Breast Cancer

July 1, 2021 12

BREAST CANCER IN MEN / WOMEN

Breast Cancer in Men

Breast cancer is often thought of as something that only affects women, but men can get it in rare cases. It grows in the small amount of breast tissue men have behind their nipples.

It usually happens in men over 60, but can very occasionally affect younger men.

Symptoms of breast cancer in men

The symptoms of breast cancer in men include:

a lump in the breast – this is usually hard, painless and does not move around within the breast
the nipple turning inwards
fluid oozing from the nipple (nipple discharge), which may be streaked with blood
a sore or rash around the nipple that does not go away
the nipple or surrounding skin becoming hard, red or swollen
small bumps in the armpit (swollen glands)

Read more about the symptoms of breast cancer in men.

When to see your GP

See your GP if you have:

a lump in your breast
any other worrying symptoms, such as nipple discharge
a history of breast cancer (in men or women) in members of your family and you’re worried about your chances of getting it

It’s very unlikely you have cancer, but it’s best to get your symptoms checked. Your GP will examine your breast and can refer you for tests and scans for breast cancer if needed.

If you do not have symptoms but have a clear family history of breast cancer, your GP may refer you to a genetic specialist to discuss your risk of getting it.

There are some inherited genes that increase your risk of cancer and a blood test can be done to check for these. Read about testing for cancer risk genes.

Treatments for breast cancer in men

The treatment for breast cancer in men depends on how far the cancer has spread.

Possible treatments include:

surgery to remove the affected breast tissue and nipple (mastectomy) and some of the glands in your armpit
radiotherapy – where radiation is used to kill cancer cells
chemotherapy – where cancer medicine is used to kill cancer cells
other medicines that help stop breast cancer growing – including tamoxifen and trastuzumab (Herceptin)

Many men have surgery followed by 1 or more of the other treatments. This can help stop the cancer coming back in the future.

Read more about treatments for breast cancer in men.

Outlook for breast cancer in men

The outlook for breast cancer in men varies depending on how far it has spread by the time it’s diagnosed.

It may be possible to cure breast cancer if it’s found early.

A cure is much less likely if the cancer is found after it has spread beyond the breast. In these cases, treatment can relieve your symptoms and help you live longer.

Speak to your breast care nurse if you’d like to know more about the outlook for your cancer.

Causes of breast cancer in men

The exact cause of breast cancer in men is not known, but there are some things that increase your risk of getting it.

These include:

genes and family history – inheriting faulty versions of genes called BRCA1 or BRCA2 increases your risk of breast cancer
conditions that can increase the level of oestrogen in the body – including obesity, Klinefelter syndrome and scarring of the liver (cirrhosis)
previous radiotherapy to the chest area

It’s not certain that you can do anything to reduce your risk, but eating a balanced diet, losing weight if you’re overweight and not drinking too much alcohol may help.

Symptoms-Breast cancer in men

The main symptom of breast cancer in men is a lump in the breast. The nipple or skin may also be affected.See a GP if you have a breast lump or any other symptoms that worry you.

It’s very unlikely you have cancer, but it’s best to get your symptoms checked.

Breast lump

Cancerous breast lumps usually:

only happen in 1 breast
grow under or around the nipple
are painless (but in rare cases they can hurt)
feel hard or rubbery
do not move around within the breast
feel bumpy rather than smooth
get bigger over time

Most lumps and swellings are not a sign of cancer. They’re usually caused by something fairly harmless, such as enlarged male breast tissue (gynaecomastia), a fatty lump (lipoma), or a fluid-filled bump (cyst).

A GP can check your lump and refer you for tests and scans for breast cancer if needed.

Other symptoms

Other signs of breast cancer in men include:

the nipple turning inwards
fluid oozing from the nipple (nipple discharge), which may be streaked with blood
a sore or rash around the nipple that does not go away
the nipple or surrounding skin becoming hard, red or swollen
small bumps in the armpit (swollen glands)

You may get further symptoms if the cancer spreads to other parts of your body, such as your bones, lungs or liver.

