A Patient Journey for Breast Concerns

Breast cancer is the most common type of cancer in the UK.There are around 60,000 new breast cancer cases each year – this means breast cancer will affect 1 in 8 women during their lifetime. Breast cancer can also occur in men; however, this is rare and of the 60,000 diagnosis around 340 of them will be men. Breast cancer is not one single cancer – there are various different types of breast cancer which affect different parts of the breast. Cancer is also diagnosed at different stages of the disease and can grow at different rates – for this reason treatment will differ from person to person.

Because of how common breast cancer is, women are encouraged 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 changes. 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 and any breast size, so it’s important for all women to check their breasts regularly.

There are various signs and symptoms of breast cancer however it is important to remember that not everyone who experiences these symptoms will have breast cancer;

• The first and usually most notable symptom women will experience is a lump or a thickened (harder feeling) area of skin, this could be on either breast or under your armpit.
• A change in the shape or size of one breast.
• A redness or rash on the breast and/or around the nipple.
• A change in the texture of the skin (for example dimpling effect like that seen on an orange peel).
• Discharge (a liquid) which comes from your nipple (without it being squeezed).
• The nipple becoming inverted (pulled into the breast).

If you notice any changes in your breasts, make an appointment to speak with your GP as soon as you can.

The 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, however, that only a quarter of women called back for further testing are diagnosed with cancer.

It’s also important to remember that 90% of lumps are not cancerous, and there are often other explanations for these other symptoms, but it is best to let your doctor check and ease your concerns.

What will happen when I see my doctor?

Your doctor will ask you about your symptoms – if you have found a lump, for example, you will be asked how long ago you noticed it. Your doctor 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; if your doctor feels it necessary 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, 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 may be taken (a small sample of tissue cells taken from the body) to test the cells for cancer.

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.

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 plan. The types of treatment available include;

• Surgery - either to remove the cancerous lump (lumpectomy) or to remove the breast or breasts (mastectomy). Surgery may also be carried out if the cancer has spread or if you decide on reconstructive surgery in order to rebuild a breast shape with which you are comfortable.
• Radiotherapy - 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 therapy - can be used to block the effect of oestrogen on the cancer cells.
• Biological therapy - a group of drugs that block the growth and spread of cancer.

Treatment will depend on the stage and grade of cancer you have (that is, on how big it is and how much it has spread).  Speak to your MDT to understand the types of treatments you are being offered.

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

Sources used in writing this article are available on request.

_{Last revised: 20 October 2016}

_{Next review: 20 October 2022}