An overview of breast cancer during Cancer Awareness Month
words by Kamakshi Jani
With 55900 new breast cancer cases per year, or more than 150 cases per day in the UK, breast cancer accounts for 15% of all new cancer cases. Incidence rates have increased by 18% since the early 1990 (Cancer research data from 2016-2018). This article aims to provide an overview of this disease from signs and symptoms to treatment options and common misconceptions.
There are several signs and symptoms of breast cancer as seen in the above diagram. Whilst depicting the most common symptoms, please note that this list is not exhaustive. Any concerns regarding anomalies found in the breast region should be raised with your GP or personal physician.
It should be noted that no two breast cancers are the same – in fact, there are several causes of breast cancer including, but again, not limited to: age; previous cancer history; alcohol; density of breast tissue; radiation exposure; increased oestrogen levels; being on the contraceptive pill; familial history and genetic mutations. These factors may directly or indirectly increase the risk of developing breast cancer.
Studies investigating links between age and incidence of breast cancer have found an association between the two. Namely, that there is an increased risk of developing breast cancer with age. According to Cancer Research UK, the average age of diagnosis in men is 68 and 63 in women. However, increased radiation exposure or previous treatments involving radiation to the chest for conditions such as lymphoma at a younger age increase the risk of developing breast cancer at a younger age.
Factors such as early non-invasive cancer cell changes or previously having breast cancer lead to a higher chance of developing (secondary) breast cancer in the same or other breast. It should be noted that benign changes in breast tissue, such as cells growing abnormally in breast ducts / lobes, may also increase risk. Whilst the density of breast tissue gradually decreases with age as the amount of glandular tissue decreases, increased breast tissue density will also increase the possibility of more cells becoming cancerous. Unfortunately, this increased density makes mammograms harder to read and increases difficulty in spotting abnormal tissues.
Normal and abnormal growth of breast cells is regulated by oestrogen. One of the most common causes of breast cancer is due to abnormally high oestrogen levels. In fact, higher levels can be caused by multiple factors from being overweight to accidental exposure to estrogen in the environment such as the breakdown products of the pesticide DDT. Existing medical treatments such as HRT (Hormone Replacement Therapy) or ingesting hormonal medication can increase the risk of breast cancer. Studies have found that whilst all types of HRT – except for vaginal oestrogen – increase the risk of developing breast cancer, there is only an increased risk if undergoing HRT for over a year.
Certain lifestyle choices such as consumption of alcohol have been linked to breast cancer. Also being on the combined contraceptive pill may increase the risk of breast cancer too. It is interesting to note that studies undertaken over the last century indicate no significant association between moderate consumption of alcohol and breast cancer. However, there is a significantly increased risk in those consuming around three alcoholic drinks per week. Pre-existing conditions, e.g. liver disease, which may or may not be affected by this particular lifestyle choice, may exacerbate the likelihood of suffering from this disease.
Whilst studies from the 1990s demonstrated an increased prevalence of breast cancer in hormonal birth control users, modern day birth control formulations contain much lower doses of the hormones linked to those risks. However, research has shown a slightly increased risk of developing breast cancer with risk decreasing and returning to normal after 10 years of pill consumption being stopped.
With increasingly busy and work-orientated lifestyles in the last century, more of us are choosing to have children later in our lives or to simply not have children. Whilst this may be ideal for us socially, biochemically this causes oestrogen levels to remain at higher levels with continual exposure to oestrogen due to the lack of interruption by pregnancy.
Both males and females are affected by breast cancer. For males, a disorder known as Klinefelter syndrome increases the risk of male breast cancer. This syndrome is present at birth and currently affects every 1 in 1000 men.
Finally, strong family history of familial breast cancer and/or genetic mutations can increase the risk of breast cancer. Studies have found both abnormal BRCA1 and BRCA2 genes to be genetically inherited and increase rates of incidence among families. Within the male population, the BRCA1 gene is responsible for 1% of cases and the BRCA2 gene is responsible for 6% of cases. As demonstrated by these smaller percentages, most male breast cancer cases occur in men with no family history of breast cancer or inherited gene abnormality.
Whilst there is no guarantee to completely prevent one’s chance of developing breast cancer, the risk of being affected by it can be reduced by maintaining a healthy lifestyle; regularly exercising; limiting fat intake and performing routine breast self-examinations where you look out for the key signs and symptoms.
The NHS Breast Screening program has produced this five-point plan for being breast-aware.
1. Know what’s normal for you
2. Look at your breasts and feel them
3. Know what changes to look for
4. Report any changes to a GP without delay
5. Attend routine screening if you’re aged 50 to 70
(It is recommended to always see a GP if you are concerned about or experiencing any unusual symptoms – whereby they might decide to refer you to a specialist clinic for further tests.)
Whilst breast cancer is unique for each patient, there are numerous common treatments available. Treatment of breast cancer may involve one or a combination of treatments depending on individual circumstances, primarily stage and method of detection. Five of the most common and most successful treatments include: chemotherapy, radiotherapy, surgery, hormone therapy and targeted therapy.
In the UK (according to 2016-2018 Cancer Research data), there are 11,500 breast cancer deaths per year (32 every day). It is the 4th most common cause of cancer death – accounting for 7% of all cancer deaths – and 2nd most common cause of cancer death in females. However, mortality rates have decreased by 39% since the early 1970’s (36% decrease in females; 43% decrease in males). Furthermore, in the past decade, mortality rates have decreased by 19% (17% decrease in females; males remain stable).
Whilst over 95.8% of women diagnosed with breast cancer survive for one or more years, 85% will survive for five or more years in England (2013-2017 Cancer Research data). It is predicted that 75.9% of women diagnosed in England will live for 10 or more years. Due to the increased screening and more favourable treatable tumour characteristics, survival is highest for women diagnosed between 60-69. Survival after breast cancer continues improving and has doubled in the last 40 years. Currently 8 in 10 women diagnosed will survive the disease – a stark comparison to just 4 in 10 in the 1970s. Mortality rates are expected to decrease by 26% (~31 deaths/100k females) by 2035.
Whilst awareness for this cancer is increasing in the present day, there still remains a few misconceptions regarding the disease.
“ Breast cancer only affects females” : Breast cancer, while most prevalent in females, occurs in less than 1% of males. Approximately 2,650 men are expected to be diagnosed with the disease in 2021 with 530 men expected to die due to it. However, the lifetime risk of men being diagnosed with breast cancer is about 1 in 833.
“ Breast cancer is contagious” : Breast cancer is not a contagious disease. It is not possible to ‘catch’ breast cancer or ‘transfer’ it to someone else. Breast cancer is due to the uncontrolled outgrowth of mutated breast cells. By regularly checking for common signs and symptoms, it is possible to detect breast cancer early.
“ Mammograms can cause breast cancer to spread” : A mammogram – essentially an x-ray of the chest – is considered the ‘gold standard’ for detection. According to the National Cancer Institute, “The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low.”
“Coffee / Deodrants and Antiperspirants can cause breast cancer” : There is no known or established link between caffeine, antiperspirants/ deodorants, and breast cancer.
“ All lumps mean breast cancer” : Not all lumps indicate breast cancer. Finding a lump during a routine self-examination doesn’t mean that you have breast cancer. Many lumps are the result of cysts of scar tissue in the breast. Be aware of other symptoms mentioned earlier like pain, swelling, skin thickening. If in doubt, always discuss changes in the breast with your GP or doctor.