These symptoms can include:

feeling tired all the time
aching or painful bones
shortness of breath
feeling sick
itchy skin with yellowing of your skin and eyes (jaundice)

Diagnosis-Breast cancer in men

See your GP if you have symptoms of breast cancer. They will examine you and ask about your symptoms.Your GP can refer you to a specialist breast clinic for the following scans and tests if needed.

Ultrasound scan

An ultrasound scan of your breast may be done to look for a lump in your breast and see it it’s solid or filled with fluid. A solid lump is more likely to be cancerous.

An ultrasound scan uses high-frequency sound waves to produce an image of the inside of your breast.

You’ll need to remove your top for the test, which involves a small device being moved over your chest to create an image on a screen.

Breast X-ray (mammogram)

An X-ray of your breast, called a mammogram, may be done to look for any lumps or unusual areas.

You take your top off for the test and your chest will be firmly pressed against a special plate while the scan is taken.

Biopsy

If a lump or unusual area is found in your breast, a biopsy will be done to check if it’s cancer.

This is where a small piece of breast tissue is removed using a needle. Local anaesthetic is used first, to numb your skin, so the biopsy needle does not hurt.

The piece of tissue will be checked in a laboratory to see if it contains any cancer cells and to find out more about the cells (such as whether hormone treatment might work).

Coping with a diagnosis

Being told you have breast cancer can cause a wide range of emotions, such as shock, fear, confusion and, in some cases, embarrassment.

Feelings of isolation are also common. This may be because there’s little in the way of information and advice for men with breast cancer.

Speak to your GP or care team if you’re struggling to come to terms with your diagnosis. They can offer support and advice.

You may also find it useful to talk to other men with the condition. Cancer Research UK has Cancer Chat, an online forum for anyone affected by cancer.

Treatment-Breast cancer in men

The treatment for breast cancer in men largely depends on how far the cancer has spread. Possible treatments include surgery, radiotherapy and medicines.

You’ll be cared for by a team of specialists who will help you make decisions about your treatment.Your recommended treatment plan will depend on how far the cancer has spread, but the final decision about going ahead with treatment is yours.

You may find it useful to write a list of questions you’d like to ask your team. For example, you could ask about the advantages and disadvantages of particular treatments.

If the cancer has not spread very far beyond your breast, a cure may be possible. This will usually involve surgery, possibly followed by radiotherapy or a course of medicine.

If the cancer has spread into other parts of your body, a complete cure may not be possible. But treatment can help relieve symptoms and slow down the spread of the cancer.

Surgery

An operation called a mastectomy is the main type of surgery for breast cancer in men.

It involves removing all the breast tissue from the affected breast as well as the nipple, and possibly also the glands in your armpit and some of the muscle under your breast.

The operation is done under a general anaesthetic (where you’re asleep). You’ll probably need to stay in hospital for 1 to 2 days.

It can take several months to fully recover. The Royal College of Surgeons of England has a leaflet for people recovering from a mastectomy with detailed information and advice.

Your body after surgery

After surgery, there’ll be a straight scar across your chest where your nipple used to be and possibly a dent where the breast tissue was removed.

The scar will be raised and red at first, but it should flatten and fade with time. The area will also be bruised and swollen for a few weeks.

It may be possible to have further surgery at some point to improve the appearance of your breast and create a replacement nipple. Other options include tattooing a new nipple on to your chest.

Talk to your care team about how your chest will look after surgery and what options you have for improving its appearance if necessary.

Possible complications

Side effects and risks of a mastectomy include:

pain and discomfort for 1 to 2 weeks – you’ll be given painkillers to help with this
numbness or tingling around the scar and in your upper arm – this should pass within a few weeks or months, but can occasionally be permanent
a wound infection, causing redness, swelling, warmth or discharge from the wound – tell your nurse or doctor if you get any of these symptoms
painful swelling in your arm (lymphoedema) – this may be permanent, but can be treated. Read more about treatments for lymphoedema

Before having surgery, talk to your surgeon and breast care nurse about the possible risks.

