2023 October – Breast Cancer Awareness Month

Breast cancer is the most common type of cancer for women in Australia accounting for almost 30% of all cancers diagnosed in females. By the end of 2023 it is estimated that 20,500 females will have been diagnosed with breast cancer and that 3300 of previously and newly diagnosed women will die in 2023 as a result of breast cancer. Although breast cancer is more common and affects 1 in 8 women, men can also have breast cancer at a rate of about 1 in 667. The impact of a breast cancer diagnosis is not only felt by those diagnosed but by their loved ones too. October is breast cancer awareness month, and you might notice people wearing pink ribbons as a reminder to check yourself for signs of breast cancer, to talk about it with friends or loved ones, to learn more about breast cancer or to make a donation toward important and ongoing breast cancer research. Given the prevalence of breast cancer in Australia, many people wearing a pink ribbon and getting involved in breast cancer awareness month will be honouring those who have survived breast cancer or those who have passed away. This article will discuss the common types of breast cancer, symptoms, screening tools, common treatments, the outcomes of breast cancer and support for those who have or know someone who has a diagnosis of breast cancer.

What is Breast Cancer?

Breast cancer happens when cells in breast tissue start to grow in an uncontrolled way potentially spreading into other body tissues. Female breasts are composed of breast ducts which carry milk produced in the breast to the nipple, lobules which are the glands that produce milk and then fatty and connective tissues that support these structures. Breast cancer most commonly occurs in the cells that line the ducts and lobules and less commonly in the supporting tissues. The main types of breast cancer are non-invasive and invasive. These can be further described by their subtype.

Non-invasive breast cancers

Ductal carcinoma in situ (DCIS) and lobular carcinoma (LCIS) in situ are when the abnormal cancer cells are growing just within the ducts or the lobules of the breast and have not grown into other breast or body tissues. These are sometimes called “pre-cancers” and while they are not considered to be life threatening, they do increase the risk of developing invasive cancer over time and do need treatment and ongoing monitoring.

Invasive breast cancers

Most breast cancers are invasive at the time of diagnosis. This means that they have spread into the breast tissues surrounding the ducts or lobules or lymph nodes. Invasive ductal carcinoma (IDC) is the most common type of invasive cancer accounting for around 80% of cases. Invasive lobular carcinoma (ILC) is the other common invasive breast cancer. Over time both of these cancers can spread by the lymphatic system to other more distant parts of the body like the lungs, liver and brain.

Subtypes of breast cancers

There are subtypes of breast cancer, the common types including;

• Hormone receptor positive breast cancer which accounts for about 60-70% of breast cancers. In this subtype the cancer cells express receptors for female hormones (progesterone and oestrogen) which cause the cancer to grow.
• HER-2 receptor positive breast cancer occurs in around 20% of breast cancers. Here the cancer cells express a receptor called human epidermal growth factor receptor 2 (HER2) and this promotes cancer growth.
• Triple negative breast cancer means that the cancer cells do not have oestrogen, progesterone or HER2 receptors. This type of cancer is aggressive and accounts for about 15% of breast cancer.

You can have both hormone receptor positive and HER-2 positive breast cancer at once.

Do we know what causes breast cancer?

While the cause of a person’s breast cancer is not always clear there are some known risk factors for developing breast cancer. These include but are not limited to:

• female gender.
• increasing age.
• BRCA1 or 2 genetic mutations.
• increased breast density.
• prolonged use of oral contraceptives and hormone replacement therapy.
• excessive alcohol use.
• smoking.
• sedentary lifestyle and poor diet.
• a history of breast cancer in direct family members.

How do we find breast cancer?

Being on the lookout for common symptoms and undertaking self-screening is important for all people, in particular if you fall into the higher risk groups of being female, over 50 years of age, BRCA1 or 2 positive, have a direct family member with a history of breast cancer. But everyone should be vigilant.

Self-screening via a self-conduced breast exam or an examination completed by your GP is the first step in finding breast cancers. The exam is very simple, takes less than 5 mins to do (perhaps before you shower). It involves looking at your breasts in a number of positions and feeling your breasts in a systematic way so all areas including into your armpit and up to your collarbone are felt for changes. The most important thing is to check regularly and to know what is normal for your breast.

Things you or your doctor might notice during an examination that would prompt further evaluation for breast cancer might include:

• Lumps or thickening in the breast.
• Nipple sores or change in the nipple shape.
• Nipple discharge or turning in.
• Changes in the size or shape of the breast.
• Breast pain.
• Skin changes such as dimpling.

The majority of changes you might find when you self-examine are not likely to be breast cancer but if you notice something out of the ordinary it is important to follow it up with your GP. Not everyone who ends up being diagnosed with breast cancer has symptoms and as such other screening tools like mammograms are useful.

What is a mammogram and who needs one?

Mammograms are an x-ray of breast tissue that can locate changes that may be too small to be felt during a self or doctor conducted examination. Mammograms can either be a screening tool for women who have no signs or symptoms of breast cancer, or it can be used to further evaluate when there is suspicion of breast cancer due to a sign or symptoms, i.e., a lump. The mammogram is straight forward and brief but somewhat uncomfortable. You will be asked by the radiographer to remove your clothing from the waist up to expose your breast tissue. Each breast is then pressed between two x-ray plates to allow clear imaging of the breast tissue. Each breast has two x-rays taken for your doctor to review and discuss with you at a follow up appointment.

A screening mammogram is recommended every 2 years for all women between 50-74 years of age who have no symptoms and who are low risk for breast cancer. For women who have a parent, sibling or child with breast cancer undertaking screening mammograms from age 40 onwards should be seriously considered in discussion with your GP. For all women aged 50 and over, mammogram testing is free and can be arranged through Breast Screen Australia by invitation or through your own GP. If you are in a high-risk group your GP may recommend other investigations such as an MRI which is in part covered by Medicare. In general, a positive finding on a mammogram requires further investigation that may be invasive in nature, i.e., biopsy.

