Overview
The breast is made of milk glands, the ducts that carry milk, and fat. Breast cancer begins when cells in this tissue divide out of control and form a lump.
Left alone it can spread to the lymph nodes under the arm and then to the bones, lungs or liver. Found early, it is far more likely to be controlled.
Symptoms
The first sign is usually a new lump or thickening in the breast, chest or armpit. It is often firm and frequently painless.
- A new lump or swelling in the breast, chest or armpit
- Dimpling or puckering of the skin, like orange peel
- A change in the size, shape or colour of one breast
- A nipple that turns inwards, or a rash or crusting on it
- Nipple discharge, especially if it is blood stained
Most lumps are not cancer, and these changes often have harmless causes. Examination and tests are the only way to tell.
When to see a doctor
See a doctor within a few days for any new lump, a change in the skin or nipple, nipple discharge, or a change in the size or shape of one breast.
Causes
Breast cancer starts with gene changes inside breast cells that let them multiply without stopping. Most build up over a lifetime and are not inherited.
Female hormones affect how the tissue grows, which is why menstrual life, pregnancy and breastfeeding shift the risk. A small share of cases run in families, through inherited changes such as BRCA1 and BRCA2.
Risk factors
- Being a woman, and growing older: most cases are found after fifty
- A mother, sister or daughter with breast or ovarian cancer, or an inherited BRCA1 or BRCA2 change
- A past breast cancer, or to the chest
- Periods starting early, menopause coming late, no pregnancy, or not breastfeeding
- Being overweight after menopause, drinking alcohol, or being inactive
- Hormone replacement therapy
Complications
Untreated, the cancer grows into nearby tissue, reaches the lymph nodes, and can settle in the bones, lungs, liver or brain. Cancer that has spread can often be controlled for a long time, but it is much harder to cure.
Treatment brings its own problems: tiredness, hair loss, nausea and infections with , arm swelling after lymph node surgery, and early menopause. Each can be helped, so tell the team.
Prevention
- Keeping to a healthy weight, particularly after menopause
- Being physically active on most days, and limiting alcohol
- Not using tobacco in any form
- Breastfeeding, where that is possible
- Knowing how your breasts normally look and feel, and reporting a change early
Women with a strong family history can be offered genetic counselling and that starts earlier or happens more often.
Diagnosis
A breast clinic usually does three things in one visit: the doctor examines both breasts and the armpits, an image is taken, and cells are sampled if anything looks doubtful.
The image is a , an X-ray of the breast, or an scan, often preferred in younger women whose breast tissue is denser. A takes a small core of tissue with a needle under local anaesthetic.
If cancer is confirmed, the sample is tested for hormone receptors and for HER2, and scans look for spread.
Treatment
Treatment is planned by a team and almost always combines more than one approach.
- Surgery to remove the lump with a margin of healthy tissue, or the whole breast, usually with some lymph nodes
- , often after surgery that conserves the breast
- , given before or after surgery
- Hormone treatments, for cancers that grow in response to oestrogen
- Targeted medicines, for cancers that carry HER2
Reconstruction can be done at the same operation or later. Finishing the whole planned course matters, and follow up then continues for years.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Any lump in the breast means cancer.”What is true?
Fact
Most breast lumps are not cancer. Cysts, fibroadenomas and other harmless changes are common, and breast tissue also feels lumpy at some points in the month. Even so, a lump cannot be judged by feel alone, so it is examined and, if needed, scanned and sampled.
Myth“Breast cancer only happens to women whose mother or sister had it.”What is true?
Fact
A family history does raise the risk, but it is not needed for breast cancer to develop. The main risk factors are simply being a woman and growing older, and most breast cancers are found after the age of fifty.
Myth“A biopsy or an operation makes the cancer spread.”What is true?
Fact
Reviews of the evidence find no meaningful link between a needle biopsy and the cancer returning locally, spreading to other organs or shortening survival. Fear of this is a common reason tests get delayed, and the delay is the real danger.
Myth“Men cannot get breast cancer.”What is true?
Fact
Men have breast tissue too, and a small share of breast cancers occur in men. A lump behind the nipple, a nipple that pulls in, or discharge in a man should be examined in exactly the same way.
Myth“A lump that does not hurt is nothing to worry about.”What is true?
Fact
Breast cancer lumps are often painless, which is one reason they are ignored. Pain is a poor guide in either direction, so whether to get a lump checked should not depend on whether it hurts.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
If most lumps are not cancer, why bother getting mine checked?
Because no one can tell the difference by feel alone, not even an experienced doctor. A short examination, a scan and, where needed, a needle sample settle the question in a week or two. If the lump is harmless you can stop worrying, and if it is not, it has been caught at the easiest stage to treat.
Will I lose my breast?
Not necessarily. Many women have only the lump and a margin of surrounding tissue removed, usually followed by radiotherapy. Whether the breast can be conserved depends on the size and position of the cancer and on its type. Where the whole breast does have to be removed, reconstruction can often be offered.
How often should a mammogram be done?
A mammogram uses a low dose of X-rays, and screening programmes exist because finding breast cancer early lowers the number of deaths from it. Different countries invite women at different ages and intervals, commonly from around the age of forty or fifty. Ask your doctor what suits your age and family history.
Can breast cancer come back after treatment is finished?
It can, which is why follow up appointments continue for years and why hormone tablets are often taken for a long time after surgery. Tell the team about a new lump, bone pain that does not settle, breathlessness or weight loss you cannot explain, rather than waiting for the next scheduled visit.
