A Patient Journey for Breast Concerns

Breast cancer is not only the most common cancer among; it is the most common cancer overall in the UK . There are around 50,000 new breast cancer cases in women in the UK each year – or roughly 140 women each day (there are also, it should be noted, around 400 cases of breast cancer in men each year in the UK). As a result of this prevalence, it is essential for women to be ‘breast-aware’ – to know what’s normal for their breasts, to check them regularly, to take part in screenings where possible, and to see a doctor if they notice any abnormalities. Breast cancer is most common in older women – 80% of cases are in women aged 50 and over – but can affect women of any age, so it’s equally important for all women to monitor themselves.

Advice for women with breast concerns, including breast cancerThe best way of detecting early-stage breast cancer is to undergo mammography screenings. A mammogram uses X-Rays to spot cancers that may be difficult to physically detect (if they’re very small, for example). In the UK, under the NHS Breast Cancer Screening Programme, women aged over 50 can take advantage of free three-yearly mammograms. If you receive a positive result in a mammogram, you will be referred for further testing. It’s worth noting, though, that only a quarter of women called back for further testing are diagnosed with cancer.

The next-best way to detect breast cancer is regular self-examination. It is important to check your breasts regularly enough to know what is normal for you and to be able to notice any deviation from that norm. It’s important to both look at your breasts and feel your breasts. If you notice any lumps or areas of thickened tissue, a change in the size of one of your breasts, discharge from one of your nipples, lumps or swelling in your armpits, dimpling on the skin of the breasts, a rash around the nipple, or any other change in the appearance of one of your breasts (such as the nipple becoming ‘sunken’) , you should see a doctor. It’s important to remember that 90% of lumps are not cancerous , and there are often other explanations for these other symptoms, but it is nonetheless important to always get them looked at by a medical professional.

Your doctor will ask you about your symptoms – if you have found a lump, for example, you will be asked how long ago it was detected – and will usually also perform a visual and manual examination of both breasts and axillae (armpits). You will not be diagnosed with cancer on the basis of this initial assessment; you will usually be referred to a specialist breast cancer clinic for further testing.

If you’ve been referred to the breast cancer clinic by your GP after self-examination, you may first be given a mammogram; if you’ve been referred from a screening programme, you may nonetheless be required to undergo another mammogram. Younger women (aged under 35) may instead have a breast ultrasound scan (imaging produced by inaudible high-frequency sound waves), since their breasts are denser and thus harder to penetrate with X-Rays. Biopsies (microscopic examination of tissue taken from the body) are also often used.

If you are diagnosed with cancer, other tests such as CT scans (computerized composites of X-rays which form detailed pictures), MRI scans (imaging of the brain or spine made using magnetic fields and radio waves) and bone scans may be used to establish whether the cancer has spread to other parts of the body.

There are many treatments available. Women diagnosed with breast cancer will be assigned a multidisciplinary team (MDT) of specialists who will work together to devise an appropriate treatment and care strategy for you. This will depend on the stage and grade of cancer you have (that is, on how big it is and how much it has spread). Treatments will often include more than one element. One treatment avenue is surgery – either to remove the cancerous lump (this is sometimes called a lumpectomy), or to remove the entire breast (this is called a mastectomy). Further surgeries may be necessary if your cancer has spread, and reconstructive surgeries may be suggested in order to rebuild a breast shape with which you are comfortable. Radiotherapy is another treatment avenue – this consists in the targeted application of measured doses of radiation to the cancer cells. Chemotherapy (the use of anti-cancer medications) is often used after surgery to kill off any remaining cancer cells. Hormone treatment is often in cases where the cancer is stimulated by certain hormones – this will often come after both surgery and chemotherapy. Other treatments exist for other less common forms of breast cancer.

It is hugely important to remain aware of your psychological wellbeing if you are diagnosed with cancer, and to seek and take support where you can. talkhealth is happy to recommend a number of charities that may be able to help you with the support you need, including Women’s Health Concern.

Our breast problems forum is a dedicated area of the talkwomen'shealth forum where you can find support from the talkhealth community.