Breast cancer

[Doc Alan]

Breast cancer is the commonest in the UK and Philippines. Most ( 4/5 ) are over the age of 50. As at least 1/9 women will develop the cancer at some stage in their life, it’s likely we all have experience of it, directly or indirectly ( and it does occasionally affect men ).


There are several different types – either non-invasive or invasive. It’s the ability to invade breast tissues and beyond – either directly or through lymphatics / blood vessels - which determines the outlook.


If there are symptoms, the first to be noticed is usually a lump. Remember that most lumps are NOT cancer, especially in younger women.


There are risk factors – but none of these are certainties and there’s an element of luck. Family history may be the result of chance, or ( in up to 10% ) be due to “ faulty “ genes – such as BRCA1 ( Angelina Jolie has this ) or BRCA2. Others include some benign lumps, dense breast tissue, hormones ( especially oestrogen levels ), obesity, and alcohol. Cosmetic implants may delay diagnosis ( but not cause cancer ).


Apart from breast self examination, diagnosis may be made by clinical breast examination, mammogram, ultrasound, and biopsy ( a “ needle core “ of tissue examined by microscopy ).


We often talk about “ survival “ rates for cancers – not necessarily the same as “ cure “. In the UK survival rates have been improving for three decades and are now over 80% at 5 years, compared to 75% for Filipinos. About 2/3 survive 20 years in the UK, whereas a smaller number even survive 10 years in the Philippines ( overall perhaps only 40% ).


The outlook for breast cancer depends on how early or advanced it is ( stage ) at diagnosis, and also microscopic type. Early diagnosis is vital ! In the UK there is an established breast screening programme for women aged 50-70 years ( 47-73 by 2016 ). The system is not perfect – there is concern about over-diagnosis ( non life-threatening cancers ), and of course its cost ( about £ 100 million / year ). Screening simply isn’t widely available in the Philippines, although awareness has recently improved with at least some treatment benefits payable by PhilHealth. Late diagnosis and cost of effective ( not “ alternative “ ) treatment are major reasons for less good survival.


Genetic testing provides an estimate of risk – not diagnosis of existing – breast cancer. In the UK there are 35 testing centres, and it’s expected that women will be offered testing if, depending on factors such as family history, they are thought to have a 10% probability of carrying faulty ( BRCA1 or 2 ) genes. The centres may become overwhelmed by increasing demand … but such testing is in any case beyond reach of the vast majority in the Philippines.


The option of removal of both breasts ( and possibly also ovaries ) is not the only one. Even with a family history, “ faulty genes “ may not be present and each woman needs medical appraisal and counselling BEFORE testing. There are other, less drastic options. These include more frequent screening ( mammography and MRI or magnetic resonance imaging ). A recent study published in the Lancet suggests that drugs such as “ Tamoxifen “ ( a “ selective oestrogen receptor modulator ) could be helpful in preventing breast cancer in women thought to be at increased risk. A decision is expected this year whether this should be available on the NHS.


ALL patients referred to hospital breast cancer units in the UK are discussed – confidentially – in multidisciplinary team meetings. This provides the best treatment for each individual, including choice of drugs, surgery, and radiotherapy. Risk assessment and “ survival statistics “ are not absolute. Just as there are different types of breast cancer, so also each patient is unique and deserves respect .


http://www.nhs.uk/Conditions/Cancer-...roduction.aspx

http://www.philstar.com/health-and-f...-breast-cancer

http://www.abante.com.ph/issue/oct18...m#.UZOSjrWG1FY

http://opinion.inquirer.net/37470/curing-breast-cancer

[raynaputi]

Great post Doc!

[Doc Alan]

Great post Doc!

Thanks Rayna

[Arthur Little]

... Yet ANOTHER excellent thread, Alan ... one that is, as always, well~thought out and particularly timely - in the wake
of the film star, Angelina Jolie's fears and resultant mastectomy.

There isn't a great deal that I, personally, can add to what you have already explained so expertly as regards the diagnosis, treatment and ultimate prognosis of this all~too~prevelant disease and its consequent, highly~emotive impact globally. But, far from wishing to appear in any way morbid, I would earnestly hope and that each and every one of the ladies on our forum will very carefully.