Radiotherapy

Radiotherapy is a treatment where radiation is used to kill cancer cells. In breast cancer in men, it may be used to:

help stop the cancer coming back after surgery
slow down the spread of the cancer and relieve symptoms if a cure is not possible

It involves several treatment sessions where a machine is used to carefully aim beams of radiation at the cancer. Each session usually lasts for 10 to 15 minutes and you can go home afterwards.

A typical course of treatment involves 2 to 5 sessions each week over 3 to 6 weeks.

Side effects

Radiotherapy is not painful, although you’ll probably get some side effects. Most of these should pass once treatment stops.

Common side effects of radiotherapy include:

sore, red skin (similar to sunburn) on your chest
feeling very tired
feeling sick
temporary hair loss in the area of your chest being treated

Read more about the side effects of radiotherapy.

Hormone therapy

Hormone therapy is a treatment that involves taking medicine to block the effects of a hormone called oestrogen.

Around 9 in 10 breast cancers in men are “oestrogen receptor positive”, which means the cancer cells need oestrogen to grow.

Hormone therapy can be used to:

help stop the cancer from coming back after surgery
slow down the spread of the cancer and relieve symptoms if a cure is not possible

The most commonly used hormone medicine is tamoxifen. This is taken as a tablet or liquid every day, usually for 5 years, but sometimes for longer.

Side effects

Tamoxifen can cause some unpleasant side effects, such as:

feeling sick (this usually goes away quite quickly)
hot flushes
weight gain
difficulty sleeping
changes in mood, such as feeling irritable or depressed
loss of sex drive (libido)

Tell your care team if you have any troublesome side effects. Other hormone medicines, such as a type called aromatase inhibitors, are available if needed.

Chemotherapy

Chemotherapy is a treatment where powerful medicine is used to kill cancer cells. It may be used if hormone therapy is not suitable for you.

In breast cancer in men, chemotherapy may be used to:

help stop the cancer coming back after surgery
slow down the spread of the cancer and relieve symptoms if a cure is not possible

It involves several treatment sessions where medicine is given directly into a vein. Each session usually lasts a few hours and you can go home afterwards.

A typical course of treatment involves 6 sessions, with a break of a few weeks between each one to allow your body to recover.

Side effects

Chemotherapy can cause a range of unpleasant side effects, although most of these should pass once treatment stops.

Side effects of chemotherapy can include:

feeling very tired
feeling and being sick
temporary hair loss
being more vulnerable to infections – tell your care team if you feel unwell or develop symptoms such as a fever and chills
loss of appetite
diarrhoea
infertility

Read more about the side effects of chemotherapy.

Trastuzumab (Herceptin)

Trastuzumab (brand name Herceptin) is a medicine that blocks the effect of a substance called human epidermal growth factor receptor 2 (HER2).

In some breast cancers in men, HER2 helps cancer cells grow.

Trastuzumab is usually used after radiotherapy or chemotherapy to help stop the cancer coming back.

It’s given as a liquid directly into a vein, or as an injection under your skin. You go into hospital for treatment and can go home shortly afterwards.

A typical course of treatment involves a treatment session every 3 weeks for a year.

Side effects

Trastuzumab can cause some unpleasant side effects, such as:

a reaction to the medicine – this can cause chills, a fever, swelling of your face and lips, headaches, hot flushes, feeling sick, wheezing and breathlessness
tiredness and difficulty sleeping
diarrhoea or constipation
an increased risk of infections
loss of appetite and weight loss
pain in your muscles, joints, chest or tummy
heart problems

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Breast cancer in women

Breast cancer is the most common type of cancer in the UK. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer.

About 1 in 8 women are diagnosed with breast cancer during their lifetime. There’s a good chance of recovery if it’s detected at an early stage.

For this reason, it’s vital that women check their breasts regularly for any changes and always have any changes examined by a GP.

In rare cases, men can also be diagnosed with breast cancer. Find out more about breast cancer in men.

Information:

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.

