Breast cancer: Risks, signs and symptoms, screening, and how to assess your own breasts: Professor Christobel Saunders
So, my name is Christobel Saunders and I’m a breast surgeon here in Perth, in Western Australia, and I’ve been on the advisory board of the Virtual Medical Centre for some years now.
What we want to talk about today is about breast cancer. Now breast cancer is, I’m sure you’re all aware, a common condition unfortunately and about 1 in 8 women in Australia will develop breast cancer in their lifetime. The good news is of course that most women will do very well, most will survive and thrive and recover and be cured from the disease.
What a lot of women would like to know about is what makes them at risk of breast cancer. So many women will come to me and say, “Am I at increased risk of breast cancer?”
Well, there are some things we know put you at increased risk. Clearly, being a woman. It’s also, like many cancers, a disease as we get older that becomes more common, so after 50 breast cancer becomes increasingly more common than in younger women. However, for a few women there will be considerably higher risk and those are usually those who have a strong family history. Now, that doesn’t necessarily mean just one or even two relatives who had it at an older age, but this really means many female, sometimes male, relatives who have had breast cancer at a young age, so below 50, or even below 40.
Also, there are other cancers that may be associated. So for example, if there’s a strong family history of ovarian cancer. Women who suspect that they have a strong family history are well advised to go and discuss that with their general practitioner and perhaps be referred to a familial cancer clinic.
However, 95% of the population – at least – don’t have those very high risk factors. But there are some other things that can increase your risk, at least somewhat. We know that women who have been on the oral contraceptive pill for a long time may be at increased risk, but that risk decreases about down to normal when it’s stopped. And of course breast cancer is pretty unusual in very young women who are on the pill.
HRT, that’s a very interesting question. Many women are concerned to take HRT and it does slightly increase the risk of breast cancer. But to be honest, only slightly. And if taken for severe symptoms and for a relatively short amount of time, say 4 years or less, the risk is not great.
Being overweight and not exercising much significantly increases your risk of breast cancer, and we certainly advise women that the best thing they can do to decrease that risk is attempt to get a healthy body weight and do regular exercise, and by that we mean at least 30 minutes of strenuous exercise 5 day a week.
Alcohol is another important risk factor for breast cancer and we very much advise women to moderate their alcohol. That doesn’t mean necessarily having none, it may mean just having 1 glass or perhaps 2 glasses of alcohol a day, but certainly keeping it as low as practicable.
Another really important risk factor that perhaps people don’t know about for breast cancer is something called mammographic density. Now, essentially that means that when you have a mammogram you have a lot of white area or dense tissue on the mammogram. Now that is something you’re born with, that’s not something that you can change. But it’s important to know about it because it not only increases your risk of breast cancer, but it also makes those mammograms harder to read. And again, it may be worth discussing with your general practitioner what you can do about all of these and try to get an assessment from your GP.
What would your GP then do?
Well, hopefully he will advise you about healthy lifestyle, about cutting down on alcohol and exercise, but he may also recommend a different screening regimen. So for example, if you’re at very high risk you may need to go and see a familial cancer clinic and perhaps have a different kind of screening, or if you have some family history you may need annual mammography from the age of 40 rather than what we would normally recommend which is a 2-yearly mammogram from the age of 50.
So those are the risk factors for breast cancer and there are some of the things you can do about it. And if you want to know more, there’s a fantastic thing called the ‘Risk Calculator,’ which is on a website from Cancer Australia. So just google “Cancer Australia” and find the risk calculator, and that will give you a good idea of both what your risk may be as an individual but also what you can do to decrease that risk and manage it better.
Signs and symptoms
Now, women also ask very frequently, “What are the signs and symptoms of breast cancer?”
So, what do I need to worry about if I find something wrong? Well, of course, the most common sign of breast cancer is a lump in the breast and for any woman who develops a lump in the breast – particularly if it persists more than a few weeks and if it’s not changing with their menstrual cycle, or if she’s post menopausal, passed the menopause, if she develops a new lump – it’s really important to go and see your doctor as soon as possible and get it checked out. 9 out of 10 times it will be nothing but it is important to get it checked out.
Other things to notice are whether your breasts are changing in shape one from the other, whether there’s any redness or change of the skin, or any nipple changes, particularly nipple discharge. All of those things are things to take note of and go and see your doctor.
Other rarer changes that may be associated with breast cancer are a lump under the arm, or other problems with the breast such an increase in size or redness of the breast.
Many breast cancers nowadays, in fact about a third, are detected by mammographic screening. It is important for women to consider, over the age of 50, getting a mammogram every 2 years. Now, this is important and we know that it decreases the chance of women dying of breast cancer and tends to pick up cancers early, but there are a few downsides of screening, including an increased diagnosis of things that would never harm a woman in her lifetime. If you want more information about mammographic screening and the benefits, and some of the perhaps harms of screening, it’s important that you get more information either from your GP or again, go online to Cancer Australia and the breast screening websites and you’ll find some really good information for patients about the importance of mammographic screening, what it involves, but also some of the downsides.
Assessing your breasts
Finally, we’d like to talk about how to assess your own breasts. Nowadays we know that regular, ritual, monthly breast self-examination probably doesn’t do us any good. It just makes us worried when we find changes and perhaps go and see the doctor for lots of unnecessary things. So what we really suggest nowadays is something called breast awareness. In other words, get to know what your own breasts are like, make sure that you notice any changes and go and see your GP promptly should you notice any of the problems that I talked about earlier, such as a lump or nipple discharge. And how do you do that? Well, you ensure that you know how to examine your own breasts. We usually recommend doing this, for example, in the shower or in the bath with a wet soapy hand, and with the flat of your hand feel all over your breasts to see if you can feel a lump. It’s also important to have a good look in the mirror and see if you notice any changes including when you put your arms up over your head. Again, there are many good websites that you can look at on the internet to show you exactly how to do this.
But the real message is if you notice any changes, particularly changes that persist more than a few weeks, go and see your GP and get them checked out. We know that diagnosing breast cancer early is one of the keys for curing the disease.
|For more information on breast cancer, types of breast cancer and its investigations and treatments, as well as some useful videos, see Breast Cancer.|
|For more information on identification of genes that may affect your breast cancer risk, see Genetic Typing of Cancers.|
|For more information on the benefits and risks of mammography and how to prepare for a mammogram, see Mammography (Breast Imaging).|
|To calculate your breast cancer risk, see the Cancer Australia risk calculator.|