Therefore, for that reason, I've taken the liberty of making this article of yours a 'Sticky' in the hope it will, in turn, receive the attention it truly deserves.

[sars_notd_virus]

Very excellent thread ..thanks doc

Breast cancer is the commonest in the UK and Philippines. Most ( 4/5 ) are over the age of 50. As at least 1/9 women will develop the cancer at some stage in their life, it’s likely we all have experience of it, directly or indirectly ( and it does occasionally affect men ).

...yes it can also affect men, here's the link:

http://www.cancerresearchuk.org/canc...-cancer-in-men

[Steve.r]

Brilliant Alan as ever. Can I ask, how cases differ if a woman has had more children? Specially like in the Philippines where the average number of children is (generally) higher than that of the UK and if breast feeding is beneficial to reduce the occurrence of breast cancer? I think you will know what I am getting at.

[Doc Alan]

Thank you Arthur, Mari and Steve .


It is a serious topic, and a celebrity like Angelina Jolie certainly raises awareness – even for a limited time.


It’s also important to be positive – 8 out of 9 women in the UK, and 9 out of 10 in the Philippines will NOT get breast cancer in their lifetime ; and the outlook IS improving.


Further, most women with one affected close relative will NOT get this cancer ; while most who ARE unlucky don’t have a positive family history.


We don’t fully understand the causes. Hormones – especially oestrogen – are important. In answer to Steve’s question, not having children ( or having them later in life ) could slightly increase the risk ; similarly breast feeding ( commoner in the Philippines ) is thought to decrease risk. There may of course be other health risks in having too many children.


Apart from preventive removal of her breasts, Angelina now has to contend with the increased risk of ovarian cancer. Surgical removal is the “ definitive “ answer, but there are other options for some women ( sterilisation, contraceptive pill ).


Luckily ovarian cancer is FAR less common than breast cancer, in both countries. A UK GP may see only one patient with this cancer in a working lifetime. Screening ( by ultrasound imaging and a “ CA125 “ blood test ) are not completely reliable and symptoms of advanced cancer are often vague. But – as with breast – most ovarian tumours are benign ( not cancer ), especially in younger women where size does matter ( large tumours may not be cancerous ).

[Rosie1958]

Thank you so much Doc Alan for raising awareness of such an important topic. I lost an aunt to breast cancer at the age of 52 and also a friend who was only 42. Two of my staff also have wives suffering from breast cancer at the moment too, one of whom has had chemotherapy, radiotherapy and a double mastectomy with reconstruction recently and now appears in remission

[Doc Alan]

Thank you Rosie .

It’s important to stay positive on the topic of cancer. While rising life expectancy is leading to more people having cancer, improved treatments mean that a larger proportion are cured, or at least survive long term .


There is further good news in that the US Supreme Court recently ruled that human genes cannot be patented. This should allow clinical laboratories to perform the tests for BRCA1 and BRCA2 more cheaply, and guidelines governing tests on the NHS could be relaxed.


Prostate cancer may affect a similar proportion of males to that of females developing breast cancer. Members may therefore be interested in a new separate thread on this topic.

[Doc Alan]

There is now a new patient advice leaflet to be circulated with invitations for NHS breast screening. It’s not an easy decision whether to attend for breast screening for those living in the UK – and even harder in the Philippines where you have to pay.


The leaflet aims to help in that decision.


It explains breast cancer as I have already tried to do in this thread. Screening uses an X-ray test called a mammogram – the whole appointment at the breast screening unit should take under half an hour.


A letter is sent to the woman, and to her GP, with the result, within 2 weeks of the appointment. Almost all are normal. Of the 4 in every 100 asked to come back for more tests, 1 will have cancer. These tests include clinical examination, possible repeat mammogram, ultrasound scan, and a needle ( core ) biopsy for microscopy.
1 in 5 of these cancers is non-invasive ( confined to the breast ducts ) ; 4/5 are invading adjacent tissue.


