Breast cancer is the most common cancer among New Zealand women. One in nine women will be diagnosed with breast cancer during their lifetime.
Cancer is when some of the cells in our body get out of control. These ‘cancerous cells’ keep multiplying, forming a lump called a tumour that can spread to surrounding tissue, such as the breasts, causing damage.
The best treatment for breast cancer is finding it at an early stage. Mammograms can pick up breast cancers that are as small as a grain of rice. By the time you can feel a breast cancer, it is already about the size of a cherry or walnut. Mammograms are a low-dose x-ray of the breast tissue. The radiation is equivalent to that received when flying from Invercargill to Auckland.
- Women: - make sure you have a FREE screening mammogram (test to pick up early signs) every 2 years from age 45 to 69 years of age
- This is worth doing as mammograms can detect pre-cancerous changes or breast cancers at an early stage when treatment is more successful.
- Men - encourage your wives/partners to have this test done
- If you find a breast lump, see your doctor to have it checked
- The risk of breast cancer increases with age and positive family history
- If you have been diagnosed with breast cancer, read these sections for further information and seek help from supporting agencies
Breast cancer is a malignant tumour which starts in the breast tissue. Breast cancer is the most common cancer in New Zealand women. The majority of breast cancers begin in the milk ducts (ductal cancers), while a small number start in the milk sacs or lobules (lobular cancers). Within these two groups there are different subtypes of breast cancer.
Some breast cancers grow very slowly, others develop more rapidly. Breast cancer can spread to the lymph glands and to other parts of the body, such as the bones and liver.
About your breasts
Your breasts are designed to make milk after pregnancy. The breast tissue extends almost to the collar bone at the top and to the armpit at the side. Lying beneath the breasts are the chest muscles and ribs.
Breast tissue is made up of milk glands, connective tissue and fat. The milk glands consist of milk sacs (lobules) where milk is made, and ducts which take the milk to the nipple.
In your breast area and armpit there are lymph glands or nodes which are connected by a system of lymph ducts. These glands and ducts are part of the lymph system which helps your body to fight infection.
Your breasts do not stay the same throughout your adult life. Your monthly period, pregnancy, age and weight changes can all alter their shape. Some women find their breasts feel more tender and lumpy before their period. This is quite normal.
How many people get breast cancer?
- In New Zealand, about 2300 women are diagnosed each year with breast cancer.
- Breast cancer can occur at any age, but is most common in women between the ages of 50 and 70 years.
- Men can develop breast cancer, though rarer and adds up to about 1% of all breast cancers.
What causes breast cancer?
The causes of breast cancer are not clear, so there is no certain way to prevent it. There are some clues, or risk factors, about who is more likely to develop the disease.
The most important risk factors are:
- age - a woman's chances of developing breast cancer increase as she gets older
- previous breast cancer
- 'atypical hyperplasia' (the milk ducts contain increased numbers of abnormal cells) can be seen in a breast biopsy
- a family history of breast cancer.
Women with a family history of breast cancer may have an increased risk of getting breast cancer. The risk can be mild, moderate or high and depends on the number of relatives affected, whether they are first or second degree relatives, (first degree are sisters or brothers and parents) and the age of the relative(s) when their breast cancer was found.
However, even among women with a high risk, most will not develop breast cancer. Those women with a very strong family history of breast cancer, who are shown to have inherited one of the abnormal genes associated with breast cancer, have an increased risk of developing breast cancer.
It is important to know that most women who develop breast cancer have no family history of the disease, so being aware of what to watch out for and having regular mammograms are your best protection.
|Videos - Breast awareness campaign||NZ Breast Cancer Foundation|
Breasts undergo changes throughout a woman's life, particularly the normal changes experienced during the menstrual cycle.
Some breast changes may be early signs of breast cancer, including:
- a lump or lumpiness
- thickening of the tissue
- nipple changes, for example:
- a blood-stained discharge from one nipple
- an inverted nipple (unless the nipple has always been turned in)
- a rash on a nipple
- skin dimpling
- a change in shape
- a painful area
- a rash or red marks which appear only on the breast.
Although these changes do not necessarily mean you have breast cancer, any breast change should be checked by a doctor.
