Breast cancer deaths in the UK average 12,400 a year, with more than 44,600 new cases of breast cancer diagnosed annually⁽¹⁾. Eight out of 10 breast cancers ⁽²⁾ are found in women aged 50 years or over. Younger women are at less risk, with approximately 8,600 women under 50 diagnosed every year, 1,500 of whom are aged between 35 and 39. The risk is even smaller in men, with 300 or so male breast cancers diagnosed each year ⁽³⁾.

Despite these facts, breast cancer survival rates are improving thanks to the national screening programme, which is detecting potential breast cancers earlier. Improvements in drugs and other treatments are also having an impact.

Since 1990, breast cancer deaths have fallen by 18 per cent ⁽⁴⁾. It is, however, still the third biggest cause of death from cancer, after lung cancer and bowel cancer.

Public education concerning breast cancer is also thought to be behind the recent improvements in mortality rates.

What factors can influence the risk of getting breast cancer?

• Age - as with many other diseases, the older you are, the greater your risk becomes
• Previous diagnosis of breast cancer - if you have had breast cancer before, your risk of getting it again increases, although drug treatments, such as Tamoxifen, are helping to lower that risk
• Genetic causes - some breast cancer cases are thought to be genetic, which means your risk of getting breast cancer will be greater than that of the general population if one or more close relatives from the same side of your family have had the disease. If you have breast cancer in your family, you can download information ⁽⁵⁾ from the National Institute for Health and Clinical Excellence (NICE)

Other risk factors for breast cancer include:

• Having a non-cancerous (benign) breast disease in the past
• Starting your periods early (11 years old or younger) and finishing having periods late (54 years or older)
• Not having breastfed or had children, or if you had your first child late in life
• Being overweight after having the menopause
• Taking the contraceptive pill and hormone replacement therapy (HRT) may also increase your risk slightly
• Being a moderate or heavy drinker of alcohol
• Exposure to high amounts of radiation, including radiotherapy treatment to the chest for Hodgkin's lymphoma

How many different types of breast cancer are there?

1. Invasive ductal breast cancer (ductal carcinoma) is the most common type of breast cancer, accounting for up to 85 per cent of cases ⁽⁶⁾. It is not the same as ductal carcinoma in situ (DCIS), as ductal carcinoma cancer cells are found in the lining of the milk ducts in the breast
2. Invasive lobular breast cancer is less common than invasive ductal breast cancer, and is found in around 15 per cent of cases ⁽⁶⁾. In this form, cancer cells are found in the lining of the breast lobes
3. Ductal carcinoma in situ (DCIS) is an early stage of breast cancer where cancer cells are found in the ducts of the breast. In DCIS there is a small chance that the breast cancer has spread to the lymph nodes (glands in the armpits) or to other parts of the body
4. Lobular carcinoma in situ (LCIS) is regarded as a benign (non-cancerous) condition where cell changes are found inside the lobes of the breast. If you are diagnosed with LCIS, you could have a higher risk of developing breast cancer later on
5. There are less common types of breast cancer, including inflammatory breast cancer, where the breast becomes red, swollen and sometimes painful to touch, and Paget's disease, which can begin as a rash on and around the nipple

What signs do I need to look out for?

While most women realise that a breast lump could be a sign of cancer, there are other signs and symptoms to watch out for:

• Changes in the size or shape of the breast
• Rash on or around the nipple
• Changes in the shape of the nipple (including an inverted nipple)
• Changes in the breast, such as puckering or dimpling of the skin
• Lumps or swellings in the armpits
• Blood-stained discharge from the nipple

What is breast awareness?

Examining your breasts ⁽⁷⁾ is important, so you get used to their size, shape and texture. Knowing what your breasts are like is very important, as you will notice anything unusual. You may, for example, notice more lumpiness around the time of your period, but this can be completely normal.

What do I do if I find a lump?

Nine out of 10 breast lumps are non-cancerous (benign) ⁽⁸⁾, so there is no need to panic. If you find a strange lump or notice a change in your breast, discuss it with your doctor as soon as you can.

