A woman’s breasts are symbolic of feminity, youth and life. They nourish, nurture and comfort a woman’s children and they contribute to her sexuality and femininity. Sadly, cancer of the breast remains the commonest cancer in women in the last decade. Detecting breast lumps early can save your breast and cure the cancer.

In order to safely eliminate the possibility of breast cancer, it should be mandatory for every woman to examine her breasts on a monthly basis or go for regular checks. Fortunately, not all breast problems are breast cancer, benign breast disorders may arise as a result of the cyclical hormonal fluctuations that occur in every woman before menopause or during the menstrual cycle. These disorders are in fact part of a spectrum that extends from a normal state, to overt benign disease.

Common Breast Problems

Not all breast problems are breast cancer, benign breast disorders may arise as a result of the cyclical hormonal fluctuations that occur in every woman before menopause or during the menstrual cycle. These disorders are in fact part of a spectrum that extends from a normal state, to overt benign disease. In between the two poles are disorders that should preferably be referred to as aberrations, rather than actual disease. Most of the conditions that result from the normal cyclical hormonal changes found in every woman, are just aberrations or slight deviations from normal. True disease is not that common in this setting. Symptoms of breast problems such as pain, nipple discharge or a mass should however prompt you to see your doctor.

Breast problems present in three different ways

  • Breast Pain

    What do I need to know about breast pain?
    Many women have breast tenderness and pain, also called mastalgia. It may come and go with monthly periods (cyclic) or may not follow any pattern (noncyclic).

    Cyclic pain is the most common type of breast pain. It may be caused by the normal monthly changes in hormones. This pain usually occurs in both breasts. It is generally described as a heaviness or soreness that radiates to the armpit and arm. The pain is usually most severe before a menstrual period and is often relieved when a period ends. Cyclic breast pain occurs more often in younger women. Most cyclic pain goes away without treatment and usually disappears at menopause.

    Noncyclic pain is most common in women 30 to 50 years of age. It may occur in only one breast. It is often described as a sharp, burning pain that occurs in one area of a breast. Occasionally, noncyclic pain may be caused by a fibroadenoma or a cyst. If the cause of noncyclic pain can be found, treating the cause may relieve the pain.

    Breast pain can get worse with changes in your hormone levels or changes in the medicines you are taking. Stress can also affect breast pain. You are more likely to have breast pain before menopause than after menopause.
    Does breast pain indicate breast cancer?
    Breast pain is not a common symptom of breast cancer. But in some cases painful lumps are caused by breast cancer.
    If breast pain becomes severe or lasts longer than 3 weeks, call your doctor to discuss your symptoms.
  • A Breast mass/lump

    There are many different types of breast lumps. An ultrasound is used to tell what a lump is. Most lumps are not breast cancer.
    i. Developmental abnormalities in breast embryology
    • The nipple may fail to evert, giving rise to an inverted nipple, which is thus congenital (present from birth). If a woman suddenly develops an inverted nipple in adulthood, this should be checked by a doctor as it may be the first sign of breast cancer. Management of congenital nipple inversion can both be undertaken by manual techniques or surgery.
    • Supernumerary or additional breasts or nipples may develop along the milk line or milk streak. During pregnancy and lactation this supernumary breast tissue and nipples may enlarge and even produce milk. If it is of concern surgical removal of the tissue can be undertaken.
    • Breast absence or amazia. If something goes wrong with the embryological development, such as a genetic abnormality or if the pregnant mother is exposed to some poison (toxin, such as a toxic drug, or a virus), the breast may fail to develop. This can be managed by reconstructive surgery.
    ii. Prepubertal breast development
    This is a type of premature breast development which often occurs on one side only. The breast will develop without any problems. Occasionally this is seen in young toddlers or pre-teenagers.
    Management:
    • Investigations like an ultrasound may be done to ensure no other secondary sexual development is occurring

