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Breast cancer facts October 2019

 

Breast cancer facts October 2019

By Professor Gordon Wishart, consultant breast surgeon

 

Incidence
  1. Breast cancer is the most common cancer diagnosed in the UK, and the most common cancer in women, with more than 54,000 cases per annum. Breast cancer incidence is strongly related to age, with the number of cases rising steadily from age 30-34. Currently 1 in 8 women will be diagnosed with breast cancer but this is predicted to rise to 1 in 7 by the year 2024.

Risk factors
  1. There are a number of risk factors for breast cancer including family history, lifestyle, hormonal & genetic factors. Breast cancer is NOT caused by deodorants, underwired bras, smoking or high-fat diets. You can reduce your risk by breastfeeding, reducing your alcohol intake, taking more exercise, losing weight if post-menopausal or stopping HRT.

Genetics
  1. Inheritance of one of the known breast cancer genes (BRCA1 & BRCA2) is extremely rare in the population, and usually only affects families with at least four close family members with breast and/or ovarian cancer, but if present has up to a 90% of causing breast cancer during that patient’s lifetime. It is now recognised that there are many other genetic variants (SNPs) that cause smaller, additive breast cancer risk and these can now be analysed in a saliva DNA sample. Genetic testing of blood/saliva and the tumour itself is likely to become much more common during the next 5-10 years to help select the optimal treatment for individual patients, what is now call personalised medicine.

Symptoms
  1. Common symptoms include finding a lump in your breast, an area of skin dimpling or puckering or bleeding from the nipple. Breast pain is a very common symptom in women of all ages and is not commonly associated with breast cancer. If you find a new change in your breast, check with your GP to find out if you need referred to a breast clinic for further investigation.

Breast awareness
  1. The majority of women find a lump in their breast themselves, so being breast aware and checking yours breasts monthly is a good idea. Look for any changes in your breasts standing in front of the mirror with your arms by your side then raised, and if you examine yourself, do it lying down in bed or the bath as this picks up lumps more easily. If you find a new change in your breast, check with your GP to find out if you need referred to a breast clinic for further investigation.

Screening
  1. Mammography is the only method of breast screening that has been shown to save lives. Despite a free 3-yearly programme of screening mammography in the UK from age 47, uptake has been slowly falling and is now close to 70%. In general, screen-detected breast cancers require less treatment and have a better survival than those detected following the development of a lump or other symptoms.

One-stop clinics
  1. If you find a lump or other change in your breast, make sure you get referred to a one-stop breast clinic, where all the investigations (breast examination, breast ultrasound +/- mammograms and biopsy if required) are preformed on the same day. A Cambridge study has shown that this “triple assessment” approach to investigation makes the correct diagnosis in 99.6% of cases. This is higher than any other diagnostic process in medicine.

Treatment
  1. Breast cancer treatment can involve a number of different treatment options including surgery, chemotherapy, hormone therapy, radiotherapy and targeted treatment such as Trastuzumab (Herceptin). Not all patients require all these treatments, and your breast team will recommend the optimal treatment for you based on the characteristics of the tumour and your general health. Surgery is the most important treatment in terms of long-term survival, and the other treatments provide additional smaller survival benefits on top of that.

Survival
  1. Breast cancer survival has been improving since the 1980s due to the development of specialist breast cancer teams, greater breast awareness, breast screening and improved breast cancer treatments. Survival rates in England are comparable with the best countries in Europe (Norway. Sweden) up to around age 65, so make sure your friends and family over this age get offered all treatment options. In general, 2 out of every 3 women diagnosed with breast cancer will now survive for 20 years or more.

General information
  1. Finally, there is so much written about breast cancer that is wrong or misleading. There is however a wealth of information from more reputable websites such as Cancer Research UK and cancer charities such as Macmillan. If you are diagnosed with breast cancer, the best source of information is your breast surgeon, your breast oncologist and your specialist breast cancer nurse so make sure you ask them all the questions that are important to you.

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