What is breast cancer and how common is it?
Breast cancer occurs when abnormal breast cells grow in an uncontrolled way. These abnormal cells can invade the surrounding tissue and may spread to other parts of the body. Breast cancer is the most common cancer amongst women and likely to become the most common cancer overall. 1 in 8 women will develop breast cancer in their lifetime. It also affects a small number of men each year. Fortunately, breast cancer treatments are continuously evolving and becoming more effective. The prognosis of breast cancer is quite good, with 91% of breast cancer patients surviving at least 5 years.
Am I at risk of breast cancer?
As a woman, during your lifetime, there are many factors that can influence your risk of breast cancer. Risk factors for breast cancer can include personal factors, family history and genetic factors, hormonal and lifestyle factors. Some of the factors are modifiable (they can be changed), such as lifestyle factors and medication use. It is known that keeping a healthy weight, reducing alcohol intake and undertaking regular physical activity can reduce your risk of breast cancer. Unfortunately, other factors cannot be changed, such as age, gender and family history. Having one of more risk factors for breast cancer does not necessarily mean that you will develop breast cancer. At your appointment, Dr Bell will perform a detailed assessment of your breast cancer risk and discuss this with you. If applicable, Dr Bell will recommend a tailored screening program and discuss options to reduce your breast cancer risk.
For more information regarding risk factors for breast cancer, please visit these websites:
How can breast cancer be detected?
Breast cancer generally presents in one of two ways, symptomatic or via screening. The diagnosis will be made by conventional breast imaging (mammogram/ultrasound) and a biopsy. Occasionally, specialised scans (such as MRI scans) are required to help with the diagnosis.
Symptoms of breast cancer
Breast cancer can present with a number of different breast symptoms.
The most common presentation is the finding of a new breast lump
Other presenting symptoms include:
a new thickening or ridge
a change in size or shape of the breast
skin changes, such as dimpling or redness
nipple changes including:
new nipple inversion
change of the nipple skin (crusting or redness)
unusual unilateral breast pain (uncommon presentation)
In rare cases, breast cancer will be detected when it has already spread to other organs (metastatic breast cancer). The symptoms depend on what part of the body is affected (most commonly bone, liver, lungs or brain).
Breast cancer screening
What is the role of breast screening?
Australia has a national breast cancer screening program (BreastScreen Australia) that aims to detect breast cancer early and reduce illness and death from breast cancer. The earlier the cancer is found, the better the chances of surviving it.
Who is eligible for breast screening?
Women aged 50-74 years are invited to have a free screening mammogram every 2 years. However, BreastScreen will also accept women between 40-49 years of age and those older than 74.
Find out more at Breastscreen QLD.
What are the types of breast cancer?
There are multiple types of breast cancer. Each type has its own characteristics and management. Dr Bell will be able to discuss your diagnosis with you and formulate a specific treatment plan. The most common types are listed below.
Non-invasive breast cancer
DCIS (Ductal Carcinoma In Situ)
DCIS is a condition in which there are cancer cells present within the milk ducts of the breast, but they are confined to the duct by a protective layer. Over time, these cancer cells may break through this layer into the surrounding breast tissue and become an invasive cancer. As we cannot accurately predict when or if this will happen, DCIS is currently always treated by surgical excision and radiotherapy may be recommended.
LCIS (Lobular Carcinoma In Situ)
Even though the name suggests that this is a similar condition to DCIS, it is not considered to be a precursor to invasive breast cancer, but more of a risk factor for developing breast cancer in the future. If a needle biopsy reveals LCIS, generally a surgical (open) breast biopsy will be performed to rule out any surrounding malignant (cancerous) changes. Given the higher risk of breast cancer, Dr Bell will discuss a tailored screening program with you.
Invasive breast cancer (carcinoma)
Invasive carcinoma, no specific type (NST)
This is by far the most common type of breast cancer, accounting for 70-80% of all invasive breast cancers. It is also known as invasive ductal cancer (IDC) and arises from the ducts of the breast.
