How Is Breast Cancer Diagnosed
During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:
- Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
- Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
- Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.
After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .
Pregnancy Diagnosed During Or After Breast Cancer
Studies of pregnancy after a diagnosis and treatment of breast cancer are retrospective and most are case-controlled investigations. Although one study showed an increased risk for relapse, most other studies show either no difference in recurrence or a decrease in risk of recurrence. Breast cancer survivors and their medical caregivers are advised to fully discuss the risk of recurrence when discussing post-cancer reproductive choices.
What Is Secondary Breast Cancer
Secondary breast cancer is when breast cancer spreads from the breast to other parts of the body, becoming incurable. Breast cancer most commonly spreads to the bones, brain, lungs or liver.
While it cannot be cured, there are treatments that can help control certain forms of the disease for some time and relieve symptoms to help people live well for as long as possible.
There are an estimated 35,000 people living with secondary breast cancer in the UK. In around 5% of women, breast cancer has already spread by the time it is diagnosed.
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In Situ Breast Carcinoma Incidence
- There are around 8,300 new breast carcinoma in situ cases in the UK every year, that’s 23 every day .
- In females in the UK, breast carcinoma in situ accounted for around 8,300 new cancer cases every year .
- In males in the UK, breast carcinoma in situ accounted for around 30 new cancer cases every year in 2016-2018.
- Incidence rates for breast carcinoma in situ in the UK are highest in people aged 65 to 69 .
- Each year around a tenth of all new breast carcinoma in situ cases in the UK are diagnosed in people aged 75 and over .
- Since the early 1990s, breast carcinoma in situ incidence rates have tripled in the UK. Rates in females have around tripled , and rates in males have around doubled .
- Over the last decade, breast carcinoma in situ incidence rates have increased by almost a third in the UK. Rates in females have increased by around a third , and rates in males have remained stable .
- Most in situ breast carcinomas are intraductal.
- In situ breast carcinoma is more common in White females than in Asian or Black females.
- Breast carcinoma in situ incidence rates in England in females are 28% lower in the most deprived quintile compared with the least, and in males are similar in the most deprived quintile compared with the least .
- Around 910 cases of breast carcinoma in situ each year in England in females are linked with lower deprivation.
- An estimated 63,800 women who had previously been diagnosed with in situ breast carcinoma were alive in the UK at the end of 2010.
Symptoms Of Breast Cancer
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.
You should also see a GP if you notice any of these symptoms:
- a change in the size or shape of one or both breasts
- discharge from either of your nipples, which may be streaked with blood
- a lump or swelling in either of your armpits
- dimpling on the skin of your breasts
- a rash on or around your nipple
- a change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain is not usually a symptom of breast cancer.
Find out more about the symptoms of breast cancer.
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How Does Breast Cancer Start
Breast cancer occurs when cells in the breast grow out of control. Different kinds of breast cells develop into different . Most breast cancers begin in the breast ducts or lobules . These are known respectively as invasive ductal carcinoma and invasive lobular carcinoma. Other less common types of breast cancer include inflammatory breast cancer and ductal carcinoma in situ.
Though breast cancer is most common in women, men can develop it as well. A mans lifetime risk of breast cancer is about 1 in 883. This year, the American Cancer Society estimates that about 2,620 men will be diagnosed with breast cancer.
A New Option For Scotlands Most Common Cancer
The targeted drug osimertinib was the third cancer treatment approved in the latest batch of SMC decisions.
Scotland is the only part of the UK where lung cancer is the most common cancer. Its great news that a better treatment option is being made available for people with advanced forms of the disease, said Ferguson.
Around 10% of non small cell lung cancers, the most common type of lung cancer, have a genetic error that means they produce a faulty version of a molecule called EGFR, which drives the growth of the cancer cells. Osimertinib works by blocking this faulty EGFR molecule, helping to stop the cancer from growing and spreading.
