Breast cancer affects 1 in 8 women over their life time and approximately 55,000 women in the UK were diagnosed in 2015.
It can occur in men , but only around 400 male breast cancers were diagnosed at the same time.
The cause of breast cancer is due to many different things but include:-
1. Being a Women. The high levels of the female hormone Oestrogen is the main cause of breast cancer.
Women make oestrogen in the ovaries, and after the menopause in the fatty tissue and muscle by an enzyme called
Aromatase. Oestrogen is also taken as a medicine in the Contraceptive Pill, or HRT .
2. Age. Increasing age increase the risk of breast cancer. The incidence is:-
1 in 2000 in a 30 yr old woman,
1 in 200 in a 40 yr old woman,
1 in 50 in a 50 yr old woman.
1 in 25 in a 60 yr old woman,
1 in 13 in a 70 yr old woman.
3. Genes. Genetic abnormalities account for a small number (5%) of breast cancers BRCA 1 and BRCA 2 are a group of know gene faults that increase the risk of breast cancer. There is often a family history of breast or ovarian cancer in women who carry these genes.
4. Life Style: Excess alcohol, or weight increase the risk of breast cancer . Keeping the amount of alcohol a women drinks to less than 14 units, and maintaining a healthy weight will reduce the risks of breast cancer.
Providing a women is fit enough, the main treatment for breast cancer is to remove it using Surgery.
This involves a general anaesthetic and surgery to remove the cancer (lump) with the nearest lymph nodes under the arm. The nearest lymph node is called the sentinel node, and is found by injecting a small amount of radioactivity and blue dye into the breast and tracing it under the arm using a radioactivity camera called a Gamma Probe.
For most women (70%) this is a Wide Local Excision (lumpectomy) and Sentinel lymph node biopsy.
This surgery is usually performed as a day case and takes around 45 minutes to an hour. The Radioactivity is injected before surgery in the medical physics department, while the blue dye is injected once under anaesthetic in theatre.
The surgeon (Miss Langlands) will place a surgical cut around the areolar if the tumour is close to the nipple, or over the lump if in the upper outer or lower part of the breast. A second cut is placed under the arm pit to find the sentinel lymph node. wounds are closed with dissolving sutures supported by surface steri-strips and a dressing.
With all surgery there are some small risks and these include:
Bleeding ,Scaring, Seroma fluid ,Indentation, puckering, blue dye staining (from the sentinel node detection) which can last up to a year, and very rarely an allergic reaction to the dye causing blistering and temporary swelling of the skin all over the body with itch.
The tissue removed is sent to the Pathology department for examination , and results are usually ready 2 weeks after surgery.
They will be discussed at the multidisciplinary team and a plan for further treatments made:
This can Include:
More surgery:- if the microscopic tumour is less than 1 mm from the cut surface after removal or the sentinel nodes have breast cancer disease in them. Some times it will be necessary to remove the whole breast called a mastectomy.
If a mastectomy is needed, an immediate reconstruction may be possible, and Miss Langlands will discuss this with you.
Chemotherapy: For patients with risk factors for the disease to spread or come back;-
Risk factors include, large size ,high grade cancers, Lymph node involvement, cancers which are Oestrogen receptor negative or Her 2 receptor positive. Your Surgeon and Oncologist will discuss this with you and explain the pathology report along with the treatment recommendations. See Breast Information page to download a booklet more on chemotherapy.
Miss Langlands works closely with Dr Chris Bradley Consultant Medical Oncologist who will help guide and advise patients referred for this treatment.
There are different types of breast cancer classified by the expression of three receptors (ER/PR/HER2)
Group 1 (luminal A). This group includes tumors that are ER positive and PR positive, but negative for HER2. Luminal A breast cancers are likely to benefit from hormone therapy and may also benefit from chemotherapy. These cancers do very well with endocrine therapy.
Group 2 (luminal B). This type includes tumors that are ER positive, PR negative and HER2 positive. Luminal B breast cancers are likely to benefit from chemotherapy and may benefit from hormone therapy and treatment targeted to HER2.
Group 3 (HER2 positive). This type includes tumors that are ER negative and PR negative, but HER2 positive. HER2 breast cancers are likely to benefit from chemotherapy and treatment targeted to HER2. These cancers benefit from chemotherapy with Herceptin and Pertuzumab
Group 4 (basal-like). This type, which is also called triple-negative breast cancer, includes tumors that are ER negative, PR negative and HER2 negative. Basal-like breast cancers are likely to benefit from chemotherapy. These cancers usually need chemotherapy as they are not hormone sensitive.
Radiotherapy:- All patients who have a successful lumpectomy for cancer will be recommended to have radiotherapy to the breast. This will reduce the risk of disease coming back in the breast (recurrence) by around 66%. A few patients who have a had a mastectomy may also need radiotherapy to the chest if the cancer is large (5cm), involves the lymph nodes, or has involved margins.
See Breast Information page to download a booklet more on radiotherapy.
Endocrine medication: If the cancer removed is hormone sensitive , by carrying the Oestrogen receptor, then hormone receptor blockers can be used such as Tamoxifen, or Aromatase inhibitors (Arimidex, Letrozole of Exemestane). These tablets will be prescribed for you and are usually taken once a day for 5 years.
Information booklets on these treatments can be downloaded by clicking here on the Breast Information page.
One Stop Breast Clinic
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Breast Cancer Treatment
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Miss Fiona Langlands Consultant Surgeon
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