Breast Cancer
Breast cancer is the most common cancer in women in WA. Every year more than 1,200 women are told the news that they have been diagnosed with breast cancer.
- Does breast cancer occur in younger women?
- What is a breast prosthesis?
- How do I wear a breast prosthesis?
- How do I care for my prosthesis?
- Where can I buy a breast prosthesis?
- Can I get financial assistance to buy a prosthesis?
- What other support services are available?
What is breast cancer?
Breast cancer is the growth of abnormal cells in the breast. These abnormal cells grow and divide faster than normal cells. They can also invade the breast and surrounding tissue and spread to other parts of the body.
The breast is made up of fat, connective tissue and glandular tissue that forms sections called lobules and lobes (a collection of lobules). The breast (milk) ducts connect the lobes to the nipple. There are a number of different types of breast cancers, most of which begin in the breast ducts.
What is precancerous (very early) breast cancer?
There are two very early, or precancerous, types of breast cancer:
- Ductal carcinma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS) is where cells in the breast duct have started to turn into cancer cells. These precancerous cells are unable to spread through the lining of the duct and can usually be successfully removed by surgery. If left untreated some, but not all, DCIS will become invasive. However, the dilemma at present is that there is no way of identifying which cases of DCIS will become invasive. Removal of all the DCIS is effective treatment.
Lobular carcinoma in situ (LCIS) is where there are changes in the cells in the breast lobule. However, LCIS does not mean the cells are starting to turn into cancer cells. It is normally managed by careful monitoring rather than treatment.
Most women diagnosed with LCIS do not develop breast cancer. However, if you have been diagnosed with LCIS you have an increased chance of developing breast cancer in either breast compared to women in the general population.
What is early breast cancer?
- Invasive ductal breast cancer is the most common type of early breast cancer. About 80% of all breast cancers diagnosed are invasive ductal breast cancer. This means the cancer cells have spread from the duct to breast tissue.
- Invasive lobular breast cancer is less common and occurs when cancer cells in the lobule spread to breast tissue.
What is advanced (or secondary) breast cancer?
- Locally advanced breast cancer is breast cancer that has spread from the breast to the tissues and lymph nodes surrounding the breast.
- Metastatic breast cancer is breast cancer that has spread to other parts of the body, for example the bones, lungs or liver.
Once breast cancer has spread to other parts of the body it is more difficult to treat.
Treatments for metastatic breast cancer cannot cure the cancer, but they can improve quality of life. Treatments used for secondary breast cancer may include surgery, chemotherapy, radiation therapy or hormonal therapies.
For more information about treatment, support services and practical issues for people with secondary cancer call the Cancer Council's Cancer Helpline on 13 11 20.
How does secondary breast cancer develop?
As a cancer grows, over time the cancer cells develop the ability to invade into the surrounding body tissue. If the cells are able to enter blood or lymph vessels (part of our immune system), the cancer cells can travel to other parts of the body. This may happen before the cancer is found and treated, but it may also happen if any cancer cells are left behind after treatment.
As the cancer cells travel around the body they become trapped in other organs and tissues. Most of the cancer cells will die, but some may develop into a secondary tumour.
Breast cancer that has spread from the breast into the lymph nodes or other tissues next to the breast is called locally advanced breast cancer. This is not the same as secondary breast cancer.
Locally advanced breast cancer is treated using a combination of surgery, radiotherapy, chemotherapy and/or hormonal therapy.
How can I look out for breast cancer?
A woman’s breasts change throughout life. Being aware of these changes and learning how your breasts feel at different times can help you understand what is normal for you. If you are familiar with your breasts you may be more likely to notice any unusual changes that could be a sign of breast cancer.
Women of all ages should become familiar with their breasts. But it becomes more important as you get older as the risk of breast cancer increases with age.
Everyone’s breasts are different. It is important that you get to know what your breasts look and feel like, so you know what is normal for you. There is no right or wrong way to do this, however the following suggestions can be used as a guide:
- Look in the mirror and feel your breasts from time to time.
- Feel them while you are in the shower or bath, lying in bed or getting dressed. It should only take a few minutes.
- Remember to feel all the breast tissue, from the collarbone to below the bra line and under the arms.
- Use the flat part of your fingers and the finger pads to feel near the surface and deeper into the breasts.
If you are still having your periods, expect your breasts to feel different at different times of the month. For example, some women get painful, lumpy or swollen breasts just before their period starts and softer breasts after their period has finished.
