Breast cancer treatment

This section provides information about breast cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types breast cancer treatments available.

About breast cancer

Breast cancer is the most common type of cancer found in women in the UK. A mammogram is an X-ray of your breast that screens for breast cancer. Although it mainly affects older women, it can occur at a younger age. Consequently, as part of Circle Health's continuing commitment to quality care, our Breast Screening Mammography programme includes the screening of asymptomatic women (without symptoms) aged 40 and over.  A screening every 12-18 months is recommended between 40 and 49 years of age and every 2 years after 50.

As part of the NHS Breast Cancer Screening Programme, women aged 50-70 are invited for a mammogram every 3 years, with some trusts offering screening to those aged 47 -73. After 73, although mammograms are available, they need to be requested individually by the woman.

Younger women can get breast cancer too. So whatever age you are, it’s important that you get to know what’s normal for you and your breasts. Men are also at risk of developing male breast cancer so everyone should be aware of potential symptoms.

If you notice any changes in how they look or feel, you should see your doctor as soon as possible. As you can’t always feel a lump, it’s important to go to your Breast Cancer Screening appointments.

Here you can find out more about the different types of breast cancer, risk factors, what causes it and how it’s treated.

Facts about breast cancer

• Breast cancer is the most common cancer in the UK^[i]
• It affects around 48,000 women in Britain every year^[ii]
• Breast screening saves around 1,300 lives a year in the UK^[iii].

What is breast cancer?

Your breasts are made of fat, connective tissue and lots of tiny glands called lobules.

Our bodies replace cells all the time. Normally, they only make new cells when and where they’re needed. If breast cancer occurs, the cells in your breasts have started to grow and multiply abnormally to form a growth or tumour.

^[i] NHS Choices, Breast cancer (female), Introduction. https://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Introduction.aspx
^[ii] NHS Choices, Breast cancer (female), Introduction
^[iii] Cancer Research UK, Mammograms in breast screening https://www.cancerresearchuk.org/about-cancer/tests-and-scans/mammogram

Types of breast cancer

There are several types of breast cancer. Each develops in a different part of the breast and is classed as either invasive or non-invasive.

Non-invasive breast cancer means the cancer cells are confined to the breast lobules and ducts. This does not always present asa lump, it’s most often found on a mammogram. If non-invasive breast cancer isn’t treated, it can develop into invasive breast cancer.

Invasive breast cancer means the cancer cells have spread to breast tissue surrounding the ducts and lobules.It can also spread to the lymph glands under your arm. Sometimes invasive cancer cells can spread to other parts of your body through your lymph glands or bloodstream.

Ductal carcinoma in situ (DCIS) 
‘In situ’ is another way of saying a cancer is non-invasive. Ductal carcinoma in situ is the earliest form of breast cancer. It means there are cancer cells in your breast ducts, but they’re contained and haven’t spread to any other breast tissue. It’s often picked up during mammograms when women have breast screening.

Lobular carcinoma in situ (LCIS)
Lobular carcinoma in situ isn’t actually cancer. It means that the cells that line your breast’s lobules change in a way that increases the risk of breast cancer in the future. Women who have lobular carcinoma in situ will be offered regular mammograms to monitor for any changes.

Invasive ductal breast cancer
Around nine out of ten breast cancers are ductal cancer. It means the cancer started in the cells that line your breast’s ducts and is spreading to the surrounding tissue.

Invasive lobular breast cancer
Invasive lobular breast cancer is less common. Around one out of ten breast cancers are lobular cancer[iv].This happens when the cancer cells that started in the lining of your breast’s lobules spread to other parts of your breast. If you’re diagnosed with breast cancer in both breasts at the same time, it’s more likely to be lobular breast cancer than ductal breast cancer.

Uncommon types of breast cancer
There are other, less common types of breast cancer. These include inflammatory breast cancer and Paget’s disease.

^[iv] Cancer Research, Invasive lobular breast cancer https://www.cancerresearchuk.org/about-cancer/breast-cancer/types/invasive-lobular-breast-cancer

Causes and risk factors

While the exact cause of breast cancer isn’t known, there are some things we know definitely increase the risk.