    iii. Solid Masses

    • Fibroadenoma
    • Fibroadenomas are highly mobile (breast mouse), round, smooth, firm masses in the young woman’s breast, usually present in the teenager and the early twenties. Fibroadenomas arise from lobules and show hormonal dependence similar to the lobules from which they develop. Most fibroadenomas are 1 – 2 cm in size and growth beyond 5 cm is unusual. They may be multiple. These lumps are quite innocent and can be left well alone. They may disappear spontaneously.
    • Most patients with these masses should have a triple assessment of a clinical examination, an ultrasound and a needle biopsy. Six month follow-up is necessary to see if the fibroadenoma is growing.
    • When these tumours reach giant proportions (giant intracanalicular fibroadenoma), it is generally advisable to remove them, as they cause a lot of distress, and distort the breast simply due to their unwieldy size.
    • During pregnancy and lactation the size of fibroadenomas may also vary. Fibroadenomas in pregnancy will be managed by sonar and needle biopsy. They do not interfere with breastfeeding.
    • Calcified fibroadenomas are sometimes found in the elderly as hard discrete mobile masses that are readily identified on mammography. Surgical excision may be done through cosmetic incisions with attention to moving around local breast tissue so as not to leave an unsightly dent in the breast.
    • Cystosarcoma Phyllodes (Phyllodes tumour)
    • There is a rare growth that may be confused with a fibroadenoma. This is the phyllodes tumour, which is more aggressive than fibroadenomas. They can be more difficult to diagnose, therefore a rapidly growing breast mass (one that has increased by over a 1 cm in six months) should be excised. Because they have the capacity to recur after removal by lumpectomy, and also because around 10% – 20% show features of malignancy (rarely they can spread, more commonly they reoccur locally and more aggressively), a procedure involving wide local removal with at least a 1 cm – 2cm margin is essential. This will always require some form of breast reconstruction when operating on the patients.
    • Solid Cystic Masse
    • Breast Hamartomas (Fibroadenolipoma)
      Hamartomas of the breast usually present as painless palpable masses. They are larger and softer than fibroadenomas. A core biopsy is recommended for diagnosis. Hamartomas have a distinct picture on mammogram showing a circumscribed density separated from normal breast tissue by a thin radiolucent zone. If clinical examination and investigations cannot be correlated, surgical excision is recommended.
    • Galactocele presents as a breast lump
      This is simply a milk retention cyst, where no bacterial infection occurs. It can be treated by needle aspiration (the removal of a sample of fluid and cells through a needle) and milk suppression. Surgical excision can also be performed with the use of reconstructive techniques.
    • Fat necrosis
      Severe breast trauma (a motor vehicle accident or being punched in the breast) may cause fat necrosis, which can mimic breast cancer. A core biopsy will usually resolve the issue, if the doctor is worried about an underlying cancer.

    • Breast Abscesses
    • Lactating breast abscess
      Unsatisfactory breastfeeding may cause milk retention and stasis (the stoppage or diminution of flow). Infection soon results. This can be adequately treated with antibiotics early on (during the cellulitis or mastitis phase).
      During this phase the frequent expression of milk will help prevent stasis and progressive infection. Cabbage leaves kept cold in the fridge also provide relief from the discomfort.
      The current recommended treatment is high dose antibiotics as well as repeated ultrasound guided aspiration. If the mother or doctor wants to stop breastfeeding, lactation can be suppressed with fluid restriction and bromocriptine (antiprolactin).Note that the baby must continue to feed on the contralateral breast to prevent a breast abscess developing there. Also, milk must be expressed from the ipsilateral breast (the one with the abscess) that is involved in the inflammatory process.
    • Non-lactating Breast Abscesses
      Breast abscesses can occur in circumstances other than lactation. They can commonly be a complication of duct esctasia, or less frequently caused by underlying malignancies, TB or HIV/AIDS. Superficial skin lesions (boils, sebaceous cysts and recurrent skin abscesses can also occur).
    • Management
      Antibiotics and ultrasound-guided drainage are the initial treatment modalities. This is followed in certain complicated cases by surgical drainage with biopsy of the abscess wall.
    • Cysts
    • Breast Cyst
      Breast cysts usually occur in the premenopausal period (35 to 50 years of age). They may be single or multiple. About 5% of women develop a breast cyst. They normally contain around 20ml of fluid. They are easily diagnosed using sonar (ultrasound). Treatment is by follow-up or aspiration. The fluid is usually yellow or greenish. Ultrasound is crucial to see it. The cyst is simple or complex. Complex cysts require aspiration and occasionally excursion.
    • Fibroadenosis (and cyclical breast pain)
      Breasts alter cyclically with the different stages of the menstrual cycle. In the week prior to menstruation, the breast normally increases in size and sometimes becomes nodular, with pain. All breasts have a certain amount of fibrosis and adenosis and disease should be attributed to a woman with breast symptoms. If concerned, a breast ultrasound can aid the doctor in determining whether this is a mass or just nodularity.
  • Nipple Discharge

    Nipple discharge is any fluid that comes out of the nipple area in your breast.
    Sometimes discharge from your nipples is okay and will get better on its own. You are more likely to have nipple discharge as you get older and if you have been pregnant at least once. Nipple discharge is usually not a symptom of breast cancer.

