Understanding Breast Cancer

This information has been prepared to help you understand more about breast cancer. The information is an introduction to the diagnosis, treatment and effects of breast cancer but is by no means exhaustive. We cannot advise about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors.

• The breast
• What is breast cancer?
• How common is it?
• Risk factors
• Symptoms
• Prevention and detection
• Diagnosis
• Further information

The breast

Both men and women have breasts. However, women’s breasts are different because they are designed to make milk after pregnancy. Breasts are made up of milk glands. The milk gland consists of two main parts:

• milk sacs called lobules
• tubes called ducts that take milk to the nipples.

Breasts also contain supportive fibrous tissue, fatty tissue and lymph vessels. Lymph vessels carry a clear fluid called lymph. Most lymph vessels in the breast lead to lymph nodes under the arm. Breast cancer spreads to other parts of the body through the lymph and blood.

What is breast cancer?

Breast cancer develops when some of the cells in the breast start to grow out of control. When this happens, a cancerous growth begins to appear somewhere inside the breast.

Most breast cancers begin in the lining of the ducts though a small number start in the milk sacs. If not treated, cancer cells from the breast can spread to other parts of the body.

There are about ten different kinds of breast cancer. Some grow slowly while others develop faster.

How common is it?

• One in 11 women in Australia will develop breast cancer by the age of 75.
• Each year in Australia approximately 11,800 women are diagnosed with breast cancer and around 2,600 women will die from the disease.
• More than 70% of all breast cancer occurs in women aged 50 and over.
• Nine out of ten women who develop breast cancer do not have a family history of the disease.

Risk factors

The causes of breast cancer are unknown. Factors that are known to increase the chance of developing breast cancer include:

• Being older. More than half the women who are diagnosed with breast cancer are over 65.
• Having a close relative, like a mother, sister or daughter (or more than one), who was diagnosed with breast cancer – especially if she was fairly young at the time of diagnosis (under 50).

Some other factors that may increase a woman’s risk include:

• Not having children
• Having your first child after age 35
• Drinking large amounts of alcohol
• Obesity, particularly for women after menopause
• Periods that start very young or stop later than usual

Having several of these risk factors does not mean that you will get breast cancer. Many women with breast cancer have no known risk factors.

Symptoms

It is common for women’s breasts to change. Some changes happen every month – breasts may become swollen and tender during periods. Breasts also change when pregnant or breastfeeding.

Changes to look out for – all the way to your armpits – include:

• A lump, lumpiness, or a feeling of thickness, somewhere in your breast
• Anything coming out of your nipple without squeezing, except breast milk
• Getting dimples in your breast
• Pain in a part of your breast
• A change in the shape
• A nipple that turns in (unless it has always been turned in)

These changes don’t mean you have breast cancer. Nine times out of 10, breast changes are not cancer.

Common causes of non-cancerous breast changes include:

• Cysts – sacs of fluid which build up in the breast tissue
• Fibroadenomas – solid tumours made up of fibrous and glandular tissue

However, if you do have any of these changes, see your doctor, just to make sure.

Prevention and detection

Prevention is better than cure, so The Cancer Council Australia and its state members work to raise awareness of women’s cancers and to educate women about how to lower their cancer risk.

You and your circle of friends can reduce your risk of developing cancer by:

• Learning what the risk factors are and where possible taking steps to decrease your risk
• Knowing the early warning signs and monitoring your health
• Attending screening programs
• Leading a healthy lifestyle.

It’s important to be aware of your body and report any changes to your doctor, and to attend available screening services. The sooner cancer is diagnosed, the better the outcome.

As well as increasing the survival rate, early detection of breast cancer makes it more likely that there will be a choice between removing the lump and keeping the breast and removing the whole breast (mastectomy). Being breast aware, that is knowing how your breasts normally look and feel, and acting on any changes by talking to your GP, and mammograms are the best methods of detecting breast cancer early.

Mammography

Regular mammograms find breast cancers earlier and save lives. The greatest benefit is for women aged from 50 to 69 years, when regular mammograms can cut the number of deaths from breast cancer by up to one-third.

The national BreastScreen program advertises two-yearly screening mammograms to women aged 50-69 years, but they are available free to women over 69 too. Around 40% of breast cancers occur in women aged 65 years and older; if you're over 69 talk to your doctor about continuing breast screening.

Although it is less effective for women in their forties (because their breasts are denser than older women’s) there is probably still a benefit in being screened. Women aged 40 to 49 years can have free mammograms through BreastScreen if they choose to.

Diagnosis

How is breast cancer diagnosed?

If you or your doctor has found a breast change in your breast, your doctor will examine your breast and ask about your family history.

If your doctor thinks the breast change could be cancer, a number of tests will be done to confirm the diagnosis.

• Mammogram - This is an x-ray of the breast. The breast is flattened between two plates of the x-ray machine. You may find this uncomfortable and a little painful. A mammogram gives the doctor more information about any lump or other change.
  
  
• Ultrasound - Uses sound waves to help find lumps or other changes in the breast. A gel is spread over your breast and a small microphone is moved over the skin.
  
  
• Biopsy - If a lump is detected on a mammogram or ultrasound a biopsy will be taken.
  Part of the lump from the area of change will be removed and examined under a microscope.
  
  A biopsy is done in several ways:
  • Fine needle aspiration - Cells from the lump are taken out with a thin needle. It’s a bit like having blood taken for a blood test. It may be a little uncomfortable but is not painful.
    
    
  • Core biopsy - A larger needle is used with a local anaesthetic.
    
    
  • Open biopsy - The whole lump is taken out. This is usually done with a general anaesthetic, so that you’re asleep while it’s going on.

Further tests

If the breast change turns out to be cancer, more tests may be done.A bone scan, chest x-ray and blood tests maybe done to check that the cancer has not spread to these parts of your body.

Further information

For further information on breast cancer, call The Cancer Council Helpline on 13 11 20 or contact your local state or territory office of The Cancer Council (see the contact us page for details)

© 2008 Cancer Council