Getting older
Around four out of five breast cancer cases are diagnosed in women over 50, which is why the NHS recommend you have breast screening every three years once you turn 47 though the NHS Breast Screening Programme^[v].

However, if you’re over 47 and concerned about your health, you can request a GP referral for a routine mammogram or breast ultrasound scan through Circle Health clinics at any time.

Your hormones
The female hormone oestrogen can stimulate the growth of breast cancer cells. The more oestrogen you’re exposed to, the greater your risk of developing breast cancer. Things like starting your period early and entering menopause late, taking HRT or the pill, not having children or having them later in life mean your body’s been exposed to oestrogen for a longer time frame or in a greater quantity.

Your weight
Weight also has an effect on your risk of breast cancer, especially for women who are overweight or obese after the menopause.

Drinking alcohol or smoking
The more heavily you smoke or the more alcohol you drink, the greater your risk of breast cancer.

Your family history
If a close relative has had breast cancer or ovarian cancer, you might be at greater risk of developing breast cancer too.As breast cancer is the most common type of cancer in women, it’s possible for more than one case in a family to be coincidental. Most breast cancer cases don’t run in the family, although some genes can increase your risk.

If you’ve had breast cancer before
You have a greater risk of getting breast cancer in either the same breast or your other breast if you’ve had breast cancer before.

There are other factors that have been linked to the chance of getting breast cancer too. Things like exposure to radiation and the density of your breasts can also increase your risk of breast cancer.

^[v] NHS Choices, Causes and risk factors https://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Symptoms.aspx

Breast cancer symptoms and diagnosis

Most women notice a lump in their breast before any other symptom of breast cancer. Lumps in your breasts are usually normal. Nine out of ten lumps aren’t cancerous and it’s just fluid or normal breast tissue. It’s still important to get any lumps in your breasts checked by a doctor or a consultant breast surgeon – the sooner you identify a problem, the easier it is to treat.

Other symptoms which you should report to your GP are:

• a change in the size or shape of your breast
• dimpled skin on your breasts
• a difference in how your nipple looks
• discharge or blood coming from your nipples
• a rash around your nipples
• a lump or swelling in your armpit
• painful breasts or armpits.

What’s normal for you?
It’s important that you learn what’s normal for you and your breasts throughout the month. For example, some women find that they have normal breast pain related to their period. Learning what’s normal for you at different stages in your life and as your breasts naturally change will make it much easier for you to spot anything unusual.

We recommend that you check your breasts a few days after your period because during your cycle, normal lumps can occur.

There’s no right or wrong technique for checking your breasts, but get in the habit of looking and feeling for any changes regularly. Perhaps when you’re in the bath, shower or getting dressed.

If you notice anything unusual – particularly if one breast feels different to the other – get a doctor to check as soon as possible.

The stages and grades of breast cancer
When you’re diagnosed with breast cancer, your consultant breast surgeon will tell you what stage the cancer’s at. This describes the size of the tumour, whether it’s spread to your lymph nodes and if the cancer cells have spread to any other part of your body.

The stage of your breast cancer will help to inform the decisions you and your consultant make about your treatment options.

• Stage 0 | Ductal carcinoma in situ (DCIS) is sometimes called stage 0
• Stage 1 | The tumour is less than 2cm, it hasn’t affected the lymph nodes in your armpit and the cancer hasn’t spread anywhere else in your body
• Stage 2 | The tumour’s between 2 and 5cm or the cancer has affected the lymph nodes in the armpit, or both. But there’s no sign that the cancer has spread anywhere else in your body
• Stage 3 | The tumour’s between 2 and 5cm, possibly attached to skin or tissues in the breast. The lymph nodes in your armpit are also affected, but there’s no sign of the cancer elsewhere in your body
• Stage 4 | The tumour could be any size and has spread to other areas of your body. This is called metastasis.

Cancer cells are also graded from 1 to 3. This identifies what the cancer looks like under a microscope. Low grade cancers tend to grow more slowly than high grade cancers. High grade cancers are also more likely to come back, but the grade system is only a guide.

Circle Health breast screening clinics
Changes in your breasts are normal and part of your development and getting older. If you’re worried about any changes, you should see a doctor as soon as possible.