    Here are some reasons for nipple discharge:

    • Pregnancy
    • Stopping breastfeeding
    • Rubbing on the area from a bra or t-shirt
    • Infection
    • Inflammation and clogging of the breast ducts (mammary duct ectasia)
    • Injury to the breast
    • Non-cancerous brain tumors
    • Small growth in the breast that is usually not cancer (intraductal papilloma)
    • Severe hypothyroidism (underactive thyroid gland)
    • Fibrocystic breast (normal lumpiness in the breast)
    • Use of certain medicines, such as birth control pills, cimetidine, methyldopa, metoclopramide, phenothiazines, reserpine, tricyclicantidepressants, or verapamil
    • Use of certain herbs such as anise and fennel
    • Widening of the milk ducts

    Cancers that can cause nipple discharge are:

    • Breast cancer
    • Paget’s disease of the breast (a rare form of breast cancer)

    Nipple discharge that is NOT normal is:

    • Bloody
    • Comes from only one nipple
    • Comes out on its own without you squeezing or touching your nipple

    Nipple discharge is more likely to be normal if:

    • It comes out of both nipples
    • Happens when you squeeze your nipples

    The color of the discharge does not tell you whether it is normal or not. The discharge can look milky, clear, yellow, green, or brown.

    Exams and Tests

    Tests that may be done may include:

    • Prolactin blood test
    • Thyroid blood tests
    • Head CT scan or MRI to look for pituitary tumor
    • Mammography
    • Ultrasound of the breast
    • Breast biopsy
    • Ductography or ductogram, an x-ray with contrast dye injected into the affected milk duct
    • Skin biopsy, if Paget’s disease is a concern

    In most cases, nipple problems are not breast cancer. These problems will either go away with the right treatment, or they can be watched closely over time. If unsure, make an appointment with your doctor to verify.

Breast Screening

The Best Protection is Early Detection, Early Detection Saves Lives

  • Breast Self Examinations

    Detecting breast lumps early can save your breast and cure the cancer. However, in order to safely eliminate the possibility of breast cancer, it should be mandatory for every woman to examine her breasts on a monthly basis or go for regular checks.
    Regular Breast Self Examinations (BSEs) could assist you in detecting any abnormalities of your breast or nipple. If, during a BSE, you become aware of a lump or notice an unusual discharge, you should consult a doctor to verify.
    When and how often should I perform BSE?
    • Examine your breasts regularly once a month
    • The best time to perform BSE is about a week after the start of your menstrual period. If you no longer menstruate, do BSE on the same day of each month, for example the first of every month
    • You should still do BSE if you are pregnant, breastfeeding or have breast implants

    Warning signs to look out for in BSE

    • A lump, swelling or thickening in the breast or underarm area
    • Change in the size or shape of one breast
    • Puckering or dimpling of the skin of the breast or nipple
    • Persistent rash or change in the skin around the nipple
    • Recent change in the nipple appearance e.g. inversion, retraction
    • Any bleeding or unusual discharge from the nipple
    • Skin redness or sore on the breast
    • Accentuated veins on the surface of the breast
    • Unusual swelling of one upper arm
    • Any enlarged lymph nodes in the armpit and collarbone areas

    See your doctor if you have any of these warning signs. Most lumps or changes in the breast are not cancer but it is important that you see your doctor about them right away.

  • Mammograms

    The best way to protect yourself from breast cancer is to go for regular mammograms. While doing monthly breast self-examination also keeps you aware of any changes to your breasts, the mammogram is currently the most reliable screening tool for breast cancer. It helps detect presence of any cancerous lumps even before they can be felt with the hand.
    How often should I go for a screening mammogram?
    • For women 40 to 49 years old: once every year (should you decide to go for screening)
    • For women 50 years and older: once every two years

    During the process, a female radiographer will put your breast between two flat plastic plates and compress for a few seconds. This is performed on one breast at a time. Some discomfort may be felt but it is important for the breast tissue to be compressed in order to take a clear X-ray.