Causes of breast cancer

The exact causes of breast cancer are not fully understood. However, there are certain factors known to increase the risk of breast cancer.

These include:

age – the risk increases as you get older
a family history of breast cancer
a previous diagnosis of breast cancer
a previous non-cancerous (benign) breast lump
being tall, overweight or obese
drinking alcohol

Find out more about the causes of breast cancer.

Diagnosing breast cancer

After examining your breasts, a GP may refer you to a specialist breast cancer clinic for further tests. This might include breast screening (mammography) or taking a small sample of breast tissue to be examined under a microscope (a biopsy).

Find out more about how breast cancer is diagnosed.

Types of breast cancer

There are several different types of breast cancer, which develop in different parts of the breast.

Breast cancer is often divided into either:

non-invasive breast cancer (carcinoma in situ) – found in the ducts of the breast (ductal carcinoma in situ, or DCIS) which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
invasive breast cancer – where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.

Other, less common types of breast cancer include:

invasive (and pre-invasive) lobular breast cancer
inflammatory breast cancer
Paget’s disease of the breast

It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland.

If this happens, it’s known as secondary, or metastatic, breast cancer.

Breast cancer screening

Mammographic screening, where X-ray images of the breast are taken, is the most commonly available way of finding a change in your breast tissue (lesion) at an early stage.

However, you should be aware that a mammogram might fail to detect some breast cancers.

It might also increase your chances of having extra tests and interventions, including surgery, even if you’re not affected by breast cancer.

Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50 to 70 years old are invited for breast cancer screening every 3 years.

Women over the age of 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47 to 73.

Find out more about breast cancer screening.

Find a breast cancer screening services near you

Treating breast cancer

If cancer is detected at an early stage, it can be treated before it spreads to other parts of the body.

Breast cancer is treated using a combination of:

Surgery is usually the first type of treatment you’ll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatments.

The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor should discuss the best treatment plan with you.

In a small proportion of women, breast cancer is discovered after it’s spread to other parts of the body (metastatic breast cancer).

Secondary cancer, also called advanced or metastatic cancer, is not curable, so the aim of treatment is to relieve symptoms.

Find out more about treating breast cancer.

Living with breast cancer

Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.

How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.

Forms of support may include:

family and friends, who can be a powerful support system
communicating with other people in the same situation
finding out as much as possible about your condition
not trying to do too much or overexerting yourself
making time for yourself

Find out more about living with breast cancer.

Preventing breast cancer

As the causes of breast cancer are not fully understood, at the moment it’s not possible to know if it can be prevented.

If you have an increased risk of developing the condition, some treatments are available to reduce your risk.

Studies have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who:

maintain a healthy weight
exercise regularly
have a low intake of saturated fat
do not drink alcohol

It’s been suggested that regular exercise can reduce your risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer.

If you’ve been through the menopause, it’s particularly important that you try to get to, and maintain, a healthy weight.

This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.

Find out more about preventing breast cancer.

Symptoms-Breast cancer in women

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should see a GP if you notice any of the following:

a new lump or area of thickened tissue in either breast that was not there before
a change in the size or shape of one or both breasts
a discharge of fluid from either of your nipples
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.

Breast awareness

It’s important to be breast aware so you notice any changes as soon as possible.

Get to know what is normal for you – for instance, your breasts may look or feel different at different times of your life. This will make it easier to notice potential problems.

Causes-Breast cancer in women

The causes of breast cancer are not fully understood, making it difficult to say why one woman may develop breast cancer and another may not.

However, there are risk factors known to affect your likelihood of developing breast cancer. Some of these you cannot do anything about, but there are some you can change.

Age

The risk of developing breast cancer increases with age. The condition is most common in women over age 50 who have been through the menopause. About 8 out of 10 cases of breast cancer happen in women over 50.

All women who are 50 to 70 years of age should be screened for breast cancer every 3 years as part of the NHS Breast Screening Programme.

Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit.

Find out more about breast screening.

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer.

However, because breast cancer is the most common cancer in women, it’s possible for it to occur in more than one family member by chance.

