‘How will I know if I have breast cancer?’

Every ten minutes, one woman is diagnosed with breast cancer in the UK. (1) October is breast cancer awareness month, where there is increased recognition, education and as a result diagnosis. The article will provide some information on the risks of getting breast cancer, key things to look out for when examining yourself and what to expect if you visit the doctor for a lump in your breast. 

What factors increase my risk of getting breast cancer?

So there are the ‘typical’ risk factors for cancer – such as older age, radiation, obesity, smoking, alcohol and family or personal history of cancer (of any sort).  ⅓ of women with breast cancer have 1 first degree relative with breast cancer. (2) 5-10% have genetic mutations such as BRCA-1 or BRCA-2. (3) BRCA stands for BReast CAncer gene. Some breast diseases can also later become cancerous. 

Oestrogen is a female hormone that stimulates the growth of cells in the breast, and the more your body is exposed to it the greater the risk that those cells can turn cancerous. Factors that can increase your estrogen exposure are starting periods at a young age; late menopause; combined oral contraceptive pill or hormonal replacement therapy. (4)

Women who have never given birth or given birth after 30 are at slightly increased risk of breast cancer. (5) This is because pregnancy allows the breast cells to mature and grow in a controlled manner. Older women who give birth are at increased risk as they have a greater exposure period to oestrogen.

How do I check my breasts? (6)

Look 

This is important because some breast conditions or cancers only show physical changes, rather than a lump in the breast.

Inspect your breasts three times in three different positions:

1. 1. Put your hands on your thighs and relax the chest muscles
   2. Press hands on hips and contract the chest muscles
   3. Hands behind your head

Key things to look out for:

• • • Do your breasts look symmetrical in terms of size and shape?
      • Although this can be helpful, some women have asymmetrical breasts and that can be completely normal. 
    • Are there any visible lumps in your breast or underneath your armpits?
    • Check your nipples
      • Are your nipples inverted?
      • Is there any discharge?
      • Is there any scaling, reddening or itching of your nipple?

Feel

There are 3 different methods to feel around your breasts for any lumps, pain or change in texture such as thickening or puckering. Use the flats of your middle three fingers. If you already saw a lump or abnormality, start with the ‘normal’ breast first so that it’s easier to compare.

Figure 1: Breast Self Examination Photograph by Gwen Shockey

Feel a lump?

Make sure you note some details on where it is, how it feels, its size and shape, and if it moves or is stuck to your breast.

Make sure you also feel under and around your armpits for any lumps (from swollen lymph nodes which help the immune system).

I think there’s something wrong, what should I do? (7)

1. Contact your GP.They will ask you some questions and do a professional physical examination. If they are unsure or they require confirmation of the diagnosis from a specialist, you will be referred to hospital specialist clinics. If they are suspicious of cancer, you will be listed on a 2-week wait to be seen as quickly as possible.
2. At the hospital, they will confirm the details from your GP, ask anything that they may have missed and will examine you again just so they have their idea of what could be going on. More often than not, they will request a mammogram (X-ray of the breasts) and/or an ultrasound. After reviewing the images, they may also ask for a biopsy (a sample of cells taken from your breast to analyse in the laboratory for any cancerous cells.)
3. Specialised care. If it is cancer, you may need further tests to help tailor treatment to the type of cancer you have and its severity. But don’t worry, regardless of the results you will be treated at the highest standard of care with loads of support services available for you. 

Can breast cancer be prevented?

Taking care of yourself by minimising your risk factors (mentioned above) will help to reduce your risk of breast cancer. 

Interestingly, breastfeeding can reduce your risk of breast cancer. (8) During breastfeeding, the cells in your breast are continuously discarding old cells and replacing them with new cells, removing those that might be damaged (and hence may cause cancer). Additionally, it reduces your oestrogen exposure, as you have fewer periods. 

Mastectomy. Women who get genetically tested (e.g. if they have a strong family history of breast cancer), may know that they have a high risk of breast cancer. In that case, they can opt for a mastectomy (surgical removal of the breasts) to reduce their risk. 

References:

1. Breast Cancer Now. Facts and statistics 2021 [Internet]. Breast Cancer Now. 2015. Available from: https://breastcancernow.org/about-us/media/facts-statistics
2. Jacobi CE. Prevalence of family histories of breast cancer in the general population and the incidence of related seeking of health care. Journal of Medical Genetics. 2003 Jul 1;40(7):83e83.
3. Anglian Breast Cancer Study Group. Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases. British Journal of Cancer. 2000 Nov;83(10):1301–8.
4. NHS Choices. Causes – Breast cancer in women [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/breast-cancer/causes/
5. Breast Cancer Risk After Childbirth. Annals of Internal Medicine. 2018 Dec 11;170(1):I–26.
6. updated DLPE. Breast Examination – OSCE Guide | Geeky Medics [Internet]. Available from: https://geekymedics.com/breast-examination-osce-guide
7. NHS Choices. Diagnosis – Breast cancer in women [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/breast-cancer/diagnosis/
8. Anstey EH, Shoemaker ML, Barrera CM, O’Neil ME, Verma AB, Holman DM. Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers. American Journal of Preventive Medicine [Internet]. 2017 Sep;53(3):S40–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069526/

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