What happens if my doctor suspects I have breast cancer?

If your doctor suspects that you have breast cancer based upon a clinical finding, like a breast lump, they will arrange diagnostic imaging such as a mammogram or MRI. The suspicious mass will also need to have a biopsy. A biopsy involves the use of a needle to take a sample of tissue from the mass. This is done under a local anaesthetic. The sample is then sent for laboratory testing looking for cancerous cells. Breast cancer is diagnosed with a combination of clinical findings, radiological imaging and tissue biopsy pathology results. If you do have a diagnosis of breast cancer the next steps are to find out if the cancer has spread to lymph nodes nearby and possibly distant sites in the body (metastatic cancer) by taking a biopsy of nearby lymph nodes and/or imaging.

What are the common ways to manage breast cancer?

Managing cancer of any type requires a large team of health professionals who will co-ordinate care. These professionals usually include your GP, one or more surgical, medical oncology and radiation oncology specialists to guide surgical, chemo and radiotherapy approaches as well as other health professionals including breast care nurses, social workers and psychologists, pharmacists and other therapists. Treatment will depend on the size of a cancer, a patients age, the type of cancer and whether it has spread locally or to other body parts. Treatments may include any number of the following options;

Surgery

Surgical removal of breast tissue and lymph nodes in the axilla (armpit) is common. What is removed depends upon the stage of the cancer and whether the lymph nodes are involved. Breast conserving surgery may be appropriate where the tumour is small or has been made smaller with chemotherapy prior to surgery. When needed complete removal of all breast tissue in a procedure called a mastectomy is indicated.

A sentinel node biopsy will likely be done. A sentinel node biopsy is the removal and testing of the first lymph node that cancer cells are likely to spread to from a primary breast tumour. If this node is clear of cancer, then it is very unlikely to have spread further. If there are signs of cancer in the sentinel node, then further lymph nodes in the armpit will be removed and further imaging will be arranged to determine if any other organs are showing signs of cancer.

Chemotherapy

Chemotherapy involves using medication that “kills” cancer cells. There are many chemotherapy agents, and these can be directed at the type of breast cancer present. Chemotherapy can be used before surgery (neoadjuvant) or after surgery (adjuvant). Chemotherapy before undergoing surgical excision of a tumour improves patient outcomes by shrinking the size of the tumour and in many cases decreasing the amount of tissue that needs to be taken (breast conservation vs total removal of breast tissue) to treat the cancer and allows more time for surgical planning, genetic testing and other interventions.

Hormone and Targeted Therapies

Hormone therapy is used to reduce the amount of female hormones in the body which helps to slow the growth of cancer cells that have hormone receptors on their surface. Which hormone therapy will depend upon factors like age, breast cancer type and whether you have reached menopause. Targeted therapy uses drugs that attack targets within the cancer cells and are currently only used in HER2 positive breast cancer.

Radiation therapy

Radiation therapy is a key part of overall breast cancer treatment for most patients particularly those who have breast conserving surgical intervention. The aim of this treatment is to destroy any undetected cancer cells. Generally, if breast tissue is completely removed in a procedure called a mastectomy, radiation therapy can be avoided in most instances. Radiation therapy can have significant side effects also known as “toxicities” including breast pain, formation of hard fibrous tissue in the treated area and potentially the lungs as well as heart problems.

Palliative Care

In some situations, breast cancer is found very late, and it has spread too far for a curative approach to treatment. In this case a palliative care doctor alongside your GP, other specialists and health care professionals may be involved to help co-ordinate treatments like chemotherapy, targeted therapy and radiotherapy to slow the progression of cancer and reduce symptoms like pain. The overall goal of palliative care is to improve the quality of life left to a person and can play a pivotal role in successful end of life care for patients and their loved ones.

Breast cancer outcomes

Due to improvements in the early detection of breast cancer and better treatment options for those diagnosed with cancer the 5-year relative survival rate for all breast cancers has improved across time. Most people will now have their breast cancer found while it is in Stage I (no spread from the original site and less than 2 cm in size) or Stage II (spread only within breast tissue or to lymph nodes and larger than 2cm in size.) The 5-year survival rate for breast cancer in women is 92% and 86.5% for men, meaning that 92% of women and 86.5% of men diagnosed with breast cancer, will survive 5 years after their diagnosis.

Summary

Breast cancer can be detected early through knowledge of common signs of breast cancer, regular breast self-examination, seeking help early from your GP and appropriate screening with a mammogram based upon your risk of breast cancer. The options for treatment of diagnosed breast cancer are improving due to the ongoing research into breast cancer detection and management and the 5-year survival rate for men and women diagnosed with all types of breast cancer is very high.

If you have any high-risk features or signs and symptoms in your breasts that you are concerned about do not wait to speak with your doctor. If you already have a diagnosis of breast cancer and are looking for support for yourself or your loved ones see the links below or speak with your doctor or other breast cancer health professional today.

Support Resources

General information about all types of breast cancer can be found at the Cancer Council of Australia website.

Pink hope is an organisation that is involved in personal support, breast cancer research and education as well as health advocacy for those people at high risk of cancer. More information about how they may be of help can be found on their website.

The breast cancer network Australia is an organisation that provides education, support and advocacy for people with a diagnosis of breast cancer as well as their loved ones. More information can be found on their website.

Talk to a Doctor Today!

Stay on top of your health. If you wish to learn more about breast cancer or have noticed any symptoms, speak to a doctor today and book a consultation.