Breast cancer

Breast cancer affects one in 11 Australian women. Around 3,000 Victorian women are diagnosed with the disease every year. It is most common in women over the age of 50 years. Men can also develop breast cancer, although this is extremely rare. Each year about 20 men a year are diagnosed in Victoria.

There are different types of breast cancer, but they all begin in the milk ducts and/or the milk lobules. Some breast cancers are found when they are ‘in situ’. This means they have not spread outside the milk duct or lobule where they began.

Most breast cancers are found when they are ‘invasive’. This means the cancers have grown beyond the duct or lobule where they began into other breast tissue or out of the breast. Breast cancer that spreads out of the breast may spread to lymph nodes in the armpit nearest the breast affected by cancer (axillary lymph nodes). It can also spread to other parts of the body such as the bones and liver.

Risks and causes
The exact cause of breast cancer is unknown, but factors that seem to increase risk include:

• Gender – being a woman.
• Getting older – most cases occur in women over 50. This is why women over 50 years of age are invited to take part in yearly mammograms to screen for breast cancer.
• Heredity – a strong family history of the disease.
• Previous history of breast cancer – women who have had breast cancer have a greater risk of developing it again.
• Certain breast diseases – some types of breast disease that are found through mammograms indicate an increased risk.

• Not having children or having children after the age of 30
• Early age at first period
• Later age of natural menopause (55 years or older)
• 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 (HRT) - also known as hormone therapy (HT) -the risk increases the longer you take it, but disappears within about two years of stopping use.

• Thickening of the tissue
• A lump or lumpiness
• Discharge from the nipple
• An inverted or ‘turned-in nipple’ (unless the nipple has always been turned in)
• Puckering or dimpling of the skin
• A change in the shape of the breast or nipple
• A painful area
• Anything that is not ‘usual’ for you.

• Physical examination – breasts and armpits are examined.
• Diagnostic mammogram – an x-ray of the breast tissue.
• Ultrasound – a device that uses sound waves to scan the breast.

• Fine needle aspiration – a very narrow needle is used to withdraw cells from the area for testing.
• Core biopsy – a larger needle is used to take a tissue sample for testing.
• Open biopsy – surgery performed under general anaesthetic to remove the whole area for testing.
• Hormone tests – if a cancer is found, it can be checked for special markers called hormone receptors to see if it will respond to hormone treatment.
• Ductogram or discharge test – for breast cancers that are causing a discharge from the nipple.
• Other tests – such as blood tests, bone scans and chest x-rays.

• Whether you have had your menopause
• The type of breast cancer you have
• The size of your breast tumour
• The stage of your breast cancer (whether or not the cancer is confined to the breast or has spread to other parts of the body)
• The grade of your cancer cells
• The results of tests on your cancer cells
• Your age, general health and personal preferences.

• Breast-conserving surgery – a smaller operation removes the cancer and some of the surrounding tissue, and usually some lymph nodes, leaving the bulk of the breast intact.
• Mastectomy – the entire breast is removed, along with lymph nodes from the armpit. Extra cancer treatment is often unnecessary.
• Breast reconstruction surgery – women who have a mastectomy may choose to have reconstruction surgery (at the time of the mastectomy or later). Options include saline-filled implants or the use of your own muscle and skin to create a breast-like shape. (If you don’t choose reconstruction, you may use a breast form or prostheses. These are pads that are worn inside your bra. They help to restore balance and are designed to look like a normal breast under clothes.)

• Radiotherapy – using x-rays (radiation) to kill any remaining cancer cells. Women who have had breast-conserving surgery often have a course of radiotherapy. Side effects can include a reddening of the skin, which looks like sunburn.
• Chemotherapy – cancer-killing drugs that are given intravenously. Chemotherapy can be offered to women with early breast cancer as an extra treatment to surgery, radiotherapy or both. Side effects can include nausea, vomiting and hair loss.
• Hormone treatments – many breast cancers are influenced by the sex hormones oestrogen and progesterone. Hormone treatment can reduce the chances of breast cancer developing again.

• Your doctor
• Breast cancer specialist
• Surgeon (specialist in breast surgery)
• Breast cancer support groups
• The Cancer Council Victoria, Cancer Helpline Tel. 131 120
• Multilingual Cancer Information Line, Victoria - see the CCV website for contact details

• Breast cancer affects one in 11 Australian women.
• It is important for all women to get to know the normal look and feel of their breasts.
• Although most breast changes aren’t caused by breast cancer, you should always consult your doctor if you notice an ‘unusual’ change.
• Treatment options for breast cancer include surgery, radiotherapy, chemotherapy and hormone treatment.

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