Breast cancer remains the most common cancer in the UK affecting over 55,000 people each year.
Worldwide, almost 2 million women are diagnosed with this disease that can also affect men (approximately 400 UK male cancers a year). Over the last 30 years, breast cancer survival has been improving in the UK – due to combination of early diagnosis, better treatments and screening.
A diagnosis of breast cancer is often made in women in their prime of life. This can be devastating to family members and subsequent treatment can interfere with work and life commitments. It is worth remembering that outcomes for the majority of breast cancers are very good with 95% of women expected to survive their disease after 1 year and 85% alive at 5 years.
UNDERSTANDING A DIAGNOSIS OF BREAST CANCER
It is important to understand what a diagnosis of breast cancer may mean as this will often determine subsequent treatments. Accessing non-recognised websites and information resources can often create more anxiety, creating unrealistic expectations regarding cancer outcomes.
Important initial questions to ask your breast specialist are:
Is this invasive or pre-invasive disease?
What is the size of the disease?
What is the grade of breast cancer?
Is the cancer sensitive to hormones?
Is the cancer HER2 positive?
Is there evidence that lymph nodes (lymph glands in the armpit) are involved?
“I had a fibroadenoma which had grown very big up to 11cm long. I began to feel very insecure about my body. I decided that it was time to get an excision. It has now been 4 weeks since I have surgery and having looked at my scar it is not visible due to my breast covering it! Mr Basu was honestly the best.”
Once the behaviour of the breast cancer is appreciated the treatments offered should make more sense. In general there are 5 recognised treatments for breast cancer which include:
4. Anti-hormone treatment (anti endocrine treatment)
5. Targeted therapy e.g. Anti HER2 treatment
Recommendations regarding treatment and sequence (e.g. surgery first?, chemotherapy first?) should have been discussed in a multi-disciplinary meeting so that it is a consensus based decision rather than an individual’s preference.
The NHSBSP (NHS Breast Screening Programme) was introduced in 1988 to screen healthy women aged 50-70 using a mammogram for breast cancer. Since 2012 the AgeX trial has offered additional screening to women aged 47-49 years and 71-73 years.
Women diagnosed with a screen detected breast cancer require special consideration, as a diagnosis of breast is often unexpected given that there are no symptoms. Medical experts remain concerned regarding the potential of overdiagnosis and overtreatment and several national and international clinical trials have been setup to understand this further.
Familial Breast Cancer and Genetic Testing
Approximately 5-10% of all breast cancers have a familial component to it – commonly known as heritability. The majority of breast cancers arise without an apparent cause, what we call spontaneously. Those where a familial component is suspected, will tend to have certain characteristics that are discussed below.
Given that breast cancer is so common, many women are related to or know someone who has been touched by this disease. Often we will see women in the breast clinic concerned about their own personal risk of developing breast cancer.
Familial breast cancer tends to
present in women at an earlier age
be associated with other types of cancer – in particular ovarian cancer
affect multiple members in a family. A common mistake is to assume that only cancers from the mother’s side affect risk. In reality, both the mother and father’s history are relevant. Close relatives diagnosed at a younger age (i.e. sister, mother – are known as first degree relatives, paternal or maternal aunt/grandparent – are known as second degree relative)
have certain “biological” features – under the microscope, the may look different to common types of breast cancer and also behave differently
Establishing familial breast cancer risk amongst women with breast cancer or healthy women with a family history is important as it may have serious consequences for the rest of the family. In addition, the risk of associated cancers needs to be considered, in particular ovarian cancer.
RISK REDUCING MASTECTOMY
In May 2013, Angelina Jolie shared her news of carrying a faulty BRCA1 gene and her decision to undergo risk-reducing mastectomy.
Since then, genetics clinics around the UK have been inundated with requests for genetic testing and risk-reducing surgery. Genetic testing is a very guarded tool offered to those who are deemed to be at increased risk. Many women not falling into this category may request testing and will ultimately be denied this if they do not fulfil certain criteria of risk. It is important to appreciate that the vast majority of familial breast cancers occur in women with an as yet unidentified genetic mutation.
Several options are available to those who are at risk of familial breast cancer. This will include tablets, risk-reducing surgery and surveillance with appropriate breast imaging. It is important to respect personal choice in this matter as reasons for considering any of the various options may be complex.