Breast cancer: everything you need to know but may be too worried to ask
Breast cancer: everything you need to know but may be too worried to ask. By Anne Montague and Michelle Hather
I’ve found a lump in my breast, what happens now?
Lumps come in all shapes and sizes and the vast majority – nine in 10 – won’t be cancerous, but always have them checked out anyway. And remember it’s not just lumps – if you notice any other changes, such as thickening, differences in the size or shape of your breast, dimpling of the skin, changes to your nipple, a discharge or rash around your nipple, swelling or lumps in your armpit or pain in one breast that persists, make an appointment to see your GP immediately. If your doctor can’t rule out the possibility of breast cancer, you will be referred for an assessment at a breast clinic.
They say they can see something on the mammogram – I’m panicking.
Try not to worry – although about one in 20 women are recalled after routine mammograms, only one in eight of these turn out to have cancer. One of the things that can show up on a mammogram is deposits of calcium within the breast tissue. Calcification isn’t harmful and is usually a sign of non-cancerous changes, but certain patterns of calcification may suggest cancer. In this case, your specialist may suggest doing a biopsy of the area.
I have an appointment at a breast clinic. What will they do?
You will have a series of tests to determine whether you have cancer and, if that’s the case, what will be the best treatment for you. The doctor will give you a physical examination and then a mammogram. Younger women tend to be given an ultrasound as well because their breast tissue is too dense to give a clear picture on mammogram. The final test is a biopsy, which involves taking a sample of breast tissue to examine under a microscope and determine whether the cells are cancerous. It can be done using a fine needle to remove some cells (fine needle aspiration), which can be uncomfortable, or a hollow needle to remove a small amount of breast tissue (a core biopsy), which is done under local anaesthetic.
How long will I have to wait until I know the results?
If you’re able to attend a one-stop clinic, you will be given the basic result – whether or not you have cancer – the same day. Elsewhere, you are likely to have to wait for at least a week to find out your results.
What are the types of breast cancer I could have?
There are many different types of breast cancer, and your doctor should explain which type you have:
● Non-invasive cancers are those that remain localised and haven’t spread further into the breast. Most non-invasive cancers are known as DCIS – ductal carcinoma in situ. You will probably still need treatment to ensure that the cancer doesn’t spread.
● Invasive cancers are those that have spread into and possibly beyond the breast. The majority – around 70-80% – of invasive cancers have started in the cells lining the breast ducts. Around 10% of invasive cancers start in the cells lining the lobes (the milk-producing glands).
● There are several other, rarer, forms of breast cancer. These include inflammatory breast cancer – a type of cancer where the breast becomes red and inflamed, and Paget’s disease – a rare condition associated with breast cancer where a red, scaly rash develops around the nipple.
The doctor may want to do further tests to check the size of the cancer and whether there has been any spread. You will probably be given blood tests and a chest X-ray, which are standard preparations for surgery – and you may be given scans (for example, an ultrasound, MRI, CT or bone scans) to give a fuller picture of the cancer or to check for any spread to other parts of your body.
What do the doctors mean when they say ‘staging’?
The stage of your cancer is determined by looking at the size of the tumour, whether your lymph nodes are affected, and whether it has spread beyond your breast to other parts of your body. Cancers are staged 1, 2a, 2b, 3a, 3b, 3c and 4. DCIS is pre Stage 1. A Stage 1 cancer is no more than 2cm across, there are no cancer cells in the lymph nodes in the armpits and the cancer hasn’t spread anywhere else, whereas a Stage 4 cancer is one that has spread to other body organs, such as the lungs, liver or bones. For more detailed information on staging, consult breastcancercare.org.uk under the diagnosis section.
What is meant by the ‘grade’ of the cancer?
The grade tells you what the cancer cells look like under a microscope.
Grade 1 cells are slow growing, Grade 2 cells look less like normal cells and are faster growing, and Grade 3 cells are very different and likely to grow fast. Your doctor may also refer to them as:
● Well differentiated (Grade 1)
● Moderately differentiated (Grade 2)
● Poorly differentiated (Grade 3)
What does it mean when they talk about ‘hormone positive’?
Some cancer cells have receptors for oestrogen on their surface. When oestrogen attaches to these receptors it causes the cancer cells to grow. Your cancer will be tested to see whether it has these receptors (ER positive). An ER or hormone positive cancer will respond to treatments like tamoxifen, which block the action of oestrogen, whereas an ER negative cancer will not. Some cancers also have progesterone receptors (PR positive) – ER positive cancers usually also have progesterone receptors.
What about the term HER2 positive. What does this mean?
Some breast cancer cells have receptors for a protein called HER2 which helps the cells to grow. If your cancer has high levels of HER2 receptors it is known as HER2 positive, and is more likely to respond well to treatment with drugs like Herceptin. About 15-25% of women diagnosed with breast cancer have a HER2 positive cancer.
I’ve heard the phrase ‘triple negative’, but I’m not sure what it refers to?
A minority of breast cancers, around 10-15%, don’t have receptors for oestrogen, progesterone or HER2. These types of cancer are known as ‘triple negative’ and are unlikely to respond to hormonal treatments like tamoxifen or Herceptin but can be treated with chemotherapy.
I thought lumpectomies were common now. Why would I need a mastectomy?
You may need a mastectomy rather than a lumpectomy if your tumour is unusually large or if there is more than one tumour. Some women have chemotherapy before surgery to shrink the tumour enough to make a lumpectomy possible. If you are having a mastectomy, you may want to discuss the possibility of breast reconstruction with your surgeon. This can be done at the same time as surgery at some hospitals or at a later date.
How long will I have to spend in hospital?
It depends on the type of operation you have. If you have a lumpectomy, you may be able to go home the same day, although some women do stay overnight. A mastectomy is a more major operation and you are likely to need to stay in hospital for several days.
Is it safer to have both breasts removed as a precaution?
If your doctor thinks there is a high chance of cancer developing in the
other breast because you have tested positive for one of the faults in the BRCA genes, which significantly increase the risk of breast and ovarian cancer, then yes. However, this is a major decision and one
that should never be taken lightly.
Will I need to have a course of chemotherapy?
Many women have chemotherapy as part of their treatment, but it will depend on the stage and grade of your cancer.
If I do have chemotherapy, will I lose my hair?
Some chemotherapy drugs cause hair loss and thinning, while others are less likely to do so. Hair loss can be reduced by restricting the blood flow to the scalp during treatment by wearing a cold cap, but that’s only useful for preventing hair loss with certain chemotherapy drugs. Cancerbackup (cancerbackup.org.uk) have information about scalp-cooling techniques. Look Good Feel Better (lookgoodfeelbetter.co.uk) also offers hair and beauty advice and workshops for women undergoing cancer treatment.
Will I need to have radiation as part of my treatment?
Your treatment plan will depend on your cancer and what your specialist advises is best for you, but radiotherapy is a fairly standard treatment after breast cancer surgery.
Once treated, is the cancer likely to come back?
Breast cancer can recur at any time, although the longer you have been clear of cancer, the lower the chances are that it will return. The statistics show that eight in 10 breast-cancer patients now survive five years or more beyond diagnosis, whereas at least two in three survive 20 years or more.
Will I be able take to take HRT in the future?
It’s unlikely that your doctor would prescribe HRT if you’ve had breast cancer because studies have shown that it can increase the risk of breast cancer coming back.