Your doctor will examine your breasts and may send you to your local breast assessment clinic, where you will be seen by a specialist and, if necessary, have further tests.

UK guidelines recommend that if you are considered an urgent case, you should get an appointment with a specialist within two weeks of seeing your GP.

One of the tests to detect breast cancer is called a mammogram, which is an X-ray of the breasts. The breast is compressed between two plates, which can be slightly uncomfortable, but should not be painful.

If you are younger, you may have an ultrasound test instead, as this may give clearer results than mammography. Younger breast tissue is denser and X-rays may not show enough detail.

Another way to test for breast cancer is a biopsy - where cell or tissue samples are removed from your breast and examined under a microscope. Another way to extract tissue or fluid is fine needle aspiration, where cells from a lump are extracted for assessment.

At what age does breast screening start?

All women in the UK aged between 50 and 70 are eligible for breast cancer screening. You can have one mammogram every three years. If you are 70 year old or more, you can still have them every three years on request. By 2012, the NHS aims to screen even more women by extending the age range to 47 to 73 ⁽⁹⁾.

If you are at high risk of developing breast cancer, you can ask your doctor if you can be screened earlier than 50 years of age. Again, as breast tissue is denser in younger women, a mammogram may not be a suitable detection method.

To find out more about the national breast cancer screening programme, visit Cancer Screening.

What are the treatments for breast cancer?

Any breast cancer treatment will be different according to the size and stage of the cancer, and if it has spread to other parts of the body.

The main treatments include the following:

• Surgery to remove the lump (lumpectomy) or the whole breast (mastectomy), although this is performed less often these days
• Chemotherapy is the use of drugs to kill cancer cells and is administered before or after surgery to reduce the size of the cancer or to reduce the chances of it returning
• Radiotherapy will kill cancer cells with radiation and normally follows surgery to reduce the risk of the cancer returning in the treated breast and/or lymph nodes
• Biological therapy is a newer treatment that uses biologic drugs, such as Herceptin®. The drugs are used in cases of early breast cancer, where there are high levels of a protein called HER2
• Hormone therapy using the marketed drugs Tamoxifen® or Arimidex® can also be used to shrink the cancer

How likely am I to recover from breast cancer?

The likely outcome of your breast cancer and its treatment (prognosis) depends on how early your cancer was detected.

The estimated relative five-year survival rate for women diagnosed in England and Wales in 2001-2003 was 80 per cent ⁽¹⁰⁾, compared with only 52 per cent for women diagnosed in 1971-1975.

The estimated relative twenty year survival rate for women with breast cancer increased from 44 per cent in the early 1990s to 64 per cent ⁽¹⁰⁾ in 2003 and continues to increase, as newer treatments become available.

Women diagnosed with breast cancer at the earliest stages have a nine in 10 ⁽¹¹⁾ chance of beating the disease. If breast cancer is advanced when the doctor diagnoses it, less than two in 10 ⁽¹¹⁾ women will survive.

How can I reduce my risk of getting breast cancer?

There are several ways that you can help yourself and reduce your risk of developing breast cancer:

• Examine your own breasts regularly. Get used to how they look and feel. If you notice a hard lump that you cannot get under or move about, go to your doctor
• Change your diet. Research suggests that more than a quarter ⁽¹²⁾ of cancers could be prevented if people ate more fruit, vegetables and fibre-rich foods. Avoid sugars, processed foods and too much saturated fat
• Avoid becoming overweight or obese. Being overweight is associated with a higher risk of breast cancer in post-menopausal women
• Breastfeed your baby. Statistics show that breastfeeding may reduce your risk. The longer you breastfeed, the lower your risk of breast cancer

Drink alcohol sensibly. Do not exceed current recommendations (two units of alcohol a day for women and three for men, where a unit is a small glass of wine).

Infolinks:

• Action Against Breast Cancer
• Breakthrough Breast Cancer
• Breast Cancer Care
• Cancer Help (Cancer Research UK)
• Cancer Backup
• Macmillan Cancer Support
• Marie Curie Cancer Care