Breast cancer is diagnosed by physical examination, mammogram, scans, taking a sample of cells from the lump, biopsy or removal of the lump, and laboratory testing on any breast tissue samples. In some cases other scans or tests may be required. Your general practitioner may arrange these tests or you may be referred directly to a specialist.
A mammogram is a breast x-ray. It will give your doctor more information about any lump or other change noticed. Occasionally, a lump that can be felt is not seen on a mammogram. Such a lump should not be ignored. Other tests will need to be done.
An ultrasound is a test using high frequency sound waves to help detect lumps or other changes.
Magnetic resonance imaging (MRI)
An MRI scan is a scan that uses magnetic resonance to detect abnormalities in the breast. This type of scan is sometimes used in lobular carcinomas to make sure there is not more than one cancer present, and it can check the other breast as well. It can also be used to check the breast if a mammogram is negative but the specialist is concerned about the lump or changes in the breast.
Fine needle aspiration
A fine needle aspiration can be done in your specialist's rooms, a hospital outpatient department, or at a laboratory by a pathologist. A very narrow needle is used to take some cells from the lump. These cells are then sent to a laboratory for examination.
A fine needle aspiration may cause a little discomfort but is not usually any more painful than a blood test. Results from this test may be available immediately or take some time, depending on where it is done.
Sometimes a biopsy will be necessary. A biopsy is the removal of a sample of a lump or the entire lump for examination under a microscope. This can be done as a core biopsy, surgical open biopsy or hook wire biopsy.
Breast cancer is treated by several different methods: surgery, radiation treatment, chemotherapy and hormone treatment. The treatment choice, using just one treatment or a combination, depends on the actual breast cancer: its type, size, and whether or not it has spread; and the individual woman: her age, general health and personal choice.
Understand the options
Before any treatment begins, make sure you have discussed the choices with your doctor. Your doctor may advise that one method of treatment is better than another. Make sure you understand the reasons for this advice. Ask for a second opinion if you want one.
You may find it useful to have your husband or partner or another friend with you when you talk to the doctor. You may also find it helpful to make a list of questions before your visit.
Surgery for breast cancer
The first treatment for breast cancer is usually surgery. This includes surgery on the breast and, for most women, on the glands in the armpit (the axillary lymph nodes). Examination of these lymph glands by the pathologist will indicate whether further treatment should be considered after the surgery.
The aim of surgery is to remove all of the cancer. The type of surgery depends on a number of factors, including the size of the cancer, the size of the breast, the position of the cancer in the breast, and the patient’s choice. Surgery may involve removing the cancer and a rim of breast tissue around it (wide local excision) or removing the whole breast (mastectomy). At the same time some of the lymph glands in the armpit are also removed.
Mastectomy is the removal of the whole breast including some of the skin and the nipple. The chest muscles are not removed. Some lymph glands in the armpit are also removed during the operation. Usually the lymph nodes are removed through the same incision during this operation (called axillary node clearance - or dissection).
Mastectomy is less disfiguring than the radical mastectomy of the past. The new type of mastectomy performed today allows for easier breast reconstruction. After mastectomy, most women will have a horizontal scar across their chest.
Breast reconstruction can be performed at the same time as mastectomy (immediate reconstruction) or after all the treatments for cancer are completed, as a separate operation (delayed reconstruction).
Breast-conserving treatment - For many women it is now possible to have smaller operations, such as partial mastectomy (or wide local excision). A breast-conserving operation involves removing the breast lump with some surrounding normal breast tissue to ensure a good clearance.
Surgery is then followed by radiation treatment to the remaining part of the breast - this is usually 6 to 8 weeks after surgery. This makes sure any cancer cells that are still present in the breast are treated, and significantly reduces the risk of cancer recurring in the remaining breast tissue. Lymph glands are also removed for examination in these smaller operations, and this is often through a separate incision (cut) in the armpit.
Breast-conserving operations have been routinely performed now for many years. Studies show that both mastectomy and breast-conserving operations with radiation treatment are equally effective in the treatment of early breast cancer. However, breast-conserving surgery is not suitable for every woman with breast cancer.
After your cancer has been removed, your surgeon will discuss your tumour with other specialists to decide what further treatment, such as radiation therapy and chemotherapy is needed.