See your doctor if you notice any unusual changes. If you find any unusual changes, it is important that you see your doctor straight away. Unusual breast changes include:
- A lump, lumpiness or thickening in the breast or under the arm.
- Changes in the skin on or around the breast, such as dimpling, puckering or redness.
- Changes in the nipple, such as inversion, new nipple discharge, or itchy or ulcerated skin.
- An area of the breast that feels different from the rest.
- New pain that doesn’t go away.
Your doctor will examine your breasts and ask about your medical history. Your doctor may send you for tests to find out what caused the changes.
Most changes are not breast cancer, however it is always important to have any changes checked out straight away by your doctor.
Is screening available for breast cancer?
Screening mammograms look for early signs of breast cancers in women without breast cancer symptoms. Mammograms may find a breast cancer that is too small to feel.
When breast cancer is detected early women have a much greater chance of being treated successfully and for most women the cancer will not come back after treatment. Screening mammograms are currently the best method available for detecting breast cancer early.
BreastScreen WA offer a free mammogram (breast x-ray) to screen for breast cancer. All women aged 50 to 69 years are encouraged to have a free mammogram every two years through the BreastScreen WA program.
All women aged 40 to 49 years who have no breast symptoms also have free access to the BreastScreen WA program should they choose to a have screening mammogram. Women aged over 70 years who have no breast symptoms also have free access to the BreastScreen WA program. They should discuss whether to have a mammogram with their doctor.
To book your appointment with BreastScreen WA, call 13 20 50 (for the cost of a local call). For more information about the BreastScreen WA program visit www.breastscreen.health.wa.gov.au or call 13 20 50.
After a screening mammogram some women may be called back for a repeat mammogram and/or further tests. This may be because there was a technical problem with the mammogram making it difficult to interpret. Some women may also be called back if something detected on the mammogram needs further investigation. BreastScreen WA offers a comprehensive assessment service for women who are found to have a screen-detected abnormality.
If a you need further testing this does not necessarily mean that you have breast cancer. For every 100 women screened, about 6 will need further tests and less than one will be diagnosed with breast cancer.
What are the risk factors for breast cancer?
The cause of breast cancer is still unknown, however research has identified a number of factors that increase the chances (risk) of developing breast cancer, including:
- Gender and age. The main risk factors for developing breast cancer are being a woman and getting older. More than 70 per cent of all breast cancers occur in women aged 50 years and over. Breast cancer is rare in women aged 20 to 30 years. Breast cancer is also rare in men.
- Previous history. Women with who have previously had breast or ovarian cancer have an increased chance of developing breast cancer.
- Family history. A woman’s risk of breast cancer is increased if one or more of her close relatives have been diagnosed with breast cancer. For example, if your mother or sister had breast cancer. However, less than 5% of all breast cancers are caused by a family history and most women with one or two affected relatives will not get breast cancer. If you have a family history of breast cancer and are concerned about your risk speak to your doctor.
- Overweight and obesity increase the risk of breast cancer. This is because body fat increases levels of the hormone oestrogen. Combining a balanced diet with regular exercise helps to maintain a healthy body weight.
- Alcohol. Regularly drinking alcohol increases the risk of developing breast cancer. Limit your alcohol intake – if you don’t drink, don’t start. If you choose to drink, have no more than one standard drink per day.
- Reproductive and hormonal factors.
- Menstruation and menopause. Women who start their periods (menstruation) at a young age or who have menopause at a late age have an increased risk of breast cancer.
- Having children. The younger a woman is when she has children and the more children she has, the lower her risk of breast cancer.
- Breastfeeding. Breastfeeding lowers the risk of developing breast cancer, probably because it reduces a woman’s total number of menstrual cycles. Breastfeeding for longer can also reduce a woman’s risk.
- Induced abortion. There is no conclusive evidence that induced abortion increases the risk of breast cancer.
- Oral contraceptives. Oral contraceptives (the Pill) cause a slight increase in breast cancer risk, however this risk gradually decreases after a woman stops taking them.
- Hormone Replacement Therapy. Women taking hormone replacement therapy (HRT) have an increased risk of developing breast cancer, particularly if they take the combined oestrogen/progesterone HRT.
How is breast cancer diagnosed?