At Circle Health, we offer specialised breast screening at our breast clinics across the country. Our specialists are highly experienced, so you will get expert advice and excellent care, with your test results delivered within 48 hours.

You can make an appointment to talk about any concerns you have with one of our consultant breast surgeons. They might recommend that you have one of the following tests to check that a lump in your breast isn’t cancerous.

• Mammogram – an x-ray of your breast
• Ultrasound – ultrasounds use sound waves to create a detailed picture of your breast if a mammogram detects a lump
• Biopsy – this is a small sample of cells or tissue taken from your breast, usually with a fine needle under local anaesthetic. Your consultant will send this to a laboratory where a specialist doctor called a pathologist will examine it.

If you’re over 47 and you haven’t had a mammogram in the last year, you can book a mammogram or a breast scan with us.

Breast cancer treatment

If you’ve been diagnosed with breast cancer, there are several treatment options for you to consider. You might need one or a combination of different treatments, which your consultant breast surgeon and breast care nurse will talk you through.

Your treatment options
Treatments include:

• breast cancer operation
• chemotherapy
• radiotherapy
• hormone therapy
• targeted therapy

As everyone’s different, your consultant breast surgeon and oncologist will take a number of things about you into account when deciding which treatment would suit you best. They’ll consider factors like:

• the type of breast cancer you have
• the size of your tumour
• what stage and grade of your breast cancer and cancer cells
• whether you’ve gone through the menopause
• your overall health.

Breast cancer surgery
For most people, surgery is the first step in their breast cancer treatment.

There are different types of surgery for breast cancer. Your consultant breast surgeon will talk to you about your options and help you to decide on the right treatment for you. You won’t be hurried to make a decision, so you can reflect on your choices and talk to your friends and family too. Your breast care nurse will support you and help you to make decisions.

Patients can either have a lump removed or the whole breast. The decision depends on the size, position and number of tumours as well as your wishes.

Breast reconstruction
Breast reconstruction replaces tissue that is removed during your breast cancer surgery to help recover some of your breast’s shape, and may be performed directly after a partial breast removal (mastectomy) or some time later.

Breasts are carefully rebuilt using a breast implant or the person’s own tissue, and some surgeons may use a combination of both techniques. Depending upon the case, some reconstruction may require more than one operation.

Find out more about our breast reconstruction treatments
If a mastectomy (removal of the whole breast) is necessary, reconstruction is usually possible and this will be discussed with you by your surgeon.

After surgery you’re likely to be offered other treatments to help stop the cancer from coming back. The treatment you have next depends on the type of breast cancer that you have.

Chemotherapy and hormone therapy
You might need to have chemotherapy or hormone therapy before or after your surgery and radiotherapy. Chemotherapy and hormone therapy can help to make the cancer easier to remove by making it smaller in your breast.

Radiotherapy
Radiotherapy is a common cancer treatment that uses radiation to get rid of any cancer cells left behind after you’ve had surgery. Radiotherapy is usually split into a course of treatments, and is usually given daily (Monday-Friday) for between 3.5 and 5 weeks.

Intra-operative radiation therapy (IORT)
IORT is a new single dose form of therapy that’s suitable for certain breast cancers at early stage 1 or 2. IORT has a number of benefits, including reduced radiation exposure to healthy tissue and organs. IORT also eliminates the need for external beam radiation treatments in certain selected patient groups and means that they can return to their normal life and daily routines more quickly because the surgery and radiation are administered at the same time. IORT is available at Circle Health Cancer Centres.

Targeted therapy
Targeted therapy helps to block the growth and spread of your breast cancer by interrupting with the cells that cause the cancer to grow.

Follow up treatment
After your breast cancer treatment, you’ll have regular check-ups and annual mammograms. At first, your appointments will probably be every few months but the intervals will become longer as time passes and you will be followed up according to your individual needs. If you notice any symptoms between your appointments, you can always contact your Circle Health consultant or breast care nurse. 

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Want to know more?
If you’d like to read more about breast cancer, treatment or living with breast cancer, please visit macmillan.org.uk or breastcancernow.org.