In the UK ALL women diagnosed with breast cancer ( or non-cancerous lumps ) are discussed by a team of specialists. Treatment may include surgery ( " wide local excision " or mastectomy ), hormone / drug treatment, and radiotherapy. These may have long term side effects.


Screening is thought to save 1 life from cancer for every 200 screened ( 1,300 / year in the UK ). The problem is that for every woman who has her life saved, around 3 are diagnosed with a cancer that would not have been life-threatening. However, already we may have a good idea ( from size and " grade " as judged microscopically ) which are more, or less, " aggressive ".


Apart from the worries an abnormality may cause the woman, they should be reassured that X-rays themselves very rarely cause cancer ; and screening rarely misses cancer.


My opinion ? Screening is still worthwhile, but for those invited for screening, read the new leaflet, then discuss with your GP .



http://www.cancerscreening.nhs.uk/br...ons/nhsbsp.pdf

[Doc Alan]

Breast cancer is in the headlines again this week. A trial of 4000 postmenopausal women at “ high risk “ ( family history / certain types of non-cancerous breast disease ) has found a drug can halve the development of cancer.


The drug ( anastrozole ) reduces oestrogen production ( which fuels the growth of most breast cancers ). It’s actually cheap, as it’s no longer patented. It’s also more effective, with less side effects, than similar drugs ( like tamoxifen ). However, its benefit would only apply to the fifth or so women at higher risk. Removal of breasts is still the likely option for those at very high risk ( with gene mutations ).


As with so many conditions, lifestyle factors are important in prevention of this cancer ( risks include less physical activity, obesity, alcohol intake, later age at first childbirth, and reduced breast feeding ).


http://www.bbc.co.uk/news/health-25346638


Although numbers of breast cancers are increasing, partly because we’re living longer, “ five year survival rates “ after diagnosis do keep improving - over 80% in the UK, but still less good in the Philippines.

.

In fact, the Philippines appears to have a high incidence of breast cancer compared to other Asian countries like China, Malaysia and Indonesia.



Both patients and surgeons in the Philippines still prefer breast removal ( mastectomy ) for this cancer, rather than “ breast conservation “ ( favoured in the UK ) as surgical treatment. The Philippines has the highest mastectomy rate in Asia and one of the lowest breast conservation rates.

Reasons given include financial constraints, fear of cancer recurrence, fear of and lack of time and resources for radiotherapy, distance from radiotherapy centres and lack of information about breast-conserving options.


http://www.gmanetwork.com/news/story...r-rate-in-asia


http://www.nhs.uk/Conditions/Cancer-...Treatment.aspx

[jm8012741]

Nice post shared. Thanks

[Doc Alan]

There will be a documentary on BBC3 tonight ( 26 March, 9 pm ), and later on BBC iPlayer, which tells the story of Kris Hallenga, who was diagnosed with late-stage breast cancer at the age of 23 ( “ Kris – Dying to Live “ ). A month after her diagnosis, she set up a charity, “ CoppaFeel ! “, with her twin sister, to help raise awareness about early diagnosis of this cancer. This brave young lady doesn’t want to be described as “ fighting “, “ suffering “, or “ battling “ - she would rather be known as “ simply living “ .



It’s VITAL to remember that the chance of developing this cancer before the age of 30 is VERY low ! The risk increases with age – it most commonly affects women over the age of 50.


Breast screening remains controversial, but its aim is to detect this cancer at an early stage before symptoms or signs develop, in the age group most at risk. It’s thought that if it could be introduced to countries such as the Philippines, the outlook would much improve.


Neither the UK nor any other country starts screening at a young age. There aren’t the resources ; interpretation of “ abnormalities “ is more difficult ; and there are risks of over-treatment ; not to mention the worry for all concerned. Even if one or more breast lumps ARE present, the vast majority in young age groups are benign / not cancer .


