Wednesday 19 September 2018

12 facts about breast cancer

Breast cancer is the most common malignant tumour found in Irish women, with 2,883 cases diagnosed each year. One in 10 women will get it at some stage in their lives. While it's most commonly detected after the age of 50, it can occur in younger women too, writes Dr Reem Salman

Responsible health choices reduce your risk of breast cancer
Responsible health choices reduce your risk of breast cancer
It is important to be breast aware

Some breast cancer risk factors - such as being a woman, age and genetics - can't be changed. Others, however, are in our control. We can make responsible health choices: eat a healthy diet, practice stress management techniques that work for you and stay active. Below are 12 facts every woman should know.

1 A LUMP DOES NOT ALWAYS MEAN BREAST CANCER - Breast cancer can present in many different ways, not just through the presence of a lump. The first symptom of breast cancer for many women is a lump in their breast, but nine out of 10 breast lumps (90pc) are benign. Only one in six breast cancer patients do not have a lump and four out of five biopsies of breast lumps are benign - meaning that they are harmless and certainly not breast cancer.

2 Breast cancer risk increases with age - There is no age limit for breast cancer, however it is more common in postmenopausal women. Around 14pc of those diagnosed are women under 44 years, 49pc are women between 45-64 years and 37pc are women over 65 years. It is important to be breast aware from an early age.

3 Hereditary risk - A staggering 85-90pc of breast cancers are caused by random genetic changes, and are not the result of a genetic mutation inherited from one of your parents. For example most breast cancers are sporadic, meaning they develop from damage to a person's genes that occurs by chance after they are born.

Inherited breast cancers are less common, making up 5pc to 10pc of cancers. Inherited breast cancer occurs when gene changes called mutations are passed down within a family from one generation to the next, many of those mutations are in tumour suppression genes, such as BRCA1 or BRCA2. These genes normally keep cells from growing out of control and turning into cancer. But when these cells have a mutation, they can grow out of control and cause cancer.

4 You can reduce your risk - Breast cancer can affect anyone - irrespective of age, lifestyle and gender, and while we cannot change our age and gender, we do have the control of our lifestyle choices. Being physically active with regular exercise, maintaining a healthy weight, quitting smoking, limiting alcohol consumption and eating healthily can lower our risk of breast cancer.

5 What causes breast cancer - Breast cancer is thought to be caused by a combination of our genes, lifestyle choices and surrounding environment. There are many things, or factors, that can increase or decrease the risk of developing breast cancer. One of the biggest risk factors is increasing age. At least four out of five breast cancers occur in women over 50. In a small number of cases, breast cancer runs in the family. Most women with breast cancer do not have a family history of the disease or the faulty genes linked to breast cancer. You can lower your risk of developing breast cancer by making changes such as drinking less alcohol, maintaining a healthy weight and being regularly physically active.

6 Types of breast cancers - There are several types of breast cancer based on the biology of the tumours. These subtypes respond to different treatments and have different prognoses. Breast tumours are currently classified using three primary tumour markers: Estrogen Receptor (ER), Progesterone Receptor (PR), and Human Epidermal Growth Factor Receptor 2 (HER-2/Neu). The term "Triple Negative" indicates none of these markers are prevalent.

7 Metastatic breast cancer - Metastatic breast cancer (also called stage four or advanced breast cancer) is not a specific type of breast cancer, but rather the more advanced stage of breast cancer. Metastatic breast cancer is breast cancer that has spread beyond the breast to other organs in the body (most often the bones, lungs, liver or brain).

Survival rates for metastatic breast cancer vary greatly from person to person, but overall, have improved over time. Of the women who have metastatic breast cancer today, it's estimated that 34pc have had metastatic cancer for at least five years. So, they've lived at least five years since being diagnosed with metastatic breast cancer. Modern treatments continue to improve survival for women diagnosed today. In fact, some women may live 10 or more years beyond diagnosis with metastatic disease.

8 Breast cancer does not mean mastectomy (removing the whole breast) - Breast-conserving surgery (lumpectomy or partial mastectomy) can often be used for early-stage breast cancers. But for some women, it can result in breasts of varied sizes and/or shapes. For larger tumours, it might not even be possible, and a mastectomy might be needed instead.

Some doctors are addressing this problem by combining cancer surgery and plastic surgery techniques, known as Oncoplastic surgery which involves reshaping the breast at the time of the initial surgery, such as doing a partial breast reconstruction after breast-conserving surgery or a full reconstruction after mastectomy breast cancer.

9 Treatment of breast cancers - Most women with breast cancer will have more than one treatment. For example, surgery, chemotherapy, radiotherapy, hormonal therapy and/or immunotherapy. The choice of treatments, and the order in whichthey are given, depends on the particular circumstances of the patient and the cancer.

Women usually have surgery to remove cancerous tissue from the breast and from the armpit if also affected. Afterwards, they often receive additional treatments to reduce the risk of the cancer returning or spreading. It is known that chemotherapy can be helpful for many breast cancer patients, but predicting who will benefit the most or the least is being studied. Sometimes, there are significant side effects (long and short-term) from chemotherapy, so having tests that can determine who really needs chemo would be useful.

10 Survival after breast cancer - Survival rates in the past five years have improved from 75pc to 82pc. More than four in five women diagnosed with breast cancer will still be alive a decade later as raised awareness, early detection and improved treatments mean survival rates are improving all the time. It is estimated that five out of six women diagnosed with breast cancer in Ireland will survive for at least five years.

11 Prevention of breast cancer - Finding cancer early saves lives and can mean that the cancer is easier to treat. Less than 1pc of women screened are diagnosed with cancer, and these women have a good chance of successful treatment. Breast screening is a very effective way of spotting breast cancer early, but it is not the only way. Cancer can occur at any time, even between screenings. It is often women themselves who first notice their breast cancer. It is therefore important to be breast aware between mammograms. If you are over 65, it is essential to continue to be breast aware.

12 Breast cancer in men - Although it is very rare, men can also get breast cancer. Less than 1pc of all breast cancer cases develop in men, and only one in 1000 men will ever be diagnosed with breast cancer. Breast cancer in men is usually detected as a hard lump underneath the nipple and areola.

● Dr Reem Salman is a consultant breast surgeon at the Beacon Hospital, Sandyford, Dublin 18.

Dr. Reem Salman

It is important to be breast aware between mammograms

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