Breast cancer in women

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 the Cancer Explained video, Dr Aziza Sisay is joined by Dr Hayley McKenzie. Together 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 into the surrounding breast tissue, outside the milk ducts or lobules in the breasts where they started.

People who have breasts include women, transgender (trans) men and people assigned female at birth.

Macmillan Cancer Support, a UK charity, 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.

Macmillan Cancer Support also has more information if you're LGBTQ+ and living with cancer.

Breast cancer isn't one single disease, and there are different types. It helps to know which type you have, because your doctors use that to decide on the best treatment for you.

A lump in the breast is the most common symptom of breast cancer. You can find lumps anywhere in your breasts, in your armpit or around your collarbone.

If you do find a lump, it doesn't necessarily mean you have cancer. But you do need to see a doctor to rule it out, especially if you're over 30.

Other signs and symptoms to look out for include:

• bleeding or crusty nipples
• skin dimpling
• one nipple that becomes, and remains, permanently turned in
• skin like orange peel
• leaking nipples

In the video below, Bami talks about the importance of checking your breasts and knowing what is normal for you.

If you have any symptoms, or notice anything else that is unusual for you, speak to your doctor.

If breast cancer is diagnosed and treated early, treatment is more likely to be successful.

You'll usually start by seeing your doctor. They'll examine you and refer you to a breast clinic to see a specialist.

This is usually if there are changes on your mammogram. Breast screening is a way of getting checked so that breast cancer is found at an early stage, when it is too small to be felt or seen.

At the breast 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.

After you have been examined, your doctor or nurse will tell you which tests you need:

A mammogram is a low-dose X-ray of the breast.

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.

In a breast biopsy, a doctor takes out a small piece of tissue or a few cells from the lump or the abnormal area in the breast. The sample is then checked for cancer cells. There are different ways of taking a breast biopsy.

If your biopsy results show breast cancer cells, you'll need more tests. Some of these check your general health, and you may have any of the following.

You'll have a blood test to check your general health and to see how well your kidneys and liver are working.

You'll have a chest X-ray so the doctors can check your lungs and heart.

You may also need other tests to learn more about the size of the breast cancer, and whether it has spread anywhere else in the body. This is known as the stage of the cancer.

An MRI scan uses magnetism to build up detailed pictures of the inside of your body. For breast cancer, doctors may use it to find out the size of the cancer and to help decide which operation you'll have.

A CT scan uses a series of X-rays to build up a three-dimensional picture of the inside of your body.

A bone scan shows up abnormal areas of bone. For this test, a small amount of a radioactive substance is injected into a vein. Then you wait for 2 to 3 hours before the scan is done.

Some breast cancer cells have receptors on the outside of them. Hormones such as oestrogen can attach to these receptors and encourage the cells to grow.

Some breast cancer cells also carry too much of a protein called human epidermal growth factor receptor 2 (HER2) on their surface.

A doctor called a pathologist tests the cancer cells for these receptors. The cells are taken during a biopsy or during surgery.

The results help you and your doctor decide which treatment will work best for you.

Breast cancer that has receptors for oestrogen is called oestrogen receptor positive breast cancer, or ER positive breast cancer. The "ER" comes from the American spelling of oestrogen, which 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.

Some breast cancer cells carry too much of a protein called HER2 on their surface. Doctors call this 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, and this helps stop the cells from dividing and growing.

Triple negative breast cancer is breast cancer that has no receptors for HER2, and none for the hormones oestrogen and progesterone.

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 doctor or a breast specialist. They can refer you to a family history clinic or a genetics clinic.

A team of specialists will meet to decide on the best treatment for you. This team is called a multidisciplinary team (MDT).

Your doctor will explain the different treatment options and their side effects. They'll also talk with you about what you should think over before you make any decisions about treatment.

For breast cancer, the first treatment is often surgery to remove it. Your surgeon will talk to you about which of these operations you could have.

In breast-conserving surgery, the surgeon removes the cancer along with some of the normal breast tissue around it.

A mastectomy is an operation where the whole breast is removed.

Most people having surgery for breast cancer will need some, or all, of the lymph nodes in the armpit removed.

During the operation, you may be asked whether you want surgery to make a new breast shape (breast reconstruction). Some people decide to have this done later instead.

You may also need support in coping with how your breast looks after surgery.

Some women have treatment before surgery, such as chemotherapy or hormonal therapy. This is called neo-adjuvant treatment, and it may be given for two reasons:

• 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. Doctors may do this for certain types of breast cancer, or when the cancer is growing more quickly. It's given to reduce the risk of the breast cancer coming back.

After surgery for breast cancer, your cancer doctor will usually offer you one or more of the treatments below. The aim is to lower the risk of the cancer coming back.

Radiotherapy for breast cancer uses high-energy rays. You'll have it after breast conserving surgery, and sometimes after a mastectomy.

Chemotherapy treats breast cancer using different drugs. You'll usually have it as an injection into a vein, though sometimes it's given as tablets.

Hormonal therapy lowers the amount of oestrogen in your body. In women who have ER positive breast cancer, this can stop the cancer cells from growing.

Targeted therapies work by interfering with the way cells grow. In breast cancer that is HER2 positive, they can lower the chance of the cancer coming back.

Bisphosphonates are drugs that support your bones by protecting them against some effects of breast cancer treatments. They can also help reduce the risk of breast cancer spreading to the bones.

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, the mammograms will cover both breasts. A double mastectomy is different, and in that case you won't be offered mammograms.

Younger women usually carry on with yearly mammograms after the first 5 years, until they reach 50.

Your treated breast will look and feel different. Your nurse can tell you what to expect and what to check for. You also need to know what to look out for in your untreated breast.

Macmillan Cancer Support have more information about the symptoms of breast cancer.

You may feel anxious between appointments. This is natural. It can 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, where you can talk to others affected by breast cancer, ask questions and share your experience

Lymphoedema is a swelling of the arm or hand on the side where you had treatment. It can happen after surgery or radiotherapy to the lymph nodes in the armpit. It usually comes on slowly, often months or years after the treatment is over.

There are things you can do to lower 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.

Breast cancer treatments can affect your sex life directly. In younger women, some treatments may also affect the ability to get pregnant (fertility). Surgery, for example, may change how you think and feel about your body (body image), and that can in turn affect your sex life.

It can take time to get used to changes in your body. If you have a partner, it can help to talk openly with them about how you feel. If the difficulties don't get better, 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 that contains hormones. Women who are 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 problems can be hard to cope with. You may find it helpful to talk to a trained counsellor.

Some treatments can bring on an early or temporary menopause. Hormonal therapy can also cause side effects that are the same as menopausal symptoms.

Doctors don't recommend hormone replacement therapy (HRT) because it contains oestrogen, and that could encourage breast cancer cells to grow. There are other ways to manage menopausal symptoms, though.

Early menopause can raise 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, give support to women going through the menopause.

Even if you already live a healthy life, you may choose to make some positive changes after your treatment for breast cancer. Small changes, like eating well and keeping active, can improve your health and wellbeing and help your body recover.

Macmillan Cancer Support has more information on finishing cancer treatment.

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