At ANY age, however, it’s worth remembering signs / symptoms which should be investigated :-


• Lump or thickening in breast
• Swelling or lump in armpit or near collar bone
• Discharge from nipple
• Change in shape or size of breast
• Change in the shape of the nipple
• Rash on nipple or nearby area
• Changes to skin on the breast such as “ dimpling “
• Pain in breast / armpit



http://www.bbc.co.uk/programmes/b03zf3tg


http://www.bbc.co.uk/news/health-26728397

[Doc Alan]

The outlook for breast cancers is improving, but it’s still in the top 5 most frequent and serious cancers in the world, the UK and Philippines. As only 1% occur in men, it’s of most direct importance to women, who deserve to be well informed on the topic.


This thread was - but is no longer - " sticky " - not my responsibility !


• For those who do find the topic important, current advice that women be screened every three years between the ages of 50 – 69 ( free on the NHS, not so in the Philippines ) HAS been supported in a recent report. It’s to be hoped that the NHS breast screening advice, last issued a couple of years ago, will soon be updated.


• At first sight, having no screening for cancers would reduce the numbers we diagnose, stop getting better treatment earlier, and result in more deaths. The outlook for breast cancers in the Philippines is less good than in the UK - partly because there is no organized screening, and also more women first attend a doctor when the cancer has already spread.

A balance is needed - it’s realised that screening for breast cancers in particular may not only save lives, but also lead to anxiety and unnecessary treatment in cases where the cancer detected is slow growing and would not have caused harm.


• An international team of experts have carefully studied all aspects of breast cancer screening. The most common way to screen is by mammography. The risks are " false positives ", " over diagnosis " with " over treatment ", and rarely even cancer caused by radiation from the screening process. The working group has concluded there IS a net benefit from inviting women aged 50 – 69 years to receive screening, in countries like the UK ( but it might not be cost-effective in countries like the Philippines with more limited resources ). Screening of women younger than 50 has less convincing net benefits ( not just cost ) ; older than 70 might be helpful.



• Other " imaging techniques " like ultrasound and MRI scanning may help in addition to mammography in certain situations, like women with a family history of breast cancer.


• Of course it’s up to individual women whether or not to be screened, and what treatment they are prepared for if cancer is diagnosed. The outlook not only depends on each individual’s cancer type ( which varies from harmless to aggressive ), but also the stage at which the cancer is diagnosed ( either through screening, or when there are symptoms like a breast lump ).


• At present the advice on screening is in this guide :-


http://www.cancerscreening.nhs.uk/br...ons/ia-02.html


• It may be updated as a result of the expert study :-


http://www.nejm.org/doi/full/10.1056/NEJMsr1504363

[Arthur Little]

Thank you so much, Alan ... for your latest update on this vitally IMPORTANT topic which - in my honest opinion - ALL ladies on the forum ought to "take to heart", bookmark for easy access and read at regular intervals, in order to safeguard their own health and wellbeing.

[Doc Alan]

The outlook for patients with breast cancer continues to improve, especially if it’s diagnosed at an early stage. To surgery, chemotherapy and radiotherapy may be added hormone or " biological " / targeted treatments with antibodies.


There is now hope for new " personalised " treatment - albeit not for another decade - resulting from a new UK study just published in " Nature ", available to read online ( http://bit.ly/1W3qEar ) - also widely reported in the media.


Breast cancers - like other cancers - result from " driver " mutations in cells. The study involved 560 breast cancers ( mostly in women, but including 4 men ). The scientists looked at the DNA of breast tissue samples and were able to find 93 genes ( a few already discovered, such as BRCA ) which, if mutated, could cause breast cancers. These are probably ALL the genes which may mutate to change normal breast tissue into cancer.


Each of these " genetic errors " COULD be exploited by new drugs. Thus in future every breast cancer patient could be given customised treatment - likely to be successful, with a minimum of side effects. It also raises the possibility of cancer-fighting vaccines " designed " for each patient according to the mutations in their individual cancers.


Even better might be a " universal cancer vaccine " which targets antigens that might be shared across cancers. However, affordable prevention ( or a cure ) for all the 200(+) types of cancer affecting human beings is probably a long way into the future. We live in hope .

[Michael Parnham]

There can never be too many updates on the topics you post Alan