Breast Cancer: What to look out for and the best treatment options available
2nd July 2020
Breast cancer is the most common cancer to affect women in the UK. Around one in 12 women will develop the disease before the age of 40 and the risk is one in eight for women aged 48 and above.
Despite its prevalence, breast cancer is very treatable due to huge advances in medicine over the years. This has drastically improved patients’ survival rate and quality of life.
We spoke to Ms Mahwash Babar, a Consultant Oncoplastic Breast Surgeon, to find out more about breast cancer, what women should look out for and what treatment options are available.
How often should women check their breasts and what should they look for?
The biggest risks for breast cancer is being a woman and having ovaries. Age then becomes a risk as you’re approaching 50. I advise women to be breast aware and acknowledge any changes in the breast.
Examine your breast with the flat of one hand with the other arm raised above your head raised up. This can be done once every two weeks particularly in the shower. Look for any changes in the nipples, any changes in shape of the breast and any discolouration.
Obviously look for lumps, but also look out for nipple discharge, any distortion, skin colouring and soreness. Around 5-8% will present with a lump in the arm. Anything that is new or different should be checked out.
What lifestyle factors can increase your risk of breast cancer?
We can’t change some risk factors like being a female. Oestrogen exposure is a factor. The oral contraceptive isn’t a significant factor but it does slightly increase the risk.
Twenty years ago, there was a lot of emphasis on the risks of hormone replacement therapy (HRT) for menopausal women. Now we know HRT is more like a propagator for breast cancer rather than the initiator of breast cancer.
Women can have HRT provided it’s an informed decision about their risks and they attend regular mammograms. If you develop breast cancer while on HRT, we would advise you to stop HRT because it can accelerate the process.
The genetic element is 5-8%. Other factors are lifestyle, stress and obesity. If you drink too much alcohol, or if you’re a smoker, you have a higher risk of developing breast cancer and slightly less response to its treatment.
How much drinking is considered too much?
For most women, half a glass of wine a day is generally acceptable. Binge drinking is a risk factor. Intake of 2 to 3 glasses of wine a day significantly increases the risk.
Can men get breast cancer?
Men can get breast cancer but the average is 1%. I see about one case of male breast cancer a year. In the last 40 years, the risk of breast cancer in females has risen by a 6th, whereas the risk in men has remained the same.
How treatable is breast cancer?
Breast cancer is one of the most curable cancers. Thanks to research, awareness, accurate data collection and new advances in medicine, we’re talking about 20-25 years survival with a good quality of life for most cancers that are detected early. It’s a huge advancement psychologically and physically.
If you are diagnosed with breast cancer, is it likely to come back?
Recurrence is the term used for the likelihood of cancer coming back. It can be local or distant. Both of these depend on the original biology and stage of the cancer.
For most early cancers, the multi modality treatment over five years or longer means that the recurrence rate is quite low. After full treatment and surveillance for five years with favourable biology, the recurrence risk is at the population level or lower than a new incident cancer risk, which is quite amazing!
Your oncologist can also provide a quantitative score for recurrence adjusting for biology and tailored adjuvant treatment.
What does ‘early’ and ‘advanced’ mean?
These terms refer to size, grade and nodal status. Early is usually small, not palpable and detected through mammography.
Advanced presentation is with a larger palpable lump, usually present for months and involves spread to the local lymph nodes under the armpit. If the cancer has spread to other parts of the body, that is called a metastatic breast cancer. This type of cancer is still treatable but not curable.
How is breast cancer treated?
Treatment is multi modality. Surgery remains the mainstay. Most of the surgery we do is breast-conserving surgery, which is curative as well as cosmetic. If a mastectomy is planned, then reconstructive surgery can be offered. For the last 15 years, reconstructive surgery has evolved and the emphasis has been on women’s choice and leading the decisions in their cancer treatment.
Reconstruction surgery can be offered as an immediate procedure. Patients having a mastectomy wake up with a reconstructed breast. They can choose implant-based reconstruction, which is a silicon prosthesis placed under the skin. It involves a stay of one or two nights and a relatively speedy recovery, especially in younger women.
Some women choose to have a reconstruction using their own body tissues from the abdomen, the back, or the thighs. It’s a relatively longer operation but it can also be offered at the same time as the mastectomy.
The second aspect is radiotherapy after surgery. Radiotherapy is local x-ray treatment given to the symptomatic breast with a specialised machine. The theory is that after getting radiotherapy, the rest of the cells lose their ability to transform into cancer cells and that’s why the recurrence rate is much lower. Radiotherapy does not have systemic side effects like chemotherapy. It is given over a period of five days to 21 days.
Molecular treatment for breast cancer
Molecular biology and treatment of breast cancer is an important aspect. Individual cells’ surface markers like oestrogen, progesterone and HER-2 are analysed, assessed and tailored treatment is provided accordingly.
Most breast cancer cells express oestrogen which allows us to use anti-oestrogen treatment. HER-2 is a growth marker on the cancer cell and targeting tailored treatment against these markers has revolutionised breast cancer treatment.
Chemotherapy may be used in advanced cancers or if the cancer has spread to the lymph nodes or other parts of the body. Chemotherapy is a systemic treatment. In some early cancers, it is used to destroy single cells in the circulation that may have escaped and can’t be picked up with any scan.
Are there any side effects to these treatments?
There are the surgical side effects of scarring, from changing breast shape to losing the breast. If women are going through menopause, they feel hot flushes and night sweats. Anti-oestrogen treatment makes it worse and bone health is affected.
The aim of breast cancer treatment is to cover all those aspects. It is important to remember that it’s a journey and we support them throughout this journey.
What is the recovery process like for breast cancer?
Within two weeks, most people I treat for breast cancer are up to their full potential. They’re working as well as driving, doing most of the chores and we encourage them to have arm and shoulder physiotherapy. Pain is usually well controlled and not a functional issue.
Radiotherapy can make them tired and chemotherapy can be tough with systemic side effects, but many patients are still able to work through it. Recovery from a surgical aspect is quite quick. The key message is that treatment is possible with a good quality of life.
The Breast Unit at St John and St Elizabeth Hospital is London’s leading breast clinic, providing the ultimate standards of care.
If you have a breast-related concern or would like a routine breast health check-up, call our friendly team on 02033701041 to make an appointment.