Breast cancer in women
নারীদের স্তন ক্যানসার
Overview
- What is breast cancer?
- Symptoms of breast cancer
- What causes breast cancer in women?
- Diagnosing breast cancer in women
- Staging and grading of breast cancer
- Receptors for breast cancer
- Treatment for breast cancer
- After breast cancer treatment
What is breast cancer?
Each year, about 55,000 women are diagnosed with breast cancer in the UK. It’s more common in women over 50, but it can also affect younger women.
In this Cancer Explained video, Dr Aziza Sisay is joined by Dr Hayley McKenzie. They take an in-depth look at breast cancer, covering how it’s diagnosed, tested and treated.
Breast cancer can be invasive or non-invasive (in-situ). When people talk about breast cancer, they usually mean invasive breast cancer. This is when cancer cells have spread outside the milk ducts or lobules in the breasts where they started, into surrounding breast tissue.
People who have breasts include women, transgender (trans) men and people assigned female at birth.
Macmillan Cancer Support has information about non-invasive breast cancer called ductal carcinoma in situ (DCIS).It’s the earliest possible form of breast cancer and is usually found during routine breast screening.
Breast cancer in men is rare. Read more information for men with breast cancer.
Macmillan Cancer Support have more information if you’re LGBTQ+ and living with cancer.
Types of breast cancer
There are different types of breast cancer. Knowing the type you have helps your doctors decide on the best treatment for you.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes breast cancer in women?
Doctors don’t know the exact causes of breast cancer. But there are risk factors that can increase your chance of developing it.
Having one or more risk factors doesn’t mean you’ll get breast cancer. Also, having no risk factors doesn’t mean you will not develop it.
Breast cancer is likely to be caused by a combination of different risk factors, rather than just one.
Macmillan Cancer Support have more about breast cancer risk factors.
Diagnosis
Diagnosing breast cancer in women
You’ll usually start by seeing your GP. They’ll examine you and refer you to a breast clinic to see a specialist.
You may be referred through NHS breast screening programmes. This is usually if there are changes on your mammogram. Breast screening is a way of finding breast cancer at an early stage, when it is too small to be felt or seen.
Get Checked Early has more information on what to expect when getting checked.
What happens at a breast clinic
At the clinic, you’ll see a specialist breast doctor or a nurse. You may also see a breast care nurse.
They’ll usually ask you if:
- you have had any other breast problems or health problems
- anyone in your family has had breast cancer or ovarian cancer
- you have been through the menopause
- you’re taking any medicines – for example, hormone replacement therapy (HRT) or the contraceptive pill
The doctor or nurse will examine your breast or chest area. They’ll also examine the lymph nodes in your armpits and above your collarbone.
Tests
After your examination, your doctor or nurse will tell you what tests you need:
Mammogram
A mammogram is a low-dose X-ray of the breast.
Breast ultrasound
A breast ultrasound uses sound-waves to build up a picture of the breast tissue. You’ll also have an ultrasound scan of the lymph nodes in the armpit.
Breast biopsy
During a breast biopsy, a doctor will remove a small piece of tissue or cells from the lump or abnormal area. The sample will be checked for cancer cells. There are different ways of taking a breast biopsy.
Further tests after diagnosis
If the biopsy results show there are breast cancer cells, you’ll need further tests. You may have the following tests to check your general health.
Blood test
You have a blood test to check your general health and how well your kidneys and liver are working.
Chest X-ray
You’ll have a chest X-ray to check your lungs and heart.
You may also have tests to find out more about the size of the cancer, or if it has spread anywhere else in the body. This is known as the stage of the cancer.
MRI (magnetic resonance imaging) scan
An MRI scan uses magnetism to build up detailed pictures of your body. It may be done to find out the size of the cancer and help decide on the operation you’ll have.
CT scan
A CT scan takes a series of X-rays, which build up a three-dimensional picture of the inside of the body.
Bone scan
A bone scan shows up abnormal areas of bone. You’ll have a small amount of a radioactive substance injected into a vein. You’ll then wait for 2 to 3 hours to have the scan.
Staging and grading of breast cancer
The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.
A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
Knowing the stage and grade helps your doctors plan the best treatment for you.
This information is about stage 1 to 3 breast cancer. If you have stage 4 breast cancer, you may find Macmillan Cancer Support’s information about secondary breast cancer helpful.
Receptors for breast cancer
Breast cancer cells may have receptors on the outside of the cells. Hormones, like oestrogen, can attach to the receptors and encourage the cells to grow.
Some breast cancer cells have too much of a protein called human epidermal growth factor receptor 2 (HER2) on their surface.
A doctor called a pathologist tests cancer cells taken during a biopsy or surgery for receptors.
The results help you and your doctor decide on the most effective treatment for you.
Hormone receptors
Breast cancer that has receptors for oestrogen is called oestrogen receptor positive or ER positive breast cancer. The term ER is used because the American spelling of oestrogen is estrogen.About 7 in 10 breast cancers in women (70%) are ER positive.
Hormonal therapy works well for ER positive breast cancer.
Breast cancer cells may also have receptors for the hormone progesterone (PR positive breast cancer). Your doctor will explain whether testing for progesterone receptors is useful in your situation.
Receptors for HER2
Some breast cancer cells have too much of a protein called HER2 on the surface. This is called HER2 positive breast cancer. The extra HER2 protein encourages the cancer cells to divide and grow.About 1 in 5 breast cancers (15 to 20%) are HER2 positive.Specific targeted therapy drugs are used to treat HER2 positive breast cancer. They lock on to the HER2 protein. This helps stop the cells from dividing and growing.
