Understanding breast cancer with Mr Arunmoy Chakravorty

Did you know…breast cancer is the most common cancer in the UK population?

According to Breast Cancer UK, it represented 15% of all new cancer cases in 2017 and is the most common cancer in women, globally. Unfortunately, it’s also on the rise. Between 1993 and 2017, cases in the UK increased by 23%.

In fact, a woman born after 1960 and living in the UK currently has an estimated 1 in 7 lifetime risk of developing breast cancer.

To mark Breast Cancer Awareness Month, we sat down with Mr Arunmoy Chakravorty – Consultant Breast Surgeon with a special interest in breast aesthetics, breast diseases and surgical oncology – to discuss the disease and to get answers to the most commonly asked questions.

What is breast cancer?

Breast cancer, as the name indicates, is cancer which develops in the breast. The breast has different components. The main is the glandular breast tissue, which has a functional unit of lobules and ductal units. Milk production happens in lobules and are secreted through the ducts. Cancer can happen within this glandular element either in the ducts or the lobules.

What are the signs of breast cancer?

Women should look for lumps and/or constant pain in the breast or in the armpit. They should also look out for nipple discharge, inversion of the nipple, changes in the colour of the skin or skin thickening, and any lumps in the armpit or around the collarbone.

When should you see a doctor?

Look out for any change in symptoms. If you experience anything like a lump, constant pain, thickening, tenderness, nipple discharge or any other symptoms in the breast, you should contact a doctor and be referred to a breast unit.

Is breast cancer hereditary?

Breast cancer is mainly sporadic, which means cancer by chance. But there is a familial component and there is a hereditary component as well. 80% of cases are sporadic, so cancer by chance. 15% is familial, when there is a strong family history. 5-10% is hereditary, which is genetically related.

Are older women more at risk of breast cancer than younger women?

Yes, cancer by chance, which is sporadic cancer, mainly affects women after the age of 47 or 50. Hence the national breast screening starts from the age of 50. However, there are ongoing trials to increase the screening age from 47-73 years.

Are there any lifestyle factors which make breast cancer more likely?

The greatest risks are being female, being in a higher age group and, of course, if there is a family history of breast cancer. There are also certain lifestyle factors, which we define as factors which can be modified. These are alcohol consumption, obesity, use of contraceptive pills for a very long period, use of Hormone replacement therapy (HRT) for a long period, and smoking.

Does taking oestrogen increase your risk of developing breast cancer?

If the combined contraceptive pill (which contains oestrogen and progesterone) has been used for five years, there is only a slight increase in risk. But if it is used for 10 years constantly without taking a break, there is an increase in risk.

In a group of 10,000 women who do not use the combined pill, about 40 will probably develop breast cancer between the ages of 30 and 39.

In a group of 10,000 women who do use the combined pill for most of their 30s, about 54 will develop breast cancer between the ages of 30 and 39.

So using the combined pill during this time causes about 14 extra cases of breast cancer in every 10,000 women ( small increase in risk )

HRT is used for women after they have gone through the menopause or while they are going through the menopause. It is often taken to improve their quality of life.

• If  63 women in every thousand who have never used HRT develop breast cancer then 83 women in every 1,000 women who use combined HRT for five years from the age of 50
• 68 in every 1,000 women who use oestrogen-only HRT for five years from the age of 50

There is a rise of between two and five percent with the use of HRT for a longer period of time.

Are the risks the same with the progesterone-only pill (POP)?

The risk will still be increased with long-term use, but it will be less than the combined pill.

Can men get breast cancer?

Men can get breast cancer but the incidence is 1%. So the chances are very low in men having breast cancer, whereas it’s between 13 and 15% of women having breast cancer.

Are trans women at a higher risk of breast cancer?

Yes, that may increase the risk. Anyone who is exposed to these hormones for a very long period of time can increase their risk. It’s the same with women who go through IVF treatment and anyone exposed to higher cycles of ovarian stimulation by those these hormones, however, there is ongoing research to establish the risks.

Can you cure breast cancer?

Yes, the outcomes for breast cancer are getting better and better. Breast cancer can be cured if caught early.

What are the treatments for breast cancer?

Surgery remains the mainstay of treatment and with all the research happening we are understanding tumour biology better. We try to tailor the treatment according to the needs of the patients.

Breast cancer has got receptors present like oestrogen, progesterone and a protein receptor. Based on these receptors, and on the size and aggressiveness of the tumour, women usually undergo surgery followed by chemotherapy, followed by radiotherapy and also followed by a hormone blocking agent if the tumour is oestrogen receptor positive. Some women may need chemotherapy at the beginning depending on their biology and occasionally to downsize the tumour.

Basically, it’s a package of treatments which includes surgery, radiotherapy, hormone blocking agents, and chemotherapy if the tumour is aggressive.

Are there any side effects from hormone blockers?

Yes, the side effects of hormone blockers can include night sweats, feeling tired, bone pain and occasionally bone thinning. It’s essentially the same as the menopause. We are trying to negate the effect of the hormones by blocking them to decrease the chances of recurrence.

Chemotherapy can sometimes cause infertility, but if the cancer is caught early and the woman is given hormone blockers then they are only taken for around five to 10 years. The blockers will cause some symptoms of the menopause, but the patient will still have their period.

What is metastatic breast cancer?

Metastatic breast cancer is when cancer has spread from the breast to the lymph node and to different parts of the body. When it’s just spread to the local lymph node, because it dictates the prognostic outcome, we call it locally advanced. It is still an early breast cancer that can be managed very well, but it has advanced from the breast to the lymph nodes.

When it spreads to the lymph nodes in the chest, or  the bones, liver or anywhere else, then we classify it as metastatic breast cancer.

What is the prognosis for breast cancer?

When we say prognostic outcome we mean 10 year survival rate. For stage one breast cancer, the prognostic outcome is more than 98%.  If it is stage two, it is more than 90%. If it is stage three, it is more than 75%. If it is stage four, that means it’s spread everywhere and 25% will have more than a five year survival rate.

Women should always be advised to self examine and they should be breast aware. They should be examined after their periods and on a regular basis. If there is any change in symptoms they should report it to their doctor and should be seen by a breast specialist.

Be sure to head to Breast Cancer Now for more advice on checking for breast cancer.

Interested in a consultation with our experienced team? Click here to learn more or book an appointment by phone 020 3370 1041 or email [email protected]