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Breast Cancer

Your Questions Answered

Mehtab Ghazi Rahman

Breast cancer is one of the commonest cancers in the world today. However, in conservative societies like ours, this is a topic that remains quite a hush-hush matter. With Breast Cancer Awareness Month having passed us by in October, this article will endeavour to answer a few questions that many women ponder about, but rarely find answers to. Breast cancer is one of the malignancies that can be easily treated, and the key to success in tackling breast cancer is 'early' diagnosis.

Is breast cancer common?
Yes. It is the commonest cancer in women. Those over the age of 50, those who have reached menopause or have a family history of breast cancer are at a higher risk of getting breast cancer than the normal population.

What is the commonest type of breast cancer?
There are many forms of breast cancer, but the commonest type is 'ductal breast' carcinoma. Breasts have tubes called ducts that carry milk to the nipple during breast-feeding. Ductal carcinoma is a condition in which there is a cancerous growth in one (or more) of these ducts. They usually manifest as lumps. Breast-feeding protects a woman against breast cancer.

What signs should worry me about breast cancer?
The main sign to look out for is a 'lump' or an area of thickened tissue in your breast. If you notice a discharge from your nipples (with blood streaks), lumps in your armpits, changes in your breast shape or size, dimpling of breast skin, a rash around your nipples or a change in your nipple shape (e.g., inward inversion of nipple), then visit a gynaecologist to get your breasts examined immediately. The earlier a cancerous lump is detected, the better the success rate of treatment.

I have felt a lump in my breast. Is this cancer?
Although having a lump may be alarming, the good-news is that the majority of breast lumps are not cancerous. In fact, 90% of all breast lumps are benign. Many women, especially those under 50 years, have cysts (fluid filled sacs) or fibroadenomas (benign growths) that appear as lumps, but are in fact harmless. However, it is always a good idea to get a new lump checked by a medical-professional to confirm that the lump is indeed risk-free.

My breasts feel lumpy before I start my periods. Should I be concerned?
No, it is common for your breasts to feel slightly lumpy before your menstrual cycle. This happens due to hormonal changes in your body, and should return back to normal once your periods have started.

Can you tell me if I have a high chance of getting breast cancer?
This is a difficult question, as many factors determine if one has a high risk of getting breast cancer or not.

* The first factor is age: the risk of breast cancer rises when you reach 50 and over, so make sure you are careful to notice any breast changes when you have reached the 50-mark.

* The second is family history : breast (and ovarian) cancer runs in families. If you have a close relative who has had breast (or ovarian) cancer, then you should take extra precautions.

* The third is having a past history of having previous cancers or breast lumps : if you have had cancer before, or you have a harmless lump in your breast, it is a good idea to remain wary as these factors increase your risk of developing breast cancer later on.

* Fourth, the greater the density of breast tissue, the higher the chance of a woman developing breast cancer.

* Fifth, being overweight raises breast cancer risk. The more you weigh, the higher a hormone called 'oestrogen' you have in your body. Too much oestrogen increases the risk of one getting breast cancer.

* Drinking alcohol increases the risk of developing breast cancer.

* Working in an environment where there is a lot of radiation such as X-rays (e.g., diagnostic centres or some industries) increases breast cancer risk.

* If you are in menopause and are taking Hormone Replacement Therapy (HRT) to alleviate menopause-symptoms, there is a small risk of developing breast cancer in the long-run. Your doctor will warn you about this prior to commencing you on the HRT medication.

I have noticed a new lump in my breast and wish to get medical help. What is the doctor going to do when I visit him/her?
When you get a new lump and have risk factors for breast cancer , it is imperative to get it seen by a gynaecologist to check whether its harmful or not, even if you don't feel comfortable visiting a clinic. The doctor is going to take a short history from you (e.g., duration of symptoms, family history, weight loss, etc.) and do a quick breast examination to examine the lump. It may be embarrassing for many women to get a breast examination done by male doctors; if this is the case, choose a female gynaecologist. Always ask for a chaperone to be present, or take a close relative for moral support when you are being examined. After the check-up, your doctor may want to do a few blood tests. These blood tests will be no different from those you have had done in the past. You may also be requested to have a mammogram done. A mammogram is an x-ray of the breast to look for a lump, or areas of calcification in the breast, which are commonly seen in breast cancers.

If my initial test results come back positive for breast cancer, what will happen next?
Your blood tests and mammogram will give the doctor a fair idea about the status of your breast lump. If the doctor feels the lump requires further investigation, he/she may order a needle biopsy (a procedure in which a small specimen of the lump is taken out for investigation using a special syringe) or an excision biopsy (a procedure carried out under general anaesthesia in which the whole lump is removed from the breast) to confirm whether the lump is cancerous or not. The doctor will also order a chest X-ray and a bone scan, as breast cancers can spread to other parts of the body, such as the lungs and bones.

If I have breast cancer, what treatment options are available to me?
Luckily, breast cancer can be treated easily, using surgery, chemotherapy, radiotherapy and hormonal therapy. The scope of this article does not allow a full explanation of each treatment strategy, but the treatment depends on the type of breast cancer one suffers from. A good doctor will select the best treatment for you depending on the cancer type and your personal preferences. The prognosis for breast cancer is usually excellent following effective treatment.

If I have breast cancer and require surgery, will the surgeon remove my breasts?
No. If diagnosed early, a malignant lump in the breast can be removed by 'breast conserving surgery', in which only the lump is removed, whilst conserving healthy tissues. The cosmetic changes to the breast are minimal in this type of surgery.

A breast will only be removed completely (mastectomy) when the tumour is located centrally in the breast or if the tumour has spread from the breast to other parts of the body. Sometimes, the surgeon will also remove some lymph nodes along with breast tissue to check if the tumour has spread to other parts of the body. Following a mastectomy, the surgeon will do a breast 'reconstruction', in which a new breast will be created using an implant or tissue from another part of your body. An alternative to having a reconstruction is having a breast prosthesis made of silicone as a substitute for the excised tissue.

Are there any medicines to stop breast cancer from returning back once I have been treated?
There are a number of effective drugs that are available. All of them work by regulating specific hormones in your body. Drugs like Tamoxifen, Aromatase inhibitors and Pituitary downregulators are all currently being used to stop breast cancers recurring. Your doctor will explain these to you at the time of prescription.

How can I minimise my chances of getting breast cancer?
There are many things that can effectively reduce your chances of getting breast cancer. Some of these are:

* Having a low fat diet, and eating lots of fruits and vegetables.

* Exercising regularly

* Maintaining a healthy weight and avoiding obesity

* Breastfeeding has shown to reduce the incidence of breast cancer by half. The longer a woman breastfeeds her baby, the lower the chance of her getting breast cancer after menopause.

Can men get breast cancer?
Yes. Although less common than in women, 'obese' men have a moderate risk of developing breast cancer, just like women. Overweight men should therefore be alert about any changes to their chests and report any abnormal findings to their doctors.

I want to find out if I am at risk of developing familial breast cancer. Is that possible?
Yes, it is. United Kingdom's National Institute for Clinical Excellence (NICE), has developed an online survey that allows women to assess their risk of developing breast cancer online, for free. Please visit to access this survey.

(Mehtab Ghazi Rahman is a Graduate of the Human Bio-Medical Sciences from the University of London, and is currently a finalist student-doctor at St. Bartholomew's and the Royal London Medical School, UoL).


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