Most cases of breast cancer do not run in families, but genes known as BRCA1 and BRCA2 can increase your risk of developing both breast and ovarian cancer. It’s possible for these genes to be passed on from a parent to their child.

The genes TP53 and CHEK2, are also associated with an increased risk of breast cancer.

Speak to a GP if breast or ovarian cancer runs in your family and you’re worried you may get it too. They may refer you for an NHS genetic test, which will tell you if you have inherited one of the cancer-risk genes.

Find out more about predictive genetic tests for cancer-risk genes.

Previous breast cancer or lump

If you have previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast.

A benign breast lump does not mean you have breast cancer, but certain types of breast lumps may slightly increase your risk of developing cancer.

Some benign changes in your breast tissue, such as cells growing abnormally in ducts (atypical ductal hyperplasia), or abnormal cells inside your breast lobes (lobular carcinoma in situ), can make getting breast cancer more likely.

Dense breast tissue

Your breasts are made up of thousands of tiny glands (lobules) that produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser.

Women with dense breast tissue may have a higher risk of developing breast cancer as there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) difficult to read, as any lumps or areas of abnormal tissue are harder to see.

Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.

Hormones and hormone medicine

Exposure to oestrogen

The female hormone oestrogen can sometimes stimulate breast cancer cells and cause them to grow.

The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty, to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to.

For example, if you started having periods at a young age and experienced the menopause later than average, you will have been exposed to oestrogen over a longer period of time.

In the same way, not having children or having children later in life may slightly increase your risk of developing breast cancer because your exposure to oestrogen is not interrupted by pregnancy.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with an increased risk of developing breast cancer.

All types of HRT can increase the risk of breast cancer, except for vaginal oestrogen.

There is no increased risk of breast cancer if you take HRT for less than 1 year.

But if you take HRT for longer than 1 year, you have a higher risk of breast cancer than women who never use HRT.

The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

Find out more about the risks of HRT.

Contraceptive pill

Research shows that women who take the contraceptive pill have a slightly increased risk of developing breast cancer.

However, the risk starts to decrease once you stop taking the pill, and your risk of breast cancer is back to normal 10 years after stopping.

Cancer Research UK has more information about the contraceptive pill and cancer risk.

Lifestyle factors

Being overweight or obese

If you have experienced the menopause and are overweight or obese, you may be more at risk of developing breast cancer.

This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Alcohol

Drinking alcohol increases the risk of getting breast cancer.

People who drink even small amounts of alcohol on a regular basis have a greater risk of getting breast cancer than people who do not drink alcohol at all. The more alcohol you drink, the more your risk of getting breast cancer increases.

Radiation

Certain medical procedures that use radiation, such as X-rays and CT scans, may slightly increase your risk of developing breast cancer.

If you had radiotherapy to your chest area for Hodgkin lymphoma you should have already received a letter from the Department of Health and Social Care inviting you for a consultation with a specialist to discuss your increased risk of developing breast cancer.

See your GP if you were not contacted or if you did not attend a consultation. You’re usually entitled to have your breast checked with an MRI scan.

If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

Diagnosis-Breast cancer in women

You may be diagnosed with breast cancer after routine breast screening, or you may have symptoms that you’ve seen your GP about.

Seeing a GP

See a GP as soon as possible if you notice any symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts.

The GP will examine you. If they think your symptoms need further assessment, they’ll refer you to a specialist breast cancer clinic.

Tests at a breast cancer clinic

If you have suspected breast cancer, either because of your symptoms or because a mammogram has shown an abnormality, you’ll be referred to a specialist breast cancer clinic for further tests.

Mammogram and breast ultrasound

If you have symptoms and have been referred to a specialist breast unit by a GP, you’ll probably be invited to have a mammogram, which is an X-ray of your breasts. You may also need an ultrasound scan.

If cancer was detected through the NHS Breast Screening Programme, you may need another mammogram or ultrasound scan.