    What to expect after a mammogram?
    If your screening results are normal, you should continue with your monthly breast self-examination and regular mammogram once every two years.*
    If your results are abnormal and you are asked to go for further tests, do not panic. Out of every 10 women who need further testing, 9 will have normal results. Having to go for further tests does not mean you have breast cancer.
    *Women aged 40 to 49, who would like to go for breast cancer screening are advised to go for regular mammograms once a year.
  • Clinical Examination

    Clinical breast examination is done at the clinic and involves a physical examination by a doctor who checks the breasts for lumps and abnormalities. If there are any suspicious findings, the patient will be referred for further tests such as a mammogram, ultrasound, or a biopsy.
    How To Prepare
    Tell your doctor if you:
    • Have a new lump or change in your breasts. This includes a change in the way your nipples look or if you have any nipple discharge
    • Some women have nipples that sink into the breast, called inverted nipples. For these women, this is normal. But if you do not have inverted nipples and notice a change where your nipple becomes inverted, tell your doctor
    • Have pain in one breast, especially if the pain is not related to having your menstrual period
    • Are or might be pregnant
    • Are breast-feeding
    • Have breast implants
    • Have had a breast biopsy
    • Have completed menopause
    • Are taking hormone therapy
    • Have a personal or family history of breast cancer

    You may want to have your examination 1 to 2 weeks after your menstrual period ends, if you are still menstruating; your breasts are less likely to be tender at that time.

Breast Cancer

The diagnosis of cancer usually evokes multiple emotions of anger, depression, anxiety, a sense of helplessness and vulnerability. Cancer patients will also experience certain fears around their treatment such as fear of being sick, fear of being in pain, fear of the side effects of treatment and fear of disfigurement. These should be discussed with your doctor as many side effects of treatment and surgery can be alleviated and knowing this will help. Anxiety about disfigurement after mastectomy can be allayed by speaking to your doctor as reconstructive surgery is an option in many breast cancer cases.
Cancer affects not only the patient but also the patient’s family and open communication between family members is important. Intimacy issues between partners must be addressed and can be problematic as each partner tries to come to terms with their feelings.
The more you know about breast cancer and the treatment options available the better equipped you will be to deal with it. Try and speak openly about your condition with your partner, your family, your friends and your doctor rather than keeping your feelings bottled up. It may also be helpful to speak to fellow breast cancer patients, psychologists and social workers from support groups like the Breast Cancer Foundation.
  • Types of Breast Cancer

    A breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer is rare in women under the age of 30 and occurs more often in women over the age of 50. Men also develop breast cancer but this is very rare.
    • Invasive ductal breast cancer

    This is the most common type of breast cancer (also known as Infiltrating or Infiltrating ductal carcinoma). It starts developing in the milk ducts of your breast, but breaks out of the duct tubes, and invades, or infiltrates the surrounding tissue of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. Invasive ductal carcinoma accounts for about 8 out of 10 of all invasive breast cancers. Although this can affect women at any age, it is more common as women grow older.

    • Ductal carcinoma in situ (DCIS)

    DCIS is an early form of breast cancer. You may hear it described as a pre-cancerous, intraductal or non-invasive cancer, which means the cancer cells are inside the milk ducts or in situ and have not developed the ability to spread either within or outside the breast.

    • Invasive lobular breast cancer

    Invasive lobular breast cancer starts in cells that make up the lobules at the end of the ducts. Breast tissue is made up of ducts and lobules where milk is made, stored and carried through to the nipple during breastfeeding.
    Invasive lobular breast cancer is uncommon, and affects about 10-15% of all women with breast cancer. It can occur at any age, but more commonly affects women in the 45-55 year age group.
    Men can also get invasive lobular breast cancer but this is very rare. It is generally no more serious than other types of breast cancer. However, it is sometimes found in both breasts at the same time and there is also a slightly greater risk of it occurring in the opposite breast at a later date.

    • Inflammatory breast cancer is so called because the overlying skin of the breast has a reddened appearance similar to that seen with some infections of the breast

    In patients with inflammatory breast cancer, the reddened appearance is caused by breast cancer cells blocking tiny channels in the breast tissue called lymph channels.
    The lymph channels are part of the lymphatic system involved in the body’s defence against infections. Inflammatory breast cancer is a rare type of breast cancer, accounting for only 1-2% of all breast cancers.

