Breast cancer

Breast cancer is the most common cancer in women in Australia (apart from non-melanoma skin cancer), with one in eight women diagnosed by age 85.

About 20,000 people are diagnosed with breast cancer in Australia each year.

Breast cancer can occur at any age, but it is most common in women over the age of 40 years.

Men can also develop breast cancer, although this is rare. Around 220 men are diagnosed with breast cancer in Australia each year. It is treated in the same way as breast cancer in women.

What is breast cancer?

Breast cancer is the abnormal growth of cells in the breast. It usually starts in the lining of the breast ducts or lobules, and can grow into cancerous (malignant) tumours. Most breast cancers are found when they are invasive. This means that the cancer has spread from the breast ducts or lobules into the surrounding breast tissue.

Invasive breast cancer can be early, locally advanced or advanced (metastatic). Advanced breast cancer is when cancer cells have spread (metastasised) outside the breast and nearby lymph nodes to other parts of the body.

About 5% of cancers are advanced when breast cancer is first diagnosed.

Risks and causes of breast cancer

Many factors can increase your risk of breast cancer, but they do not mean that you will develop it. You can also have none of the known risk factors and still get breast cancer.

iPrevent is a tool that can help you understand your level of risk for developing breast cancer compared with the average risk for people your age. Talk to your doctor for more advice.

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

• Gender – 99% of breast cancer cases are diagnosed in women.
• getting older – your risk of breast cancer increases as you get older. More than three quarters of breast cancer occur in women aged 50 years and over.
• heredity – most people who develop breast cancer do not have a family history. However, having several close family members (mother, sister or daughter) who have had breast cancer can increase your risk. Having several close relatives on the same side of the family with prostate or pancreatic cancer may also increase your risk.
• genetics – around five to 10 per cent of breast cancers occur in people who have inherited a gene abnormality (mutation) from their mother or father.
• breast density – people with dense breasts (breasts that have more glandular and fibrous tissue and less fatty tissue) have a greater chance of developing breast cancer than those with less dense breasts.
• certain breast diseases – some types of breast disease that are found through mammograms indicate an increased risk. For example, people who have atypical ductal hyperplasia have an increased risk of breast cancer. Most benign breast conditions do not increase the risk of breast cancer.
• previous history of breast cancer – women who have had breast cancer have a greater risk of developing it again.

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
• never having breastfed a child
• early age at first period (under 12 years of age)
• later age of natural menopause (55 years or older)
• alcohol intake – regular (drinking of alcohol is associated with an increased risk of breast cancer. Limiting the amount of alcohol your drink can reduce this risk)
• obesity or gaining a lot of weight after menopause – fatty tissue is the main source of oestrogen after menopause. Having more fatty tissue means higher oestrogen levels that can increase breast cancer risk
• smoking
• Not getting enough exercise or not being physically active
• 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
• you or your mother using diethylstilboestrol (DES) during pregnancy
• transgender women taking gender-affirming hormones for more than 5 years
• having radiation therapy to the chest area for Hodgkin lymphoma
• being male with a rare genetic syndrome called Klinefelter syndrome.

Early detection of breast cancer

Check your breasts

Breasts undergo many changes during a woman’s life. These changes can be due to puberty, the menstrual cycle, pregnancy, breastfeeding or changes in weight or ageing. It is important for all women to get to know the normal look and feel of their breasts.

Breast cancer sometimes has no symptoms, so regular checks are important for women aged 40 and over. Breast changes may not mean cancer, but see a doctor if you notice:

• a lump, lumpiness or thickening, especially in just one breast
• a change in the size or shape of the breast or swelling
• a change to the nipple – change in shape, crusting, sores or ulcers, redness, pain, a clear or bloody discharge, or a nipple that turns in (inverted nipple) when it used to stick out
• a change in the skin – dimpling or indentation, a rash or itchiness, scaly appearance, unusual redness or other colour changes
• swelling or discomfort in the armpit or near the collarbone
• ongoing, unusual breast pain not related to your period.

Some of these symptoms can occur without any serious disease being present.

Nine out of 10 breast changes are not breast cancer. However, just to be sure, your doctor should check any unusual breast change as early detection of breast cancer means treatment has a much better chance of success.

Screening mammography

Screening mammography every two years is provided as a free service for women aged 50 to 74 through the BreastScreen Australia program. It is used to detect breast cancer early, when you are well and have no obvious breast symptoms. Screening mammograms can detect breast cancers that are too small to be felt by you or your doctor. The earlier breast cancer is found provides the best chance of effective treatment and survival.