Your doctor may suggest that you only have a breast ultrasound scan if you’re under the age of 35. This is because younger women have denser breasts, which means a mammogram is not as effective as ultrasound in detecting cancer.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities.

Your breast specialist may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Biopsy

A biopsy is where a sample of cells is taken from your breast and tested to see if it’s cancerous.

You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected.

Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition.

Needle aspiration

Needle aspiration may be used to test a sample of your breast cells for cancer or drain a small fluid-filled lump (benign cyst).

Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

Needle biopsy

Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle.

You may have a local anaesthetic, which means you’ll be awake during the procedure, but your breast will be numb.

Your doctor may suggest that you have a guided needle biopsy, usually guided by ultrasound or X-ray, or sometimes MRI, to obtain a more precise and reliable diagnosis of cancer.

This can also distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS).

Vacuum-assisted biopsy

Vacuum-assisted biopsy, also known as mammotome biopsy, is another type of biopsy.

During the procedure, a needle is attached to a gentle suction tube, which helps to obtain the sample and clear any bleeding from the area.

Further tests for breast cancer

If a diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and the best method of treatment.

Scans and X-rays

A CT scan, chest X-ray and liver ultrasound scan may be needed to check whether the cancer has spread.

An MRI scan of the breast may be needed to clarify the results or assess the extent of the condition within the breast.

If your doctor thinks the cancer could have spread to your bones, you may need a bone scan.

Before having a bone scan, a substance containing a small amount of radiation known as an isotope will be injected into a vein in your arm.

This will be absorbed into your bone if it’s been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan.

Tests to determine specific types of treatment

You’ll also need tests that show whether the cancer will respond to specific types of treatment.

The results of these tests can give your doctors a more complete picture of the type of cancer you have and how to treat it.

In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone.

If this is the case, the cancer may be treated by stopping the effects of the hormones or by lowering the level of these hormones in your body. This is known as hormone therapy.

During a hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone.

If the hormone is able to attach to the cancer cells using a hormone receptor, they’re known as hormone-receptor positive.

While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 (HER2).

These types of cancers can be diagnosed using a HER2 test and are treated with medicine that blocks the effects of HER2. This is known as targeted therapy.

Stage and grade of breast cancer

Stage of breast cancer

When breast cancer is diagnosed, your doctors will give it a stage. The stage describes the size of the cancer and how far it has spread, and is used to predict the outlook.

Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:

stage 1 – the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
stage 2 – the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
stage 3 – the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
stage 4 – the tumour is of any size and the cancer has spread to other parts of the body (metastasis)

This is a simplified guide. Each stage is divided into further categories: A, B and C. If you’re not sure what stage you have, talk to your doctor.

TNM staging system

The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis:

T – the size of the tumour
N – whether the cancer has spread to the lymph nodes
M – whether the cancer has spread to other parts of the body

Grades of breast cancer

The grade describes the appearance of the cancer cells.

low grade (G1) – the cells, although abnormal, appear to be growing slowly
medium grade (G2) – the cells look more abnormal than low-grade cells
high grade (G3) – the cells look even more abnormal and are more likely to grow quickly

Treatment-Breast cancer in women

If you have breast cancer, you should be assigned a multidisciplinary team (MDT), which is a group of specialists who work together to provide the best treatment and care.

The main treatments for breast cancer are:

surgery
radiotherapy
chemotherapy
hormone therapy
targeted therapy

You may have one of these treatments, or a combination. The type or combination of treatments you have will depend on how the cancer was diagnosed and the stage it’s at.

Breast cancer diagnosed at routine screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment.

Your MTD should discuss with you which treatments are most suitable.

Choosing the right treatment for you

When deciding what treatment is best for you, your doctors will consider:

the stage and grade of the cancer (how big it is and how far it has spread)
your general health
whether you have experienced the menopause

You should be able to discuss your treatment with your care team at any time and ask questions.

Treatment overview

Surgery is usually the first type of treatment for breast cancer. The type of surgery you have will depend on the type of breast cancer you have.

Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted therapies.

Again, the treatment you’ll have will depend on the type of breast cancer.