    • Paget’s disease of the breast

    Paget’s disease of the breast is an uncommon form of breast cancer. This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and the areola the dark circle around the nipple. It occurs in around 1% of all women with breast cancer. Men can also get Paget disease but this is very rare.

    • Male breast cancer

    Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because they normally have lower levels of female hormones that affect the growth of breast cells.

    • Hereditary breast cancer

    Hereditary breast cancer is cancer that runs in a family. Hereditary breast cancer can develop when a faulty gene is passed on from either parent. Most breast cancer is not hereditary. About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.

    BRCA1 and BRCA2 genes
    Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (Breast Cancer gene one) and BRCA2 (Breast Cancer gene two).
    Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.

  • Risk factors for breast cancer

    Age and sex are the most important risk factors for breast cancer. Cancer of the breast is less common in women under thirty years old although it is occurring more frequently in younger and younger women. Also breast cancer is rare in males; female cancer of the breast is one hundred times more prevalent than male breast cancer.
    Another important factor in the epidemiology of breast cancer is the country of origin; thus while it is a very common disease in the west, e.g. in UK and the USA, it is far less common in Japan.
    Other risk factors are:
    • Family history of breast cancer on both mother and father’s side. If a mother or sister has or had breast cancer at a young age (30-40) then the woman’s risk is doubled
    • Family history of any cancer is also relevant as cancers such as uterine, skin, prostate, stomach, colon and breast occur together in clusters
    • First pregnancy after thirty years of age
    • Oestrogen exposure. Abnormally prolonged exposure to oestrogen increases risks
    • Early menarche (menstruation begins at ages around 10 or 11 years) and late menopause (menstruation ceases at age around fifty-five years). This exposes the women to prolonged oestrogen risk and at least doubles the incidence of breast cancer. Oestrogen appears to be a promoter of breast cancer
    • Lifestyle (saturated fat and alcohol). There is a correlation between the intake of saturated fats and the incidence of breast cancer
    • Obesity is associated with a twofold increase in risk of breast cancer in postmenopausal women. Increased body fat appears to be associated with raised oestrogen levels
    • Alcohol is a risk factor for breast cancer, particularly in the younger woman. It is well known that alcohol is a liver poison and as the liver is the site of oestrogen metabolism, alcohol may result in raised oestrogen levels, as the damaged liver does not metabolize oestrogen appropriately. More than two tots of alcohol per night increases ones risk by 24%
    • Oral contraceptive pill. Overall, there appears to be little risk of increasing the incidence of breast cancer. Thus the pill is generally safe. However, taking oral contraceptives for over ten years by young females before their first pregnancy (oestrogen window period) appears to increase the risk of pre-menopausal breast cancer slightly
    • Hormone replacement therapy (HRT or oestrogen administration). Studies have demonstrated that the risk of breast cancer does indeed increase after using HRT for more than five years. Nevertheless, the benefits of HRT for osteoporosis (thin bones that break easily), possibly Alzheimer’s disease and finally menopausal symptoms (such as hot flushes, emotional lability, dry vagina and so on), suggest that women who start menopause at a young age and are severely symptomatic should go onto HRT. The disadvantages are increased risk of cancer of the breast and uterus (womb)
  • Staging

    Patients often ask what stage their cancer has been diagnosed at. The staging philosophy is a tricky one as the management options for breast cancer (particularly regarding new chemotherapy agents and different uses for existing ones) is such a dynamic subject.
    Staging is made on clinical findings but this is often not accurate. Accurate staging can only be made after surgery, where the specimens are sent to the pathologist for histologic examination. This clinical staging (what we find on examination) is confirmed by pathology studies of the tumour and the axillary nodes.
    Staging systems are used to classify breast cancer, so that the doctor can treat the disease with a logical basis. The most commonly used staging system is the TNM staging system.
    Principles of the TNM staging system
    In brief: There are 4 Ts, 3Ns and different Ms
    • T1 = tumour size less than 2cm
    • T2= tumour size between 2cm and 5cm
    • T3= tumour size greater than 5cm
    • T4 =tumour that have attached to the structures (skin or chest wall, hot red breast of inflammatory cancer)
    • N1 refers to palpable mobile lymph nodes
    • N2 refers to fixed lymph nodes

    There are four stages: stage 1 and 2 cancers are early; stage 3 cancers are locally advanced (large breast cancers greater than 5cm) and stage 4 cancers have spread to elsewhere (M+).
    Part of the staging is to perform certain tests to determine whether the cancer has spread:
    Metastases are little islands of tumour cells that have spread from the primary cancer and taken root in distant tissues and organs. It is these metastases that eventually cause death. Doctors detect metastases with various methods.

