Breast Cancer

Overview

Breast cancer is the most common cancer in women in Australia (apart from non-melanoma skin cancer). About 20,000 people are diagnosed annually, including approximately 220 men. While it can occur at any age, it’s most common in women over 40.

What is Breast Cancer?

Breast cancer is characterized by abnormal cell growth in the breast tissue, typically starting in:

• The lining of breast ducts
• Lobules (milk-producing glands)

Most diagnosed cases are invasive, meaning the cancer has spread from the ducts or lobules into surrounding breast tissue. Breast cancer can be:

• Early stage
• Locally advanced
• Advanced (metastatic)

Risk Factors

Primary Risk Factors

• Gender (99% of cases occur in women)
• Age (higher risk over 50)
• Family history
• Genetic mutations
• Breast density
• Previous breast cancer history

Additional Risk Factors

• Late first pregnancy (after 30) or no children
• Never breastfeeding
• Early first period (under 12)
• Late menopause (55+)
• Regular alcohol consumption
• Obesity or significant post-menopausal weight gain
• Physical inactivity
• Hormone therapies

Early Detection

Check Your Breasts

Breasts undergo many changes during a woman’s life due to puberty, the menstrual cycle, pregnancy, breastfeeding, weight changes, or aging. It is important for all women to get to know the normal look and feel of their breasts.

Breast cancer sometimes has no symptoms, so regular checks are important for women aged 40 and over. Breast changes may not mean cancer, but see a doctor if you notice:

• A lump, lumpiness, or thickening, especially in just one breast
• A change in the size or shape of the breast or swelling
• A change to the nipple – change in shape, crusting, sores or ulcers, redness, pain, a clear or bloody discharge, or a nipple that turns in (inverted nipple) when it used to stick out
• A change in the skin – dimpling or indentation, a rash or itchiness, scaly appearance, unusual redness or other color changes
• Swelling or discomfort in the armpit or near the collarbone
• Ongoing, unusual breast pain not related to your period

Some of these symptoms can occur without any serious disease being present. Nine out of 10 breast changes are not breast cancer. However, just to be sure, your doctor should check any unusual breast change as early detection of breast cancer means treatment has a much better chance of success.

Screening Mammography

Screening mammography every two years is provided as a free service for women aged 50 to 74 through the BreastScreen Australia program. It is used to detect breast cancer early, when you are well and have no obvious breast symptoms. Screening mammograms can detect breast cancers that are too small to be felt by you or your doctor. The earlier breast cancer is found provides the best chance of effective treatment and survival.

Mammograms taken at different times can later be compared to show changes in breast tissue over time. Screening is open to women from the age of 40 years and can continue after the age of 74 years, however, reminders are only sent to those who are between the ages of 50 and 74 years.

Diagnosis

Breast changes are investigated through a series of tests organized by your doctor or specialist. Most breast changes are diagnosed as benign (non-cancerous). If your tests show that you may have cancer, your GP (doctor) will refer you to a specialist who will advise you about treatment options.

Initial Tests

• Physical examination – breasts and armpits are examined
• Diagnostic mammogram – an X-ray of the breast tissue
• Ultrasound – a device that uses sound waves to scan the breast
• Breast MRI – a magnetic resonance imaging (MRI) scan creates pictures of breast tissue on the computer and is mainly used for people who are at high risk of breast cancer, who have dense breasts or breast implants

Further Tests

If further tests are required, one or more procedures may be used, including:

• Fine needle aspiration – a very narrow needle is used to withdraw cells from the testing area
• Core biopsy – a larger needle is used to take a tissue sample for testing
• Vacuum-assisted core biopsy – a needle is attached to a suction-type instrument and removes a larger amount of tissue
• Surgical biopsy – surgery is performed under general anesthetic to remove the whole area for testing

Tests on Breast Tissue

If a cancer is found, it can be checked for special features to help plan treatment. This may include:

• Hormone receptor status – normal breast cells have oestrogen and progesterone receptors. Breast cancers that have too many of these receptors are known as hormone-positive breast cancers and are treated with hormone-blocking drugs
• HER2 status – HER2 is a protein found on the surface of all cells and controls how cells grow and divide. Breast cancers that have too many HER2 receptors are called HER2-positive and are often treated with chemotherapy and targeted treatments
• Triple negative breast cancer – this type of breast cancer does not have any of the three receptors commonly found on breast cancer cells (oestrogen, progesterone, or HER2). Chemotherapy is generally recommended for triple negative breast cancer

If tests show that you may have breast cancer, you may have further tests to see if the breast cancer has spread. Other tests may include blood tests, bone scans, CT scans, and PET scans (computerized tomography and positron emission tomography, respectively). Not everyone will have all these tests.

Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling.

You can also contact the Cancer Council support line on Tel. 13 11 20 and speak with a cancer nurse or call Breast Cancer Network Australia’s (BCNA) helpline for information, support, and referral on Tel. 1800 500 258.

Treatment

Treatment options for breast cancer include surgery, radiotherapy, chemotherapy, targeted therapy, hormone-blocking therapy, and immunotherapy. Usually, more than one is used. Treatment for breast cancer in men is similar to (and as effective as) the treatment for breast cancer in women.

Factors Influencing Treatment

• Location of the cancer in the breast
• Stage of breast cancer (whether or not the cancer is confined to the breast or has spread to other parts of the body)
• Grade of cancer cells – there are three grades of invasive breast cancer. Grade 1 (low grade) – the cancer cells look a bit different from normal cells and are slow growing; Grade 2 (intermediate grade) – the cancer cells grow faster than grade 1 and do not look like normal cells; Grade 3 (high grade) – the cancer cells look very different from normal cells and are fast growing
• Results of tests on cancer cells (e.g., hormone receptor status, HER2 receptor status, or triple negative)
• Age, general health, and personal preferences

Surgery

An operation to remove the cancer, surrounding breast tissue, and often, the nearby lymph nodes, is usually the preferred first treatment.