Your doctor will discuss the most suitable treatment plan with you. Chemotherapy or hormone therapy will sometimes be the first treatment.

Secondary breast cancer

Most breast cancers are discovered at an early stage. But a small proportion of women discover they have breast cancer after it’s spread to other parts of the body (metastasis).

If this is the case, the type of treatment you have may be different. Secondary cancer, also called “advanced” or “metastatic” cancer, is not curable.

Treatment aims to achieve remission, where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full.

Surgery

There are 2 main types of breast cancer surgery:

breast-conserving surgery, where the cancerous lump (tumour) is removed
mastectomy, where the whole breast is removed

In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a breast.

Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.

Breast-conserving surgery

Breast-conserving surgery ranges from a lumpectomy or wide local excision, where the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed.

If you have breast-conserving surgery, the amount of breast tissue that is removed will depend on:

the type of cancer you have
the size of the tumour and where it is in your breast
the amount of surrounding tissue that needs to be removed
the size of your breasts

Your surgeon will always remove an area of healthy breast tissue around the tumour, which will be tested for traces of cancer.

If there’s no cancer present in the healthy tissue, there’s less chance that the cancer will return.

If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.

After having breast-conserving surgery, you’ll usually be offered radiotherapy to destroy any remaining cancer cells.

Mastectomy

A mastectomy is the removal of all the breast tissue, including the nipple.

If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy.

If the cancer has spread to your lymph nodes, you’ll probably need more extensive removal (clearance) of lymph nodes from the area under your arm (axilla).

Reconstruction

Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast.

Reconstruction can be done at the same time as a mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction).

It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.

Lymph node surgery

To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy may be done.

The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They’re part of the lymph nodes under your arms (axillary lymph nodes).

The position of the sentinel lymph nodes varies, so they’re identified using a combination of a radioisotope and a blue dye.

The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.

If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under your arm.

Radiotherapy

Radiotherapy uses controlled doses of radiation to kill cancer cells. It’s usually given after surgery and chemotherapy to kill any remaining cancer cells.

If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy to give your body a chance to recover.

You’ll probably have radiotherapy sessions 3 to 5 days a week, for 3 to 5 weeks. Each session will last a few minutes.

The types of radiotherapy

The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

Types of radiotherapy include:

breast radiotherapy – after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
chest-wall radiotherapy – after a mastectomy, radiotherapy is applied to the chest wall
breast boost – some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed; however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue (fibrosis)
radiotherapy to the lymph nodes – where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be in the lymph nodes

The side effects of radiotherapy

Side effects of radiotherapy include:

irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin
extreme tiredness (fatigue)
excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm (lymphoedema)

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medicine to kill cancer cells.

It’s usually used after surgery to destroy any cancer cells that have not been removed. This is called adjuvant chemotherapy.

In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy.

Several different medicines are used in chemotherapy, and 2 to 3 are often given at once.

The choice of medicine and the combination will depend on the type of breast cancer you have and how far it has spread.

Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight.

The medicines are usually given through a drip straight into a vein.

In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 4 weeks and then have a break. Each treatment session is known as a cycle. You may have up to 8 cycles of chemotherapy.

The main side effects of chemotherapy are caused by its influence on normal, healthy cells, such as immune cells.

Side effects of chemotherapy include:

infections
loss of appetite
feeling sick
being sick
tiredness
hair loss
sore mouth

Many side effects can be prevented or controlled with medicines that your doctor can prescribe.

Chemotherapy medicine can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers.

If you have not experienced the menopause, your periods may stop while you’re having chemotherapy treatment.

After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again.

But this does not always happen and you may enter an early menopause. This is more likely in women over 40, as they’re closer to menopausal age.

Your doctor will discuss with you the impact that treatment will have on your fertility.

Chemotherapy for secondary breast cancer

If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy will not cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life.

Hormone treatment

Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These are known as hormone receptor-positive cancers.

Hormone therapy lowers the levels of oestrogen or progesterone hormones in your body or stops their effects.