    • X-ray chest for lung spread
    • X-ray bones for bony spread
    • Brain scan for cerebral metastases (MRI)
    • Ultrasound (sonar and CAT scan for liver secondaries
    • Blood tumour markers (these should be used as a serial assessment, not as individual values)

    Note that a cancer has to be at least 5mm in size or be symptomatic for these tests to positive for cancer.

  • Treatment of breast cancer

    The aim of treatment is to stop any spread of the cancer and, if possible to remove all cancer from the body. In deciding on the most suitable treatment, your Doctor will consider the size of the tumour, the type of breast cancer and whether the tumour has spread to the lymph nodes or other parts of the body. The lymph nodes in the armpit are of particular importance.

    Surgery
    Your surgeon will discuss with you the most appropriate type of surgery, depending on the size and any spread of the cancer. Before any operation make sure that you have discussed it fully with your surgeon.
    For many women it is now possible to have a smaller operation to conserve the breast rather than a mastectomy. This is known as breast conserving surgery. All breast surgery, however, will leave some type of scar, and the cosmetic effect depends on the technique used. You may like to discuss with your doctor or nurse beforehand what your breast will look like after surgery.
    i. Segmental excision/Wide local excision
    This is the removal of the breast lump together with an area of surrounding tissue. The axillary lymph nodes are also removed. Radiotherapy is given to the breast following recovery from the procedure.
    ii.Mastectomy
    A mastectomy is surgery to remove a breast or part of a breast. It is usually done to treat breast cancer. Types of breast surgery include:
    • Total (simple) mastectomy – removal of breast tissue and nipple
    • Modified radical mastectomy – removal of the breast, most of the lymph nodes under the arm, and often the lining over the chest muscles
    • Lumpectomy – surgery to remove the tumor and a small amount of normal tissue around it
    Which surgery you have depends on the stage of cancer, size of the tumor, size of the breast, and whether the lymph nodes are involved. Many women have breast reconstruction to rebuild the breast after a mastectomy.
    Sometimes mastectomy is done to prevent breast cancer. Only high-risk patients have this type of surgery.
    iii. Sentinel Lymph Node Biopsy
    The procedure involves injecting a small amount of radioactive material and a dye that identifies the first (sentinel) node to receive cells from the tumour. Sometimes there are 2 or 3 nodes at this point together, if so they are usually taken out together. If the sentinel lymph node/s have cancer cells in them or are positive, it is usual to have all the lymph nodes removed (axillary clearance). If this node is clear, it usually means that the other nodes are clear. With this procedure, removal of all the lymph nodes under the arm can be avoided for those patients whose sentinel nodes are clear.
    iv. Lymph node removal
    Removal of all the lymph nodes or axillary clearance is usually done when there has been a biopsy confirmed diagnosis of cancer spread in the lymph nodes in the armpit. For most women this operation can be performed without causing serious difficulty with shoulder movement, or arm swelling.
    v. Breast Reconstruction
    It is often possible for women who have had a mastectomy to have breast reconstruction. Sometimes this can be done at the same time as the mastectomy, but often it is done some months, or even years after the original operation. If you would like to consider breast reconstruction, discuss it with your surgeon before surgery so that he or she can tell you about the different methods available.
    After your operation
    You will be encouraged to get out of bed and start moving about as soon as possible after your operation. You may have one or two drainage tubes in place from the wound. These will usually be removed a few days after the operation by the nurses on the ward.
    The length of your stay in hospital will vary according to the type of surgery you have had. Following local excision your stay will probably be quite short; after a mastectomy your stay could be several days.
    Before you leave hospital you will be given an appointment for your post-operative check up. This is a good time to discuss any problems you have after your operation.
    Chemotherapy
    Chemotherapy is a treatment using drugs that cure or control cancer. These drugs can be used on their own or with each other. This treatment may be given before or after surgery.
    Chemotherapy may be given directly into a vein as an injection or through an intravenous infusion. It may also be given in tablet form. Most chemotherapy regimens are given intravenously in an oncology day ward.
    Sometimes, two or three courses of chemotherapy are given before surgery. This happens when the tumour is large. The chemotherapy may shrink the tumour and make the operation easier and more effective. Once you have recovered from surgery you may need further chemotherapy.
    Radiotherapy
    Radiotherapy is the use of high energy x-rays to treat cancer. These high-energy rays are produced by a machine called a linear accelerator and are able to damage and destroy cancer cells within the treatment area. Radiotherapy also affects normal cells in the area being treated, but they are generally better able to recover than cancer cells. Treatments are usually given regularly over a period of time to have the greatest effect on the cancer cells whilst limiting the damage to normal cells.
    Radiotherapy may also be used in more advanced stages of breast cancer. It can help to control previously untreated disease in the breast or help relieve cancer-related symptoms, such as pain caused by the cancer spreading to other parts of the body. In these situations, the extent of treatment will depend on individual circumstances, but would usually be given over a much shorter period of time.
    Hormone Therapy
    Hormone therapy will be prescribed if your breast cancer is hormone receptor positive. In his type of breast cancer there are receptors on the cell surface that latch onto the female hormone oestrogen, which stimulates the cancer cell to grow. If your breast cancer isn’t hormone sensitive (receptor negative tumours) hormone therapy will not be of benefit.
  • Fast Facts