Triple negative breast cancer
Breast cancer that doesn’t have receptors for either HER2 or the hormones oestrogen and progesterone is called triple negative breast cancer.If you have triple negative breast cancer, you may be offered genetic testing. This is offered even if you don’t have a family history of breast cancer.
Most breast cancers caused by a change in the BRCA1 gene are triple negative. Your cancer doctor or breast care nurse can explain more about this to you.If you’re worried about breast cancer in your family, talk to your GP or breast specialist. They can refer you to a family history clinic or a genetics clinic.
Treatment
Treatment for breast cancer
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your doctor will explain the different treatment options and their side effects. They’ll also talk to you about the things you should consider when making treatment decisions.
The first treatment for breast cancer is often surgery to remove it. Your surgeon will talk to you about having one of these operations.
Breast-conserving surgery
Breast-conserving surgery is when the cancer and some surrounding normal breast tissue is removed.
Mastectomy
A mastectomy is when the whole breast is removed.
More treatments
You’ll usually need some, or all, of the lymph nodes in your armpit removed.
You may be asked to decide if you want surgery to make a new breast shape (breast reconstruction) during the operation. Some people may decide to have this done later.
Macmillan Cancer Support have more information about having an operation for breast cancer.
You may also need support when coping with how your breast looks after surgery.
Treatment before surgery
You may have treatment, like chemotherapy or hormonal therapy, before surgery. This is called neo-adjuvant treatment. It may be given:
- to shrink a larger cancer
- so you can have breast-conserving surgery instead of a mastectomy
Sometimes you may have chemotherapy or targeted therapy before surgery instead. This may be given for certain types of breast cancer, or when the cancer is growing more quickly. It’s given to reduce the risk of the cancer coming back.
Treatment after surgery
Your cancer doctor will usually offer you one or more of the following treatments after surgery. This is to reduce the risk of breast cancer coming back.
Radiotherapy
Radiotherapy uses high-energy rays. You’ll have it after breast conserving surgery and sometimes after a mastectomy.
Chemotherapy
Chemotherapy uses different drugs to treat breast cancer. You’ll usually have it as an injection into a vein or sometimes as tablets.
Hormonal therapy
Hormonal therapy reduces the amount of oestrogen in the body. It can prevent breast cancer cells from growing in women who have ER positive breast cancer.
Targeted therapy
Targeted therapies interfere with the way cells grow. They can reduce the risk of HER2 breast cancer coming back.
Bisphosphonates
Bisphosphonates are drugs that help to protect the bones against some effects of breast cancer treatments. They can also help reduce the risk of breast cancer spreading to the bones.
Macmillan Cancer Support have more information about treatments for breast cancer.
After breast cancer treatment
After treatment, you’ll have regular check-ups with your cancer doctor, or regular contact with your breast care nurse.
You’ll have mammograms every year for 5 years on the other breast.
If you’ve had breast-conserving surgery, you’ll have mammograms on both breasts.
If you’ve had a double mastectomy, you’ll not be offered mammograms.
After 5 years, if you’re 50 or over, you’ll usually have mammograms through the breast screening programmes.
Younger women usually continue to have yearly mammograms after the first 5 years, until they reach 50.
Be aware of changes
Your treated breast will look and feel different. Your nurse can tell you what you to expect and what to check for. It’s also important to be aware of what to look out for in your untreated breast.
Macmillan Cancer Support have more information about symptoms of breast cancer.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan Cancer Support also has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan breast cancer forum – you can talk to others affected by breast cancer, ask questions and share your experience
Lymphoedema
Lymphoedema is a swelling of the arm or hand on the side you had treatment. It sometimes happens after surgery or radiotherapy to the lymph nodes in the armpit. It usually develops slowly, months or years after treatment.
There are things you can do to help reduce your chances of developing lymphoedema. If you notice any swelling in your arm, hand or chest, always ask your doctor or nurse to check it. The earlier lymphoedema is diagnosed, the easier it is to manage and treat successfully.
Sex and fertility
Breast cancer treatments can have a direct effect on your sex life.
In younger women, some treatments may also affect your ability to get pregnant (fertility). For example, surgery may affect how you think and feel about your body (body image) which can affect your sex life.
It can take time to adjust to changes to your body. If you have a partner, it can help to talk openly with them about your feelings. If any difficulties don’t improve, ask your breast care nurse or doctor for advice.
If you haven’t been through menopause, your doctor or nurse will advise you not to use contraception containing hormones. Women thinking of getting pregnant in the future will usually be advised to wait for 2 years.
If doctors think your treatment may affect your fertility, it may be possible to remove eggs from your ovaries before treatment starts. This may mean you can have fertility treatment in the future.
Fertility issues can be hard to cope with. You may find it helpful to talk to a trained counsellor.
Early menopause
Some treatments can cause an early or temporary menopause. Hormonal therapy can cause side effects that are the same as menopausal symptoms.
Doctors don’t recommend hormone replacement therapy (HRT). This is because it contains oestrogen. This could encourage breast cancer cells to grow. But there are different ways of managing menopausal symptoms.
Early menopause can increase the risk of bone thinning (osteoporosis). Macmillan Cancer Support have more information about looking after your bones.
A number of organisations, including the Daisy Network, provide support to women going through the menopause.
Complications
After treatment, you might feel ready to make a few healthy changes, even if your lifestyle was already a good one. Small steps such as eating well and staying physically active can support your recovery and lift your sense of wellbeing.
Macmillan Cancer Support offers further guidance on adjusting to life after cancer treatment.
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