If you or your doctor find unusual changes in your breast, further tests will be carried out to determine if you have breast cancer. These include:
- Diagnostic mammography. Diagnostic mammography uses the same technique as screening mammography. However, in this case it helps determine whether the breast changes or abnormalities that you or your doctor has found are breast cancer.
- Ultrasound. This is a painless test that uses sound waves to create a picture of the breast tissue on a small screen similar to a television. Ultrasound is often used for young women whose breasts are too dense to give a clear picture with mammography. It is also used to see if a breast lump is solid or contains fluid.
- Fine needle aspiration. A very thin needle is inserted into the breast and a sample of cells is removed. Ultrasound or x-ray may be used to guide the needle to the area of the breast that is being examined. The cells are examined to see if they are cancer cells.
- Core biopsy. A needle is inserted into the breast and a small core of tissue is removed so it can be examined for signs of cancer. As with fine needle aspiration, ultrasound or x-ray may be used to guide the needle to the area of the breast that is being examined. This procedure is carried out under a local anaesthetic.
- Surgical or open biopsy. In some cases surgical biopsy may be necessary to remove part or all of the lump for examination. It is performed under general anaesthetic in hospital.
What treatments are used for breast cancer?
The type of treatment you are offered will depend on your situation and the type of breast cancer you have. This is because treatment that is best for one woman may not be suitable for another.
Although nearly all treatments have side effects, most can be effectively managed. Ask your doctor to explain what side effects to expect and how best to manage these.
Treatments used for breast cancer include:
- Surgery. There are two types of surgery for breast cancer – breast conserving surgery or a mastectomy. Breast conserving surgery removes the breast cancer and a small area of healthy tissue around it. This procedure can also be called a lumpectomy, wide local excision or complete local excision. Breast conserving surgery plus adjunct radiation therapy is as effective as mastectomy for most women diagnosed with early breast cancer. A mastectomy involves the removal of the whole breast affected by cancer. If you are considering breast reconstruction you should discuss this with your doctor before your surgery. In most cases breast surgery also involves the removal of one or more lymph nodes in the armpit, to test whether the breast cancer cells have spread.
- Radiation therapy. Radiation therapy uses x-rays to destroy cancer cells that may be left in your breast or breast tissue after surgery. You may experience some pain or discomfort after each treatment, although the treatment itself is painless. Radiation therapy does not make you radioactive and does not cause hair loss. It is usually given over a 5 to 6 week period. Radiation therapy can also be used to reduce the size of the cancer and to relieve pain or other symptoms.
- Chemotherapy. Chemotherapy uses anti-cancer drugs to help destroy cancer cells that may have spread to other areas of your body. Chemotherapy reduces the chance of the cancer coming back. It may be used in addition to surgery and radiation therapy.
- Hormonal therapy. If your cancer cells are the type that respond to hormones, you may be given hormonal therapy to help destroy remaining breast cancer cells, or any cancer cells that may have spread to other areas of your body. Hormonal therapy may be used in addition to surgery, radiation therapy and chemotherapy.
What about complementary therapies?
Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life and to reduce pain. However, there is no evidence that these therapies can cure or prevent cancer.
It is important to remember that some of these therapies have not been tested for side effects, may work against other medical treatments and may be expensive. Let your doctor know about all complementary therapies you are thinking of using.
Does breast cancer occur in younger women?
With high profile young women such as singer Kylie Minogue and actress Belinda Emmett being diagnosed with breast cancer, you may have the perception that breast cancer is on the increase in younger women.
In fact, breast cancer is still a rare occurrence in young women. Around five per cent of all breast cancer cases are found in women under the age of 40.
This means little, however, if you are a young woman with breast cancer.
Being aware of and preventing breast cancer is still important for young women.
Become familiar with the look and feel of your breasts and report any unusual changes to your doctor.
Breast cancer can be harder to detect in young women as their breast tissue is often thicker than breast tissue in older women. Because a young woman’s breasts are so dense, a mammogram isn’t always useful for detecting early breast cancer.
Because detection can be difficult, the cancer is often advanced when it is discovered. Young women may also ignore the warning signs and symptoms because they think they are too young to get breast cancer.
Quite often, the cancer is discovered when the young women or their partner find a lump in the breast. This is why it is important for women to regularly check their breasts. Know what is normal for you and report any changes to your doctor.
That said, not all lumps are cancer! Finding lumps in the breast is not uncommon for young women. In most cases, these lumps turn out to be cysts (small fluid filled lump). Even so it is important to get any unusual lumps or other changes checked out – your doctor won’t think you are over-reacting!