Mammograms taken at different times can later be compared to show changes in breast tissue over time. Screening is open to women from the age of 40 years and can continue after the age of 74 years, however, reminders are only sent to those who are between the ages of 50 and 74 years.

Diagnosis of breast cancer

Breast changes are investigated through a series of tests organised by your doctor or specialist. Most breast changes are diagnosed as benign (non-cancerous). If your tests show that you may have cancer, your GP (doctor) will refer you to a specialist who will advise you about treatment options.

Initial tests you may have include:

• 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
• Breast MRI – a magnetic resonance imaging (MRI) scan creates pictures of breast tissue on the computer and is mainly used for people who are at high risk of breast cancer, who have dense breasts or breast implants.

If further tests are required, one or more procedures may be used, including:

• Fine needle aspiration – a very narrow needle is used to withdraw cells from the testing area.
• Core biopsy – a larger needle is used to take a tissue sample for testing.
• Vacuum-assisted core biopsy –a needle is attached to a suction-type instrument and removes a larger amount of tissue
• Surgical biopsy – surgery is performed under general anaesthetic to remove the whole area for testing.
• Tests on breast tissue – if a cancer is found, it can be checked for special features to help plan treatment. This may include:
  • Hormone receptor status – normal breast cells have oestrogen and progesterone receptors. Breast cancers that have too many of these receptors are known as hormone-positive breast cancers and are treated with hormone-blocking drugs.
  • HER2 status – HER2 is a protein found on the surface of all cells and controls how cells grow and divide. Breast cancers that have too many HER2 receptors are called HER2-positive and are often treated with chemotherapy and targeted treatments.
  • Triple negative breast cancer – this type of breast cancer does not have any of the three receptors commonly found on breast cancer cells (oestrogen, progesterone or HER2). Chemotherapy is generally recommended for triple negative breast cancer.

If tests show that you may have breast cancer, you may have further tests to see if the breast cancer has spread. Other tests may include blood tests, bone scans, CT scans and PET scans (computerised tomography and positron emission tomography, respectively). Not everyone will have all these tests.

Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling.

You can also contact the Cancer Council support line on Tel. 13 11 20 and speak with a cancer nurse or call Breast Cancer Network Australia’s (BCNA) helpline for information, support and referral on Tel. 1800 500 258.

Treatment for breast cancer

Treatment options for breast cancer include surgery, radiotherapy, chemotherapy, targeted therapy, hormone-blocking therapy and immunotherapy. Usually, more than one is used. Treatment for breast cancer in men is similar to (and as effective as) the treatment for breast cancer in women.

Treatment depends on several factors, including:

• where the cancer is in the breast
• 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 – there are three grades of invasive breast cancer. Grade 1 (low grade) – the cancer cells look a bit different to normal cells and are slow growing); Grade 2 (intermediate grade) – the cancer cells grow faster than grade 1 and do not look like normal cells; Grade 3 (high grade) – the cancer cells look very different from normal cells and are fast growing.
• the results of tests on your cancer cells (e.g. hormone receptor status, HER2 receptor status or triple negative)
• your age, general health and personal preferences.

Surgery for breast cancer

An operation to remove the cancer, surrounding breast tissue and often, the nearby lymph nodes, is usually the preferred first treatment.

Surgery options include:

• Breast-conserving surgery – a small operation removes the cancer and some of the surrounding tissue (lumpectomy), and usually some lymph nodes, leaving the bulk of the breast intact. Breast-conserving surgery is often followed by a course of radiotherapy.
• Mastectomy – the entire breast is removed, along with some or all of the lymph nodes from the armpit.
• Breast reconstruction surgery – women who have a mastectomy may choose to have reconstruction surgery (at the time of the mastectomy or later), whereas some women choose not to undergo breast reconstruction. Options for breast reconstruction include silicone gel or saline-filled implants, or the use of your own muscle and skin to create a breast-like shape. Women who choose not to undergo breast reconstruction may use a breast form or prosthesis. These are pads worn inside your bra to help restore balance and are designed to look like a normal breast under clothes.

All surgery has some risks. Possible side effects of breast surgery include fatigue, shoulder stiffness, numbness and tingling (bruised or injured nerves), fluid build-up around the scar or armpit (seroma), swelling of the arm (lymphoedema), post-mastectomy pain and cording (axillary web syndrome). These side effects are not common, but you should be aware of the risks.

