Overview
Breast cancer is the most common cancer across Europe.
Over 80% of women with breast cancer are over 50 years old when diagnosed and 50% are over 60 years old.
The earlier the diagnosis is made the better the prognosis.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new breast cancer cases (women only, 2006) |
429,900 |
| |
328,600 (EEA) |
| |
319,000 (EU25) |
| Number of breast cancer deaths (women only, 2006) |
131,900 |
| |
87,200 (EEA) |
| |
85,300 (EU25) |
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Cancer Types
Ductal Cancer - the most common breast cancer and begins in the breast milk ducts. Some breast cancers develop in the milk glands of breast lobules (Lobular cancer).
Pagets's disease - an unusual form of breast cancer that causes a red scaling rash around the nipple. There may be associated lumps underneath the nipple.
NB. Ductal carcinoma in situ is not the same as ductal cancer, as it is not an invasive form of cancer. Instead, it is regarded as being a pre-cancerous condition.
Causes of Breast Cancer
Most breast cancers occur in postmenopausal women.
The following factors increase the risk of developing cancer:
- a strong family history of breast cancer
- not having children or having children late in life
- excessive use of hormone replacement therapy
- having used the older forms of the oral contraceptive pill (however, the risk of developing breast cancer, because of previously using such contraception, decreases with time)
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Prevention of Breast Cancer
In most cases of breast cancer there are no obvious risk factors.
Reducing obesity, consuming alcohol in moderation only and avoiding prolonged use of hormone replacement therapy all reduce the statistical risk but the impact in terms of prevention is very limited.
More important is patient awareness that breast lumps, discharge from the nipple and any tethering of the skin may be signs of breast cancer. An earlier diagnosis improves prognosis.
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Common Symptoms
- A lump or lumps in the breast
- Discharge from the nipple
- Developing an inverted nipple
- Tethering of the skin
- Any unusual appearance of the breast
- Breast discomfort
Diagnostic Tests
Mammograms are special X-ray examinations of the breast, which have been available to detect early breast cancer for about 30 years.
The use of mammograms in the earlier diagnosis of breast cancer have reduced the number of women dying from breast cancer by 35% in women over the age of 50 and for women between the ages of 40 and 50, they have reduced the risk of dying from breast cancer by over 25%.
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Prognosis
Many factors affect prognosis. These include the stage of cancer, its histological appearance, and the patient's age, general health and their individual response to treatment (which will vary). For this reason, statistics can only be considered as a general guide as they are produced by grouping together patients in whom these factors are similar but not identical. These figures are historical (often covering a 10 or 20 years period) and so do not reflect improvements in survival through modern treatment.
Survival rates indicate the percentage of people who survive the disease for a specific period of time after their diagnosis - usually 5 or 10 years. They will also include patients who are free of the disease, or still undergoing treatment.
In early breast cancer, i.e. with cancers that are less than 2 cm in diameter and with no lymph node involvement, up to 90% of patients will live 10 years or more after diagnosis.
For larger cancers and cancers that have spread to nearby lymph nodes, the results are still good with up to 75% of patients living for 10 years or more after diagnosis.
For patients whose breast cancer has spread to other areas of the body the results are less favourable - 20% of patients live for 5 years or more after diagnosis.
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Treatment
Surgery
The first line of treatment for breast cancer. It is frequently followed or combined with radiotherapy, chemotherapy and other treatments.
Breast conserving surgery (sometimes called a lumpectomy) is more frequently the chosen procedure rather than total removal of the breast (mastectomy).
Radiotherapy
Radiotherapy is used in conjunction with surgery and reduces the risk of the cancer recurring. Radiotherapy can be given in a number of ways:
- External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department.
- Intra-operative radiotherapy treatment is now recommended in some centres as an alternative to 6-7 week courses of radiotherapy after surgery. It is used in the treatment of early stage breast cancer.
- Brachytherapy is a form of radiotherapy where radioactive sources are placed into the breast tissue itself, thus providing radiation directly to the area around the tumour.
Biological treatment - monoclonal antibodies
Trastuzamab is a monoclonal antibody which is made outside the body and capable of detecting and attaching to receptors on cancer cells. It works in a different way from usual cancer therapy, such as chemotherapy or hormone therapies. It binds to the HER-2 receptors stopping growth and cell division. This adds to the effects of other anti-cancer treatments including chemotherapy. The most common side effect up to now is a decrease in heart function, which is usually partially reversible at least.
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Key Trends
Ductal Carcinoma In Situ (DCIS) is diagnosed more frequently with mammographic screening.
70% of patients with DCIS will have a recurrence, or develop cancer, if not treated with radiotherapy after a biopsy.
Breast Conserving Surgery (BCS) is increasing and is now the treatment of choice for 80% of all breast cancer patients.
Radiotherapy after surgery reduces recurrence rates.
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Current Developments
There is now interest in the use of shorter courses of radiotherapy with lower total doses. Trials suggest that radiotherapy treatments using lower doses are equally effective, and have fewer adverse effects.
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Important Research Areas
Improving the delivery of lower doses to reduce side effects whilst providing the same level of protection against recurrence of the cancer.
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Unresolved Questions
What is the optimal sequence of radiotherapy and other treatments after surgery?
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