Breast Cancer

Breast cancer, which starts in the breast tissue, is one of the most common cancers worldwide (1). No two people's experience of breast cancer is the same, so getting the right information and support early is key.

This article introduces what breast cancer is and how it’s treated, and how overall health and nutrition can help you through every stage of the breast cancer journey.

Breast cancer begins in the breast tissue, most often in the ducts that carry milk to the nipple, or the glands that produce milk (the lobules). 

The most common type is invasive breast cancer, where cancer cells have grown through the lining of the ducts into the surrounding breast tissue (2).

Other types include (2):

• Invasive lobular carcinoma, the second most common, where cancer cells from the lobules have spread into the surrounding tissue.
• Triple negative breast cancer, which tests negative for receptors commonly found in other breast cancers
• HER2-positive breast cancer, which has higher levels of a protein called HER2.
• Luminal types of breast cancer, which test positive for hormone receptors commonly found in breast cancer tissues.
• Ductal carcinoma in situ is a non-invasive or stage 0 in which breast cancer abnormal cells are found within the milk ducts but have not spread into surrounding breast tissue. It is often detected through screening and is highly treatable.

Breast cancer can also spread to the lymph nodes, small glands that are part of your immune system. Conditions such as breast cysts, fibroadenomas and intraductal papillomas are benign, meaning non-cancerous, but may still cause concern.

It is important to know that while breast cancer is a lot more common in women, men can develop it too (2).

Risk factors for breast cancer include (3):

• Age: most cases are diagnosed in women over the age of 50
• Genetics and family history: some people carry gene changes, such as BRCA1 and BRCA2, that can increase risk, while having a close family member who has had breast cancer may also increase risk.
• Hormonal factors: higher levels of certain hormones, including oestrogen or progesterone, can increase your risk.
• Reproductive factors like starting periods at an early age, going through menopause later in life, never having had children, taking hormone replacement therapy (HRT), and having denser breast tissue can all influence the risk of breast cancer.
• Lifestyle factors: for example, being overweight or obese, drinking alcohol regularly, and smoking all increase risk
• Previous chest radiation therapy: people who have had radiation therapy to the chest area may have a slightly higher risk of developing breast cancer.

Having one or more of these risk factors does not mean you will develop breast cancer, but understanding them is a helpful starting point.

Getting to know your own breast and chest means you can regularly check yourself for any changes. If you have concerns about your risk of breast cancer, speak to your doctor. 

Signs and symptoms of breast cancer may include:

• A lump in the breast, chest or armpit
• Changes in breast size or shape, in one or both breasts
• Skin changes, including dimpling (that could look like orange peel), puckering, redness or a rash on the breast, which may be harder to see on darker skin
• Changes in nipple appearance or texture, including a nipple that is turned inwards (known as inverted nipple) or discharge that is not breast milk
• Swelling or persistent pain in all or part of the breast, or in the armpit where the lymph nodes are.
• Some people also experience symptoms beyond the breast area, such as arm pain or unexplained tiredness.

While breast cancer may cause a range of symptoms, many of these can also be caused by other conditions. 

Any change to your breast or chest that is new, unusual or doesn't go away, including persistent pain, should be checked by a doctor. Early detection can make a big difference to breast cancer care.

Breast cancer diagnosis usually involves three steps: a physical examination, an imaging test, and a biopsy. During a physical examination, your doctor will check both breasts, your armpits and the surrounding area for any changes. Further tests may include:

• Mammogram, an X-ray of the breast tissue
• Breast ultrasound, which uses sound waves to build a picture of the breast tissue
• Biopsy, where a small sample of breast tissue is taken and examined to confirm whether cancer cells are present
• MRI scan, which uses a magnetic field and radio waves to create pictures of the inside of the breast.
• Genetic testing, for example, if breast cancer runs in the family or if you have a specific type of breast cancer. This can help identify gene changes such as BRCA1 and BRCA2.

The tests above can be used to stage breast cancer; in other words, how advanced it is and whether it has spread to any other part of the body. Staging (0-IV) describes tumour size (T), lymph node involvement (N) and any spread to other parts of the body, known as metastases (M).

The above investigations can help assess general health and support your care team to make decisions about your treatment.

If breast cancer is discovered, your care team will use the test results to plan your treatment.

Breast cancer treatment is highly personalised based on cancer subtype, stage, genetics and patient's preferences. Breast cancer treatment may include:

• Surgery, the first step in treating breast cancer for many people. A lumpectomy removes just the cancer cells and some normal tissue; a mastectomy removes the whole breast; while lymph node surgery may be needed if these contain cancer.
• Radiotherapy uses targeted radiation to destroy remaining cancer cells, usually after surgery
• Chemotherapy may be given before surgery to shrink the tumour (called neoadjuvant treatment), or after surgery to lower the risk of the cancer coming back (called adjuvant treatment).
• Hormone therapy, which works by blocking or reducing the hormones that help certain cancers grow. It is used often for 5 to 10 years for hormone receptor positive breast cancers (luminal subtypes).
• Targeted therapy, which works by targeting the differences in cancer cells that help them grow, e.g., HER2-targeted treatments are used for HER2-positive breast cancer
• Immunotherapy may be used in certain cases, particularly for triple negative breast cancer, if the cancer does not have receptors for hormones or HER2.

Treatment for breast cancer depends on the type and stage of cancer, your overall health, and whether the cancer cells have certain proteins called receptors. Your care team will talk you through the treatment options available to you.

Breast cancer treatments can affect energy levels, appetite, weight and overall nutritional needs, so managing these changes is another important part of your ongoing care.

In general, breast cancer diagnosed at an earlier stage is associated with better chances of recovery than when it is diagnosed at a later stage, including when cancer has spread to other parts of the body. Almost all women diagnosed at Stage 1 survive their cancer for 5 years or more after diagnosis (4). 

Survival continues to improve with modern treatments, even with higher stages. Your care team will provide you with personalised information about your case.

Recovery is different for each person, but usually involves healing from surgery, managing side effects, and rebuilding strength and wellbeing. This can take time, and it is important to be kind to yourself as you focus on:

• Wound and scar care: surgical wounds may take two to three weeks to heal. Look out for signs of infection such as redness, warmth or discharge, and contact your care team if you have any concerns.
• Physical recovery and exercise: gentle movement like walking can reduce tiredness and stiffness during recovery.
• Managing side effects: tiredness and pain are common after treatment. Pacing yourself and prioritising tasks can help you manage your energy levels.
• Emotional wellbeing and nutrition: it is normal to feel emotionally and physically tired during and after breast cancer treatment. Good nutrition can support your healing and help manage any weight changes.

Regular follow-up appointments are an important part of recovery. They help your care team monitor your health, manage any lasting side effects and spot any changes early.

For some people, treatment brings breast cancer under control to the point where signs of cancer are no longer detectable, which is called remission. 

Breast cancer can sometimes come back after a period of remission, which is called recurrence. This may be:

• local, where the cancer returns in the same area
• regional, where it returns in nearby lymph nodes
• distant, where it develops in another part of the body, also known as secondary or metastatic breast cancer.

Some types of breast cancer, particularly hormone-positive types, can recur years or even decades later. Attending ongoing check-ups give your care team the best chance of detecting changes early.

Good nutrition plays a central role in supporting your strength, immune function and recovery during treatment. If eating has become difficult, oral nutritional supplements could help your body get the nutrition it needs, even when appetite is poor. These should always be recommended and monitored by a healthcare professional to make sure they are safe and appropriate for you.

Many cancer care teams include a dietitian who can provide guidance on keeping your body well-nourished. You can ask your care team about the support available to you.