Invasive lobular carcinoma (ILC)
ILC is the 2nd most common breast cancer type, accounting for 10% of cases. It arises from the lobules of the breast and can have microscopic extensions which may not be visible on conventional breast imaging. Generally, Dr Bell will order an MRI scan to further delineate the size of the cancer. Lobular cancers also have a slightly higher chance to affects both breasts (bilateral cancer).
Other types
A number of other types of breast cancer account for the remaining invasive breast cancers. These include tubular carcinoma, mucinous carcinoma, medullary carcinoma, metaplastic carcinoma and others.
Other specific cancers
Inflammatory breast cancer
This is a specific type of breast cancer that presents with a red or inflamed-looking breast with possible skin dimpling or pitting. The breast may feel swollen and enlarged. This type of cancer behaves more aggressively, but fortunately is quite rare. Generally, chemotherapy will be the first line of treatment, followed by surgery.
Paget’s disease of the nipple
This is a rare presentation of breast cancer in which skin changes appear on the nipple and surrounding tissue (areola). These changes may involve crusting and an eczematous appearance. This condition is often associated with underlying DCIS and/or invasive cancer.
Malignant phyllodes tumour
Amongst phyllodes tumours, malignant phyllodes tumours are the least common variant. These tumours arise from the stromal cells of the breast and have a leaf-like pattern. Treatment generally includes surgery and radiotherapy.
What other features of breast cancer are important for my treatment?
Receptor status
Each breast cancer will be tested for the absence or presence of 3 receptors:
2 hormone receptors
Oestrogen (ER) and Progesterone (PR) receptors
Overexpression of HER-2 receptors
Breast cancers can be characterised into different subtypes by whether or not they are ER, PR and HER-2 positive and this greatly influences management. For example, breast cancer patients who have ER/PR positive tumours may be recommended hormonal treatment as part of their management. Dr Bell will be able to discuss the receptor status of your cancer with you, as well as the likely implications for your treatment.
Size of the cancer
Usually, breast imaging will give an indication of the size of the tumour. However, the final measurement will be on the pathology report, available after surgery.
Grade of the cancer
Breast cancer are graded into 3 grades
Grade 1 (low grade/well differentiated) – usually slow growing
Grade 2 (intermediate grade/ moderately differentiated) – intermediate growth
Grade 3 (high grade/poorly differentiated) – faster growing
Stage of the cancer
The extent or stage of breast cancer is based on the TNM (Tumour, Nodal and Metastases) system used by the AJCC (American Joint Committee on Cancer). This is an internationally accepted system to determine the stage of a variety of cancers.
Each component (T for primary breast tumour, N for lymph node status and M for distant metastases) receives a score that describes the size and extent of the cancer. Based on this score, the final stage of the cancer is calculated. The final stage ranges from stage 0 (non-invasive cancer) to stage IV (metastatic cancer).
How is breast cancer treated?
Dr Bell will have an extensive consultation with you to take a further history, perform a breast examination and discuss your imaging and biopsy findings. Breast cancer treatment consists of a multimodality approach in which several specialists work closely together to recommend the best practice treatment pathway for each individual patient. Generally, the treatment modalities for breast cancer include breast and axillary surgery, chemotherapy (including targeted agents such as Herceptin), radiotherapy and endocrine or hormonal treatment. Most patients will not require all of the available treatments.
Dr Bell will be able to advise you of your surgical options and discuss your diagnosis at the regular Multidisciplinary Team (MDT) meetings, which are also attended by medical oncologists, radiation oncologists, pathologists, radiologists, geneticists and breast care/oncology nurses. Usually, the first step in breast cancer treatment is surgery. However, in certain situations the MDT recommends starting with chemotherapy first (neoadjuvant chemotherapy), after which surgery will follow.
For more information regarding neoadjuvant therapy, please see the following website: www.myneoguide.com.
What support is there for breast cancer patients?
Being diagnosed with breast cancer can be overwhelming and daunting. Having breast cancer can have a significant impact on multiple aspects of your life. Dr Bell will address your specific concerns and worries. She works closely together with an excellent team of breast care nurses and oncology nurses and has access to physiotherapists, psychologists and social workers. Together we can help you make your breast cancer journey as smooth as possible.