To reduce your risk of breast cancer, maintain a healthy body weight, eat well, exercise regularly and limit alcohol consumption.
What is a breast prosthesis?
A breast prosthesis is an artificial breast that fits inside your bra or camisole. A well fitting prosthesis can correct the weight imbalance you may experience after your breast (or breasts) has been removed. It can help by allowing you to regain your natural shape and wear clothes comfortably.
A breast prosthesis can be an important factor in your recovery from surgery. It can be as important for your well being as it is for your posture, balance and comfort.
There are several types of breast prostheses:
- Temporary breast prostheses. After your surgery, while you are healing, you may be given a temporary breast prosthesis. This is usually made of lamb’s wool. You can wear it straight after your surgery even if the area is tender. You can obtain a temporary prosthesis by contacting the Cancer Council Helpline on 13 11 20.
- Permanent breast prostheses. A permanent breast prosthesis is usually made of silicone gel and is worn inside your bra or camisole. Permanent breast prostheses are available in a range of sizes, shapes and weights to meet your individual needs. You can be fitted for a permanent prosthesis about six to eight weeks after surgery as long as any swelling has decreased and the area has healed well. If you have had radiotherapy as a follow-up treatment, you may need to wait about four weeks after this is completed before being fitted with your prosthesis, as the area may still be sensitive.
- Partial prostheses. If you have had part of your breast removed you may find that the shape of your bra becomes difficult to fill. You may need a partial prosthesis and a trained prosthesis fitter can help you with this.
How do I wear a prosthesis?
There are many types of bras and camisoles available that already have pockets inserted in them to hold your prosthesis. You don’t always need to buy a mastectomy bra. If you have a bra that is well fitting pockets can be sewn into the bra to hold your prosthesis.
Many women find that their regular bathers need little or no adjustment. Pockets can be sewn into them if required. Specially designed fashionable swimwear that includes bra pockets for the prosthesis, wide straps and higher necklines are also available.
How do I care for my prosthesis?
A prosthesis is made of waterproof silicone gel. You can wear your prosthesis in your bathers for swimming. However some manufacturers recommend that the prosthesis is not worn in a sauna or spa. Most prostheses have a one to two year warranty, but they usually last longer than two years.
Where can I buy a breast prosthesis?
A number of metropolitan and country stores are able to fit you with a suitable prosthesis and also for a bra and bathers if required. If you are unable to access the store yourself a free home service may be available to help you. Call the Council Helpline on 13 11 20 for more information.
Can I get financial assistance to purchase a prosthesis?
Women who are permanent residents of Australia, have a current Medicare entitlement and have had a mastectomy as a result of breast cancer, are eligible to claim reimbursement through Medicare. The mastectomy may be recent or in the past.
Women are able to claim up to $400 for each new or replacement breast prosthesis. They will need to complete a claim form which is available from any Medicare office or from their website at medicareaustralia.gov.au and attach receipt as proof of purchase.
Subsequent reimbursements can be claimed no earlier than two years from the date of the last purchase. This applies for each prosthesis for each breast.
If you currently receive financial assistance from the Department of Veterans' Affairs (DVA) you may be able to claim entitlements through DVA.
For private health cover, clients can claim the difference between the amount reimbursed by health fund and the Medicare entitlement. Reimbursements are made by electronic funds transfer into a nominated bank account.
For more information visit the Medicare website as above, Cancer Council Helpline on 13 11 20, or visit any Medicare office.
What other support services are available?
- The Cancer Council Helpline 13 11 20 can answer your questions about diagnosis, treatments, management of side effects of medication or treatment, arrange practical support, put you in touch with our professional counsellors, or just listen to your concerns.
- The Look Good…Feel Better program helps women facing cancer to minimise the appearance-related side effects of treatment and maximise self confidence!
- The Cancer Council Wig Service has a range of fashionable wigs and other headwear. Our trained volunteers will help you find the look that’s right for you.
You may find the websites of these organisations useful:
- National Breast and Ovarian Cancer Centre (NBOCC) is Australia's national authority and information source on breast cancer and ovarian cancer. Funded by the Australian Government, NBOCC works in partnership with health professionals, cancer organisations, researchers, governments and those diagnosed to improve outcomes in breast and ovarian cancer.
- Breast Cancer Network Australia - the peak national organisation for Australians personally affected by breast cancer.