    • Breast cancer cannot be spread from one person to another. There is no danger in touching a person with cancer. (TRUE)
    • Nine out of ten breast lumps are benign; this means that 90% of breast lumps are not cancer. (TRUE)
    • Nine out of ten women with early breast cancer (Stage I) will be alive after five years; and those that survive for five years, will very likely live their normal lifespan. (TRUE)
    • Women themselves detect nine out of ten breast lump; so breast self-examination once a month is of vital importance. (TRUE)
    • People having radiation or chemotherapy are not radioactive or poisonous. They are not contaminated in any way. When radioactive implants such as iridium or radioactive drugs such as iodine are used, the person may be radioactive for a few days; but in these instances, the patient is nursed in an isolation ward. (TRUE)
    • If a patient has a Stage IV breast cancer that has spread to say lung, or liver, or brain, or bone, they do not as a result have lung cancer or liver cancer or brain cancer or bone cancer. Rather the cancer is classified according to its organ of origin. So, for example, if a person gets cancer of the liver, this is called liver cancer or hepatoma (primary liver cancer). If Stage IV breast cancer involves the liver, this is called metastatic liver cancer or secondary liver cancer from a primary breast cancer. (TRUE)
  • Most breast cancer is hereditary. You don’t need to worry if you don’t have a family history of breast cancer.

(FALSE) Only about 5% to 10% of breast cancer cases are thought to be the result of gene defects (called mutations) inherited from a parent. The lifetime risk for breast cancer can be as high as 80% for members of some families who inherit certain mutations of BRCA genes. The risk is not nearly as high for most women with a family history of breast cancer. On average, having 1 first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk, and having 2 first-degree relatives triples her risk. About 20% to 30% of women with breast cancer have a family member with this disease (although most of these families do not have abnormal BRCA genes). This means that most women (70% to 80%) who get breast cancer do not have a family history of this disease.

  • Monthly self examination is the best way to find breast cancer early.

(FALSE) The American Cancer Society no longer recommends that all women routinely perform monthly breast self-exams (BSE). Instead the Society emphasizes breast awareness, which means knowing how your breasts look and feel and being alert to any changes in your breasts that you may notice while showering, dressing, etc. Research has shown that breast awareness seems to be more effective for detecting breast cancer than a formal monthly BSE. When women find their own breast cancer it is usually while bathing, showering or dressing, and less often during a specific BSE. Women who still want to do monthly BSE in addition to being aware of breast changes throughout the month should ask their health care providers for instruction on how to do this exam most effectively.

Women who notice lumps or any other changes in their breasts should contact their doctor immediately even after a recent, normal mammogram. Although a woman’s awareness of changes in her breasts is important, having mammography done according to guidelines saves more lives, because mammograms can find many cancers that are far too small to be felt; it is these small cancers that are most likely to be curable.

  • Lumps are the only sign of breast cancer.

(FALSE) Skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk can also be important warning signs for breast cancer. In one uncommon but aggressive form of breast cancer called inflammatory breast cancer, or IBC, women usually do not notice a lump, and the only symptoms may be redness and thickening of the skin covering the breast, sometimes together with swelling of the breast. It is important not to ignore these changes or assume they are the result of an infection. If you have breast changes like these, get checked by a doctor.

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