Breast cancer - What you need to know

Breast cancer is one of the most common cancers occurring in women but is rare in men.

Women have a lifetime risk of breast cancer of approximately one in eight, which means that one woman in eight has a risk of developing breast cancer in her lifetime.

Breast cancer is extremely rare in women in their twenties, is uncommon in the thirties but is increasingly detected as women get older

HOW IS BREAST CANCER DETECTED?
Breast cancer commonly presents as a palpable lump in the breast, which is either felt by the patient or by her doctor. There are a number of other ways in which breast cancer may present, including thickening of the breast tissue, a bloody discharge from the nipple and a lump felt in the armpit.
Many breast cancers are detected when women have a screening mammogram. A screening mammogram is usually performed on women over the age of 40 years, or at a younger age, if clinically indicated, who do not have any palpable lumps or other worrying symptoms.
Mammograms, ultrasound and MRI scans may detect breast cancer before it presents clinically. The earlier a breast cancer is detected, the better the long-term outcome in most patients.
Mammograms are particularly good at detecting micro-calcification associated with breast cancers, including ductal carcinoma in-situ (DCIS), which if detected and appropriately treated, is usually associated with a very good long-term prognosis.
Mammograms also detect non-palpable lumps and other changes associated with breast cancer. Ultrasound is not used routinely in screening for breast cancer but is very useful in assessing the breast tissue in patients who have very dense breasts, where the cancer may be hidden by the surrounding breast and where the mammogram shows an abnormality, such as a mass.
MRI of the breasts is being increasingly used to detect breast cancer, however the need for an MRI is usually decided on by the radiologist and referring specialist.
The sooner a breast cancer is detected (when the cancer is still small and has not spread), the better the overall prognosis in the majority of breast cancer patients.

WHO SHOULD HAVE A MAMMOGRAM?
It is generally accepted that women from the age of 40 years should have regular screening mammograms. There is debate as to how often a screening mammogram should be performed. The recommendations vary from every 12 months to every three years. Patients should speak to their doctor, however if you have a family history of breast cancer, are taking HRT or have an increased genetic risk, then a mammogram is advised every 12 months.
Women whose mothers have had breast cancer should start having regular screening mammograms about 10 years before the onset age in their mother (for example: at the age of 35 years, if the mother developed cancer at the age of 45 years, or from the age of 40 years, if at an age over 50 years).
Patients over the age of 30 years, presenting with a lump or other worrying symptom should have a mammogram and ultrasound.
Patients under the age of 30 years, who have a lump, would normally have an ultrasound first and the radiologist would then decide on the need for a mammogram.
Any patient who develops a lump in the breast should first be examined by their doctor, who will then refer them for further investigation.
It is important to remember that the majority of lumps that patients and doctors feel are benign and are due to normal breast tissue, simple cysts and benign growths, such as fibro adenomas. This is particularly true in younger patients, under the age of 40 years.
Please note that mammograms and ultrasound do not detect all breast cancers and that, depending on the clinical nature of the palpable lump, a needle biopsy may still be required to exclude breast cancer.

WHAT HAPPENS IF THE MAMMOGRAM IS ABNORMAL?
If the mammogram or ultrasound shows changes which are worrisome, a biopsy is usually required to determine the underlying cause. This can be performed by your doctor if the lesion is palpable or under mammographic or ultrasound guidance. If not palpable, it depends on which investigation shows the lesion best. The biopsy tissue is then reviewed by a pathologist. If the biopsy is positive for cancer, then the patient will need to be seen by a breast specialist/surgeon, who will then decide on further management.

BREAST CANCER RISK FACTORS
There are a number of risks that are thought to affect the development of breast cancer, however the main risk factors are age and family history. As women get older, so the risk of developing breast cancer increases. Hormone replacement associated with an increased risk. If you have a family history of breast cancer, the risk doubles. A small percentage of women carry the BRCA1 AND BRCA2 genetic faults and the lifetime risk in these women increases to approximately 80%. Women with a family history of breast and ovarian cancer are particularly at risk and should discuss the options of genetic screening and breast/ovarian cancer screening with their GP or gynaecologist.

HOW CAN BREAST CANCER BE DETECTED EARLY?

• Women over the age of 30 should consult their doctor at least once a year to have their breasts clinically examined.
• Women over the age of 40 years should have a regular screening mammogram and high risk patients may need mammograms or an MRI from a younger age.
• Consult your doctor if you are worried about a lump in the breast, or any other breast changes.
• Perform regular self-examination of your breasts.

Source: Morton & Partners Radiologists Should you have any queries, please contact your doctor or contact us at Morton & Partners: Gatesville 021 637 8121 or Bellville 021 946 1020.