth Hospital is London’s leading breast clinic, providing expert and empathetic care.

If you have a breast-related concern or would like a routine breast health check-up, get in touch to make an appointment.