Surgery Options

• Breast-conserving surgery – a small operation removes the cancer and some of the surrounding tissue (lumpectomy), and usually some lymph nodes, leaving the bulk of the breast intact. Breast-conserving surgery is often followed by a course of radiotherapy
• Mastectomy – the entire breast is removed, along with some or all of the lymph nodes from the armpit
• Breast reconstruction surgery – women who have a mastectomy may choose to have reconstruction surgery (at the time of the mastectomy or later), whereas some women choose not to undergo breast reconstruction. Options for breast reconstruction include silicone gel or saline-filled implants, or the use of your own muscle and skin to create a breast-like shape. Women who choose not to undergo breast reconstruction may use a breast form or prosthesis. These are pads worn inside your bra to help restore balance and are designed to look like a normal breast under clothes

All surgery has some risks. Possible side effects of breast surgery include fatigue, shoulder stiffness, numbness and tingling (bruised or injured nerves), fluid build-up around the scar or armpit (seroma), swelling of the arm (lymphoedema), post-mastectomy pain, and cording (axillary web syndrome). These side effects are not common, but you should be aware of the risks.

Other Treatments

Depending on the cancer, other treatment options can include:

• Radiotherapy – use X-rays (radiation) to kill any remaining cancer cells. Women who have had breast-conserving surgery often have a course of radiotherapy. Side effects can include a short-term reddening of the skin, which looks like sunburn, or longer-term thickening of skin
• Chemotherapy – cancer-killing medication is given intravenously (directly into a vein). Chemotherapy can be offered to women with early breast cancer as an extra treatment to surgery, radiotherapy, or both. Chemotherapy has side effects that will depend on the type of medication you have, but can include nausea, diarrhea, and hair loss
• Hormone-blocking treatments – many breast cancers are influenced by the sex hormones oestrogen and progesterone. Hormone-blocking treatment can reduce the chances of breast cancer developing again
• Targeted therapies – uses specific drugs that are known to target the specific proteins or enzymes that play a role in the growth of cancer cells. For example, targeted treatments such as trastuzumab are used to treat HER2-positive breast cancer
• Immunotherapies – these are medicines that strengthen the immune system to fight cancer. A drug called pembrolizumab may be used for people with certain types of triple negative breast cancer
• Complementary therapies – these are designed to be used alongside conventional medical treatments. Therapies such as massage, relaxation, and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based

Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested, may prevent successful treatment of the cancer, and can be harmful.

All treatments can cause side effects. Many of these are only temporary, but some may be permanent. Your medical team will discuss these with you before you begin treatment.

Research and Clinical Trials

Early detection and better treatment have improved survival for people with breast cancer. Research for breast cancer is ongoing. The Cancer Research UK website has information about research into breast cancer.

Clinical trials can test the effectiveness of promising new treatments or new ways of combining cancer treatments and care. Clinical trials can also investigate the emotional and physical side effects of breast cancer and its treatment and explore ways of improving the quality of life for people affected by cancer. For more information about clinical trials you can visit the Breast Cancer Trials Australia website or the Australian Government Clinical Trials website and talk to your doctor about whether a particular trial may be suitable for you. It is important to always discuss treatment options with your doctor.

Breast Cancer and Your Sexuality

Breast cancer can affect how you feel about yourself (self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. These feelings are common; give yourself time to adapt.

Your medical team should discuss these issues with you before and during your treatment. If you feel you would like to discuss things further, ask your doctor for a referral to a counsellor or speak to a cancer nurse on the Cancer Council support line (Tel. 13 11 20). The Cancer Council Victoria booklet called Sexuality, intimacy and cancer may also be helpful to read.

Caring for Someone with Breast Cancer

Caring for someone with breast cancer can be a difficult and emotional time. If you or someone you know is caring for someone with breast cancer, there is support available.

The Cancer Council Victoria booklet called Caring for someone with cancer may also be helpful to read.

When a Cure Isn’t Possible

If breast cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment may be given to slow the growth of the cancer as well as improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment) with medication to relieve pain, nausea, and vomiting. The Cancer Council Victoria booklet called Living with Advanced Cancer may be helpful to read.

Where to Get Help

• Your GP (doctor)
• Breast cancer specialists (e.g., breast surgeon, breast reconstructive/plastic surgeon [breast reconstruction], medical oncologist, radiation oncologist)
• Breast Cancer Network Australia (BCNA)
  • BCNA Helpline team is available to provide support, information, resources, and a referral service for people affected by breast cancer, at all stages of the breast cancer experience. Open from 9:00am to 5:00pm Monday to Friday, Tel: 1800 500 258
  • BCNA My Care Kit – the My Care Kit is for free for women who have recently had breast surgery. It contains a specially designed Berlei bra and soft form(s). Talk to your health professional or call BCNA’s Helpline team on Tel. 1800 500 258 or email mycarekit@bcna.org.au
  • Find services, government programs, and support groups at the BCNA website
  • BCNA Online Network – online peer-to-peer support community for people affected by breast cancer, a safe space to connect with others
• Breast care nurse (BCN) or cancer nurse – to find a BCN near you visit the McGrath Foundation website
• BCNA has a series of free resources, booklets, and fact sheets in a number of languages
• Cancer Council Victoria, cancer information and support line Tel. 13 11 20
• Multilingual Cancer Information Line, Victoria Tel. 13 14 50
• WeCan website helps people affected by cancer find the information, resources, and support services they may need following a diagnosis of cancer
• Counterpart - Women supporting women with cancer