Radiation treatment is the use of radiation (rays of energy called 'photons' or little particles called 'electrons') to destroy cancer cells, usually using a machine called a 'linear accelerator'. You will see a radiation oncologist who will discuss this treatment with you.
Treatment is carefully planned to reduce any effect on normal cells. Treatment is given 4 to 5 days a week, over about 4 to 5 weeks. It is painless and only takes a few minutes for each treatment. An extra radiation ‘boost dose’ may be given to the area where the breast cancer was located, taking the overall treatment time up to 5 to 6 weeks. Partial breast irradiation is currently being investigated as an alternative to whole breast irradiation in certain patients. Radiation therapy can also be used when breast cancer comes back or recurs and cannot be surgically removed.
Chemotherapy is the treatment of cancer by drugs. The aim is to destroy cancer cells while having the least possible effect on normal cells. The drugs are usually given intravenously via a drip and, therefore, circulate around the body.
Chemotherapy is a systemic treatment (treating the whole body) compared with surgery and radiation treatment, which are local treatments to a specific area in the body (breast, chest wall, axilla, etc). There are different regimens or combinations of drugs used in breast cancer.
Treatment is often in cycles at three-weekly intervals, and may last for 6 cycles (nearly 6 months). A medical oncologist will discuss all aspects of the treatment with you.
Chemotherapy is offered to some women with early breast cancer as an additional treatment to surgery, radiation treatment or both. This is called adjuvant chemotherapy.
The women who are most likely to benefit from chemotherapy are those in whom the lymph glands in the armpit do have cancer cells. There is also a benefit from chemotherapy in women who do not have spread into armpit glands, but have more aggressive cancers (Grade 3 and oestrogen receptor negative). Women who are HER2 positive will benefit greatly from chemotherapy.
Monoclonal antibodies are drugs that recognise and bind to specific proteins (receptors) that are found in particular cancer cells or in the bloodstream.
Trastuzumab (Herceptin) is given intravenously once every week or 3 weeks, and is usually well tolerated. It may cause some impairment of heart pumping function, especially when used with a chemotherapy drug which affects the heart. A heart echo test will be done every 12 weeks to check this.
Many breast cancers appear to be influenced by the female hormones, oestrogen and progesterone.
Pre-menopausal women may be offered tamoxifen, a hormone treatment taken as a tablet. They may also have menopause induced to stop their own production of hormones. This can be done by four-weekly injections with goserelin (Zoladex) or by surgical removal (laparoscopic oophorectomy) of the ovaries. Once you stop taking goserelin your periods will usually return.
Post-menopausal women may be offered oral hormone treatments – either tamoxifen or aromatase inhibitors anastrozole (Arimidex) or letrozole (Femara), which reduce the production of hormones in the body (other than from the ovaries).
|Wide range of resources and information||NZ Breast Cancer Foundation|
|Living with Breast Cancer (excellent range of stories, videos and support)||NHS Choices|
|Questions to ask your doctor||Best Health - UK|
|Being Active When You Have Cancer (2 pages)|
|Support for positive lives with secondary breast cancer||Sweet Louise|
|Frequently asked questions about the screening programme||National Screening Unit - NZ|
|Videos - Breast awareness campaign||NZ Breast Cancer Foundation|
|Breastscreen resources in multiple languages||National Screening Unit - NZ|
Support & Personal Stories
Every woman who is diagnosed with breast cancer needs support. This can be in the form of information, someone to talk with who knows what it's like, support groups through to emotional support and practical help around the house or with the family. Don't struggle on your own. Talk with someone!
|Personal stories (English & Maori||National Screening Unit - NZ|
|Breast Cancer Video Part 1 of 3||Faultline Productions & Te Mangai Paho|
|What can you do for someone who is diagnosed?||NZ Breast Cancer Foundation|
|Support for positive lives with secondary breast cancer||Sweet Louise|
|Breast Cancer||NZ Breast Cancer Foundation|
|Breast Cancer||NHS Choices|
|What treatments work for breast cancer?||Best Health UK|
|NZ Breast Cancer facts & statistics||NZ Breast Cancer Foundation|
|Breast cancer - videos, tutorials, extensive library of resource|
Credits: Adapted from original content provided to Everybody.co.nz by Cancer Society NZ in 2007. Latest edit and update July 2014.