A trial showed that the drug improved the amount of time that adults with EGFR-positive advanced non small cell lung cancer lived for without their cancer growing significantly compared to 2 other drugs that target EGFR.
In making their decision, the SMC also considered that osimertinib may have fewer side effects than existing drugs.
The decision to approve osimertinib will be welcome news for patients and their families in Scotland, said Ferguson.
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What Are The Warning Signs Of Breast Cancer
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A mass or lump, which may feel as small as a pea.
- A change in the size, shape, or contour of the breast.
- A blood-stained or clear fluid discharge from the nipple.
- A change in the look or feel of the skin on the breast or nipple .
- Redness of the skin on the breast or nipple.
- An area that is distinctly different from any other area on either breast.
- A marble-like hardened area under the skin.
These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts.
Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
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Symptoms Of Mammary Cancer
Breast cancer in cats is usually first characterized by lumps or nodules in the breast tissue. After the cancer has progressed more, you may notice additional symptoms.
The first sign of mammary cancer in cats is lumps or nodules in the breast tissue. You might be stroking your cat or watching them roll around on the floor, and notice a lump on their underside.
Often these lumps feel like peas or marbles under the skin, but they arent always as neat as this and can be varying shapes and textures. The lump may ulcerate, leading to blood, wounds or discharge from the undercarriage. The nipples may also swell and discharge.
Depending on how far the breast cancer has progressed you may notice pain, fever, and inappetence. If the tumor has spread to the chest, you may notice a cough.
What Can I Do To Reduce My Risk
If several members of your family have had breast or ovarian cancer, or one of your family members has a known BRCA1 or BRCA2 mutation, share this information with your doctor. Your doctor may refer you for genetic counseling. In men, mutations in the BRCA1 and BRCA2 genes can increase the risk of breast cancer, high-grade prostate cancer, and pancreatic cancer.
If genetic testing shows that you have a BRCA1 or BRCA2 gene mutation, your doctor will explain what you should do to find cancer early, if you get it.
All men can lower their risk by keeping a healthy weight and exercising regularly.
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How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
General Considerations For Screening
The goal of screening for cancer is to detect preclinical disease in healthy, asymptomatic patients to prevent adverse outcomes, improve survival, and avoid the need for more intensive treatments. Screening tests have both benefits and adverse consequences .
Breast self-examination, breast self-awareness, clinical breast examination, and mammography all have been used alone or in combination to screen for breast cancer. In general, more intensive screening detects more disease. Screening intensity can be increased by combining multiple screening methods, extending screening over a wider age range, or repeating the screening test more frequently. However, more frequent use of the same screening test typically is associated with diminishing returns and an increased rate of screening-related harms. Determining the appropriate combination of screening methods, the age to start screening, the age to stop screening, and how frequently to repeat the screening tests require finding the appropriate balance of benefits and harms. Determining this balance can be difficult because some issues, particularly the importance of harms, are subjective and valued differently from patient to patient. This balance can depend on other factors, particularly the characteristics of the screening tests in different populations and at different ages.
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New Options For An Aggressive Breast Cancer
Around 2 in 10 breast cancers test positive for a protein called HER2, which encourages cancer growth and makes the disease more aggressive. New treatments are needed for people who dont respond to whats currently available.
Tucatinib specifically targets HER2, helping slow or stop cancer cells from growing. A trial showed that those who received the drug in combination with the cancer drugs trastuzumab and capecitabine lived for longer without their disease progressing compared to a placebo.
Whilst now approved for use on the NHS in Scotland, this combination is not yet cleared for use in NHS England.
The second treatment to be approved, trastuzumab deruxtecan, works differently to tucatinib. It combines 2 drugs, using trastuzumab to attach to HER2 proteins on cancer cells and then delivering the antibody drug deruxtecan directly into the breast cancer cells to kill them.
This medicine is a breakthrough treatment for people with HER2 positive breast cancer that cant be removed by surgery, or whose cancer has spread, said David Ferguson, public affairs manager for Cancer Research UK in Scotland.