The type of hormone therapy you have will depend on the stage and grade of the cancer, which hormone it’s sensitive to, your age, whether you have experienced the menopause, and what other type of treatment you’re having.

You’ll probably have hormone therapy after surgery and chemotherapy, but it’s sometimes given before surgery to shrink a tumour and make it easier to remove.

Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you having surgery, chemotherapy or radiotherapy.

In most cases, you’ll need to take hormone therapy for 5 years or more after having surgery.

If the type of breast cancer you have is not sensitive to hormones, hormone therapy will have no effect.

Tamoxifen

Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. It’s taken every day as a tablet or liquid.

Aromatase inhibitors

If you have experienced the menopause, you may be offered an aromatase inhibitor.

This type of medicine blocks aromatase, a substance that helps the body to produce oestrogen after the menopause. Before the menopause, oestrogen is made by the ovaries.

3 aromatase inhibitors may be offered. These are anastrozole, exemestane and letrozole. These are taken as a tablet once a day.

Ovarian ablation or suppression

In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.

Ovarian ablation or suppression stops the ovaries working and producing oestrogen.

Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.

Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa).

Your periods will stop while you’re taking it, although they should start again once your treatment is complete.

If you’re approaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin.

Goserelin comes as an injection you have once a month.

Targeted therapies

Targeted therapies are medicines that change the way cells work and help to stop cancer from growing and spreading. Not all types of breast cancer can be treated with targeted therapies

The targeted therapy most commonly used to treat breast cancer is trastuzumab (also known by the brand name herceptin).

Some targeted therapies are given through a drip into a vein. Others come as tablets.

Side effects of targeted therapies include:

shivering and feeling unwell
diarrhoea
feeling and being sick
headache
cough
skin rash

Risk of infection

Some of the medicines used to treat breast cancer can make you more vulnerable to infections. You should contact your care team immediately if you develop possible symptoms of infection, such as:

a high temperature
feeling shivery
you suddenly feel very unwell even though your temperature may be normal

Bisphosphonates

If you have been through the menopause, you may be offered bisphosphonates (zoledronic acid or sodium clodronate).

Recent research has shown they may help to reduce the risk of breast cancer spreading to your bones and elsewhere in your body.

Bisphosphonates will probably be given to you at the same time as chemotherapy, either directly into a vein or as tablets.

Rarely, they can cause kidney problems and osteonecrosis of the jaw (when bone in the jaw dies).

Your doctor will explain the benefits and possible side effects before starting this treatment.

Psychological support

Dealing with cancer can be a huge challenge for you and your family and friends. It can cause emotional and practical difficulties.

Many women with breast cancer will have to cope with the removal of part or all of a breast, which can be very upsetting.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness.

Your hospital doctor, specialist nurse or GP can refer you to a counsellor.

If you’re feeling depressed, talk to a GP. A course of antidepressants may help, or a GP can refer you to see a counsellor or psychotherapist.

It can also help to talk to someone who’s been through the same thing as you. Many breast cancer charities have helplines and online forums and staff can also put you in touch with other women who have had cancer treatment.

Clinical trials

A great deal of progress has been made in breast cancer treatment, and more women now live longer and have fewer side effects from treatment.

These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.

All cancer trials in the UK are carefully overseen to ensure they’re worthwhile and conducted safely.

If you’re invited to take part in a trial, you’ll be given information about it and, if you want to take part, you’ll be asked to sign a consent form.

You can refuse or withdraw from a clinical trial without it affecting your care.

Complementary therapies

Complementary therapies are therapies that may help improve physical and emotional wellbeing.

They’re given alongside conventional treatments and include:

Complementary therapies can help some women cope with their diagnosis and treatment, and provide a break from their regular treatment plan.

Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you can get them.

It’s important to speak to your breast cancer specialist nurse about any complementary therapy you wish to try to make sure it does not interfere with your conventional treatment.

Will the NHS fund an unlicensed medicine?

It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.

Your local clinical commissioning group (CCG) may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.

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Written by: Mandy Law

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