talkhealth Blog

Breast Cancer Awareness Month is here and we thought it would be good to shine a light on this very important subject.

Breast cancer is the most common cancer in females and represents a major health concern for women worldwide. It is estimated that 1 in 9 women will be diagnosed with breast cancer in their lifetime but increasing awareness, screening programmes, earlier detection and effective treatments mean that the number of women surviving this type of cancer is steadily rising. In fact, breast cancer currently has one of the highest survival rates of all malignancies.

What actually is breast cancer and why do women get it? Well, it is a cancer that develops within the breast tissue and happens when there is an overgrowth of abnormal cells in the breast that forms a tumour.

Who is at risk of Breast Cancer?

● Females – the female gender is the biggest risk factor, but males can also be affected

● Age – your risk of getting breast cancer increases as you age, and most cases occur in women over age 50

● Family history – you are more likely to get breast cancer if several of your family members have been affected

● Medication – women who take Hormone Replacement Therapy or take the Contraceptive Pill are at an increased risk of breast cancer. If this applies to you, you can discuss this in more detail with your doctor

● Women who started their periods before age 12, who have the menopause after age 55, or who don’t have children (or had their first child later in life) are at a slightly increased risk

What are the symptoms of Breast Cancer?

The symptoms of breast cancer may include any of the following:

● A change in size or shape of the breast – it may be that one breast has become larger, or that the breasts appear asymmetrical

● Changes in the nipple – in direction or shape, retracted in or flattened nipple

● Changes on or around the nipple – rash, flaky or crusted skin

● Changes in the skin – dimpling, puckering or redness, “orange peel appearance”

● Swelling in your armpit or around your collarbone

● A lump, mass, or thickening in your breast

● Constant pain in one part of your breast or armpit

What should I do if I am worried?

If you notice changes in your breasts, see your GP as soon as possible. Most breast changes are harmless and are not cancerous, but engaging with your Doctor early can reassure you

that nothing is amiss, or allow you to undergo further investigation so that you can receive a diagnosis at as early a stage as possible. Your GP will likely ask you questions about your symptoms and evaluate your risk factors for breast cancer. You will have your breasts examined, and if your GP thinks the breast changes are connected with your hormones, you might be asked to return at a different time in your menstrual cycle. Alternatively, you may be referred to a breast clinic for further assessment.

What happens at the Breast Clinic?

The Doctor will refer you to the breast clinic, likely to be in a hospital if he or she has a concern about your lump. In the hospital, you may have a triple assessment – three ways to assess your breasts with a view to diagnosing your breast complaint. It will start with the doctor asking you questions about your symptoms, past health, lifestyle, and the health of your close family members. Your breasts and underarms will then be examined. Next, a mammogram (X-ray) or Ultrasound scan of the breast will be carried out. Finally, a biopsy may be taken, in which a tiny piece of the breast tissue is removed with a small needle. Based on the results of these tests, your Doctor should be able to provide you with a diagnosis.

How can I prevent Breast Cancer?

Be Breast Aware

This is one of the most important things you can do, and it means looking at and feeling your breasts for any changes. Regular checks will help you get to know your own breasts and what is normal for you, meaning that changes are likely to be identified sooner. It is recommended that you check your breasts once a month, a few days after your period ends. A full description of how to do this is beyond the scope of this article, but if you are unsure of how to do this contact your local GP and they can show you.

Lifestyle

Eating a healthy diet and maintaining a normal weight for your height is important, especially following menopause. It is also helpful to stop smoking and cut down on alcohol. Regular exercise can help, as research has linked regular moderate physical activity with a reduced risk of developing cancer. You cannot control many of your risk factors for breast cancer, such as your gender or your age, so it’s good to focus on the ones you can make a difference to, and all of these changes are great for your overall health as well!

Breast Screening

Breast Screening means taking a mammogram (X-ray) of your breast to look for any abnormalities. The NHS breast screening programme invites eligible women aged between 50 and 70 to undergo a mammogram every three years. In the meantime, if you are worried about changes, go and see your GP – don’t wait to be invited for screening, as early diagnosis is key to a good outcome.

What treatments are available for Breast Cancer?

Surgery

If you are diagnosed with breast cancer, the treatment you will receive will depend on the stage of the disease. If your cancer is at an early stage, the lump may be surgically removed in a procedure called a Wide Local Excision. Sometimes, removal of the entire breast may be necessary. This is called a mastectomy, and can be followed by reconstruction of the breast if required. The lymph nodes in the area may be sampled or removed during these surgeries.

Radiotherapy

After your surgery, your Doctor may recommend radiotherapy to the breast or underarm to ensure that any remaining abnormal cells are targeted for treatment. Radiotherapy uses high energy x-rays to damage and destroy cancer cells in treatments that are given regularly over a period of time.

Chemotherapy

In some cases, Chemotherapy may be necessary. These are drugs which circulate in the blood and are capable of destroying cancer cells. They can be delivered in many different ways, for example, as tablets, injections, or into a vein. Many can be given on an outpatient basis, but some will require a stay in hospital.

Hormone Therapy

Hormone therapy will be prescribed if your breast cancer is hormone receptor positive. In this type of breast cancer, there are receptors on the cell surface that latch onto the female hormones, which stimulates the cancer cell to grow. Oestrogen receptor positive cancers are common and account for approximately 75% of breast cancers in post-menopausal women and around 50-60% of pre-menopausal women. Testing for hormone receptors is now routinely carried out on any tissue taken during a biopsy or after the operation to remove the breast cancer.

These are common and specialist treatments planned individually for you by your doctor. Each aims to stop the spread of cancer in the body, or if possible remove all cancer from the body. They may be used in combination or separately and can cause side effects. Your doctor will discuss the possible risks and benefits of each type of treatment with you, and answer any questions you may have.

Dr Seth Rankin is founder of London Doctors Clinic

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Dr. Seth Rankin

Dr Seth Rankin, has worked for the NHS since 2004 and is a former Clinical Commissioner. He launched London Doctors Clinic (LDC) in 2014 and is now treating over 3,000 patients per month. The company has practices across nine major commuter hotspots in London including Liverpool Street, Waterloo, Oxford Circus, London Bridge, Victoria, Kings Cross, Paddington, Canary Wharf and Fleet Street. LDC offers tourists, residents and commuters affordable and convenient access to GPs, when patients are finding it difficult getting an appointment with their local doctor. Dr Rankin says “I’m a huge fan of the NHS and there is no doubt it is a world class service. However, thousands of Londoners avoid going to the GP because they are time poor and don’t like to ask for time off work. Our aim is to provide a professional service, similar to those available in many other countries, that is easy to use and is far less potentially time consuming and stressful than a drop-in centre.” Originally from New Zealand, Dr Rankin grew up in Papua New Guinea (his parents were missionaries) and later worked in Australia for a few years before coming to the UK. He says “when I came to London I was struck by how difficult it was to get an appointment with a GP. While the Australian & New Zealand systems are far from perfect, it felt as if there was a doctor on every corner and it was always easy to get an appointment, but in the UK private doctors seemed intrinsically linked to the very wealthy. I felt there was a gap in the market for a new type of affordable GP service that could help Londoners and people visiting the capital, and also ease the burden on the NHS”. Before launching LDC, Dr Rankin already had a reputation as a successful doctorpreneur, representing 23 clinics as an NHS Clinical Commissioner and growing the Wandsworth Medical Centre to over 16,500 patients. He is the also co-founder of London Travel Clinic, which has eight centres in London providing travel vaccines, medications and advice to Londoners.