Recent and ongoing studies suggest that the drug could give patients with HER2 positive breast cancer more time before their disease progresses. Todays decision means people will have early access to this promising new medicine while the Scottish Medicines Consortium gathers further evidence in advance of its final decision.
Can Breast Cancer In Younger Women Be Prevented
For women with a family history that is suggestive of a hereditary predisposition for breast cancer, a referral for genetic counseling may be appropriate. Identifying such genetic conditions will allow for a more personalized discussion on screening and preventive treatment options. For example, screening in BRCA mutation carriers begins at the age of 25.
Measures that all women can take to reduce breast cancer risk include:
- Achieving and maintaining ideal body weight
- Limiting alcohol consumption
- Getting regular exercise
- Breastfeeding
That being said, if breast cancer does develop, early detection and prompt treatment can significantly increase a womans chances of survival. More than 90% of women whose breast cancer is found in an early stage will survive.
Young women should be counseled on breast awareness and to report any breast changes to their healthcare provider. These changes can include:
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Breast Cancer Incidence By Sex And Uk Country
Breast cancer is the most common cancer in the UK, accounting for 15% of all new cancer cases .
In females in the UK, breast cancer is the most common cancer . In males in the UK, it is not among the 20 most common cancers .
99% of breast cancer cases in the UK are in females, and 1% are in males.
Breast cancer incidence rates rates ) for persons are similar to the UK average in all the UK constituent countries.
Breast Cancer , Number of New Cases, Crude and European Age-Standardised Incidence Rates per 100,000 Population, UK, 2017
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Other Risk Factors For Breast Cancer
Other factors that seem to increase risk include:
- not having children or having children after the age of 30
- early age at first period
- later age of natural menopause
- alcohol intake
- obesity or gaining a lot of weight after menopause
- using the contraceptive pill the risk is higher while taking the pill and for about ten years after stopping use
- using hormone replacement therapy also known as hormone therapy the risk increases the longer you take it, but disappears within about two years of stopping use.
Having some of these risk factors does not mean that you will get breast cancer. Most women with breast cancer have no known risk factors, aside from getting older. More research needs to be done before we can be definite about risk factors.
In men, the main risk factor is abnormal enlargement of the breasts due to drug, chemical or hormone treatments. Men with Klinefelters syndrome can also be at risk. A mans risk increases where there is a family history of male breast cancer or a strong family history of breast cancer.
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Your Race And Ethnicity
White and Black women have the highest risk of developing breast cancer in their lifetime. Asian/Pacific Islander and Hispanic/Latina womens breast cancer rates fall in between two major groupings while American Indian and Alaska Native women are on the lowest end of risk.
While white women are more likely to develop breast cancer than Black women overall, they tend to be diagnosed at an older age . Black women have the highest breast cancer rates among women under age 40. Black women make up a higher percentage of triple-negative breast cancer cases.
What to do: If your race or ethnicity places you at higher risk, make sure you follow all screening recommendations to improve your chances of catching cancer early.
The Cost Of Breast Cancer Treatment For Young Women
Everyone with breast cancer is at risk for suffering from economic toxicity with the diagnosis, says Dr. Silber. At the time they are diagnosed with breast cancer, younger women are less likely to be financially sound or to have established themselves in a career that provides sick leave and paid time off theyre also likelier to have small children, she says.
If you suffer from economic challenges prior to a cancer diagnosis, breast cancer is going to make that worse, says Dr. Silber. Thats especially true for younger women who are from poorer socioeconomic backgrounds and dont have access to the services or much leeway in terms of employment, she says.
I take care of women who are young, poor, single mothers who may be working at jobs that dont have good human resources supportlike, for example, a young woman working at a mini mart at night, says Dr. Silber. She may be doing hard and not particularly safe work, and might not have health benefits.
It can be a struggle to keep a job or get a raisebreast cancer patients may become semi-unemployable due to all the medical appointments they need, she explains.
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