Other treatment for breast cancer

Depending on the cancer, other treatment options can include:

• Radiotherapy – use 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 short-term reddening of the skin, which looks like sunburn, or longer-term thickening of skin.
• Chemotherapy – cancer-killing medication is given intravenously (directly into a vein). Chemotherapy can be offered to women with early breast cancer as an extra treatment to surgery, radiotherapy or both. Chemotherapy has side effects that will depend on the type of medication you have, but can include nausea, diarrhoea and hair loss.
• Hormone-blocking treatments – many breast cancers are influenced by the sex hormones oestrogen and progesterone. Hormone-blocking treatment can reduce the chances of breast cancer developing again.
• Targeted therapies – uses specific drugs that are known to target the specific proteins or enzymes that play a role in the growth of cancer cells. For example, targeted treatments such as trastuzumab are used to treat HER2-positive breast cancer.
• Immunotherapies – these are medicines that strengthen the immune system to fight cancer. A drug called pembrolizumab may be used for people with certain types of triple negative breast cancer.
• Complementary therapies – these are designed to be used alongside conventional medical treatments. Therapies such as massage, relaxation and acupuncture can increase your sense of control, decrease stress and anxiety, and improve your mood. Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested, may prevent successful treatment of the cancer and can be harmful.

All treatments can cause side effects. Many of these are only temporary, but some may be permanent. Your medical team will discuss these with you before you begin treatment.

Research into breast cancer - Clinical trials

Early detection and better treatment have improved survival for people with breast cancer. Research for breast cancer is ongoing. The Cancer Research UK website has information about research into breast cancer.

Clinical trials can test the effectiveness of promising new treatments or new ways of combining cancer treatments and care. Clinical trials can also investigate the emotional and physical side effects of breast cancer and its treatment and explore ways of improving the quality of life for people affected by cancer. For more information about clinical trials you can visit the Breast Cancer Trials Australia website or the Australian Government Clinical Trials website and talk to your doctor about whether a particular trial may be suitable for you. It is important to always discuss treatment options with your doctor.

Breast cancer and your sexuality

Breast cancer can affect how you feel about yourself (self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. These feelings are common; give yourself time to adapt.

Your medical team should discuss these issues with you before and during your treatment. If you feel you would like to discuss things further, ask your doctor for a referral to a counsellor or speak to a cancer nurse on the Cancer Council support line (Tel. 13 11 20). The Cancer Council Victoria booklet called Sexuality, intimacy and cancermay also be helpful to read.

Caring for someone with breast cancer

Caring for someone with breast cancer can be a difficult and emotional time. If you or someone you know is caring for someone with breast cancer, there is support available. The Cancer Council Victoria booklet called Caring for someone with cancer may also be helpful to read.

When a cure for breast cancer isn't possible

If breast cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment may be given to slow the growth of the cancer as well as improving quality of life by relieving the symptoms (this is called ‘palliative’ treatment) with medication to relieve pain, nausea and vomiting. The Cancer Council Victoria booklet called Living with Advanced Cancer may be helpful to read.

Where to get help

• Your GP (doctor)
• Breast cancer specialists (e.g. breast surgeon, breast reconstructive/plastic surgeon [breast reconstruction] medical oncologist, radiation oncologist)
• Breast Cancer Network Australia (BCNA)
  • BCNA Helpline team is available to provide support, information, resources and a referral service for people affected by breast cancer, at all stages of the breast cancer experience. Open from 9:00am to 5:00pm Monday to Friday, Tel: 1800 500 258
  • BCNA My Care Kit – the My Care Kit is for free for women who have recently had breast surgery. It contains a specially designed Berlei bra and soft form(s). talk to your health professional or call BCNA’s Helpline team on Tel. 1800 500 258 or email mycarekit@bcna.org.au
  • Find services, government programs and support groups at the BCNA website
  • BCNA Online Network – online peer-to-peer support community for people affected by breast cancer, a safe space to connect with others.
  • Breast care nurse (BCN) or cancer nurse – to find a BCN near you visit the McGrath Foundation website.
  • BCNA has a series of free resources, booklets and fact sheets in a number of languages.
• Cancer Council Victoria, cancer information and support line Tel. 13 11 20
• Multilingual Cancer Information Line, Victoria Tel. 13 14 50
• WeCan website helps people affected by cancer find the information, resources and support services they may need following a diagnosis of cancer.
• Counterpart - Women supporting women with cancer.