LIVING WITH CANCER

Breast cancer develops when cells within the breast begin to grow in an uncontrolled way. It most commonly starts in the ducts that carry milk to the nipple or the lobules that produce milk.

Although breast cancer mainly affects women, men can develop it too. If untreated, cancer cells can spread beyond the breast to nearby lymph nodes or other parts of the body such as the bones, liver, or lungs.

Who’s most at risk and why

The risk of breast cancer increases with age and is most commonly diagnosed in women over 50.

Some people have a higher risk due to family history or inherited genetic changes such as BRCA1 or BRCA2. Lifestyle factors can also play a role. Drinking alcohol, being overweight after menopause, and long-term use of hormone replacement therapy have all been linked to a higher risk.

Breast cancer in men is rare but can occur, particularly where there is a strong family history or hormonal imbalance.

Knowing the signs

Many people first notice a change in the breast or underarm area. A lump or thickening in the breast is one of the most common signs. Other changes may include a difference in size or shape, dimpling of the skin, redness, or a rash around the nipple.

The nipple may also change in appearance, sometimes turning inward or producing discharge. Some people notice persistent discomfort or swelling in part of the breast.

Most breast changes are not cancer, but any new or unusual change should be checked by a GP.

Diagnosis: Is it cancer?

People usually enter the diagnostic pathway in one of three ways. Some visit their GP after noticing a change. Others are identified through the national breast screening programme. Occasionally breast cancer is discovered during tests carried out for another reason.

Initial checks may include a physical examination and imaging such as a mammogram or ultrasound scan. If further investigation is needed, a biopsy may be taken so the cells can be examined under a microscope.

The results are reviewed by specialists who determine the type and stage of the cancer and explain the next steps.

What’s going to happen

If breast cancer is confirmed, your case will usually be reviewed by a multidisciplinary team. This team may include surgeons, oncologists, radiologists, pathologists, and specialist nurses.

Together they consider the type of cancer, how far it has spread, and your overall health before recommending the most appropriate treatment plan.

Treatment

Treatment depends on the type and stage of breast cancer and your overall health.

Surgery is often the first step. This may involve removing the tumour and a small area of surrounding tissue (lumpectomy) or removing the whole breast (mastectomy). Nearby lymph nodes may also be examined to check whether the cancer has spread.

Radiotherapy is frequently used after surgery to destroy any remaining cancer cells and reduce the chance of the cancer returning.

Chemotherapy uses drugs to destroy cancer cells. It may be given before surgery to shrink a tumour or after surgery to lower the risk of recurrence.

Some breast cancers are driven by hormones such as oestrogen. In these cases, hormone therapy may be used to block the effect of those hormones. Targeted therapies such as trastuzumab (Herceptin) may also be offered when specific proteins are present.

In certain situations, particularly with triple-negative breast cancer, immunotherapy may also be considered.

If the cancer has spread more widely, treatment may focus on controlling symptoms, slowing the disease, and maintaining quality of life.

Prognosis

Outcomes for breast cancer have improved significantly over recent decades. When the disease is detected early, treatment is often very successful and many people go on to live long and healthy lives.

More advanced or aggressive types of breast cancer may require longer or more intensive treatment. Even in these cases, ongoing advances in targeted drugs and immunotherapy continue to improve outcomes.