Key Facts
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.
Breast cancer also affects men but at less than 1% of the rate in women.
The earlier a diagnosis is made, the better the prognosis.
Treatment for breast cancer can include surgery, radiotherapy, chemotherapy, hormone treatment and, with more recent cases, biological treatments.
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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 is the most common type of breast cancer and develops in the breast milk ducts. Some cancers arise from the milk glands or lobules (lobular cancer).
Paget’s disease is an unusual form of breast cancer that causes a red scaling rash around the nipple. There may also be associated lumps underneath the nipple.
Note - Ductal carcinoma in situ is not the same as ductal cancer, as it is not an invasive form of cancer, but is regarded as being a pre-cancerous condition.
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Causes of Breast Cancer
Most breast cancers occur in post-menopausal women.
The following factors increase the risk of developing breast cancer:
- a strong family history of breast cancer
- not having children or having children later in life
- excessive use of hormone replacement therapy
- having used the older forms of the oral contraceptive pill (however, this risk recedes 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 reduce the statistical risk of developing breast cancer. However, the impact in terms of prevention is very limited.
More important in the battle against breast cancer is the awareness that breast lumps, discharge from the nipple and any tethering of the skin may be signs of the cancer. Earlier diagnosis improves prognosis.
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Common Symptoms
The common symptoms of breast cancer include:
- A lump or lumps in the breast
- Discharge from the nipple
- The development of an inverted nipple
- Tethering of the skin
- Any unusual appearance of the breast
- Breast discomfort
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Diagnostic Tests
Mammograms are special x-ray examinations of the breast that have been used to detect early breast cancer for about 30 years.
The use of mammograms in the earlier diagnosis of breast cancer has reduced the number of women dying from breast cancer by 35% in women over the age of 50. For women between the ages of 40 and 50, they have reduced the risk of dying from breast cancer by over 25%.
Biopsy samples from suspicious areas of the breast are examined under a microscope to make a firm diagnosis.
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Treatment
Surgery
Surgery is the first line treatment for breast cancer - frequently followed or combined with radiotherapy, chemotherapy, hormone therapy and biological treatments.
Breast conserving surgery (sometimes called a lumpectomy) is frequently chosen rather than total removal of the breast (a 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, providing radiation directly to the area around the tumour.
Hormone treatment
Hormone treatment (using tamoxifen) blocks oestrogen that can stimulate breast cancers to grow. Tamoxifen has been used for more than 30 years to treat breast cancer in women and men at all stages of the disease. It helps prevent treated breast cancer from returning as well as preventing new breast cancers from developing. Tamoxifen also slows or stops the growth of breast cancer cells that have spread to other parts of the body.
Chemotherapy
Drugs commonly used to treat breast cancer include: cyclophosphamide, epirubicin, 5-fluorouracil, methotrexate, mitomycin, mitoxantrone, doxorubicin, docetaxel and some others.
Biological treatment - monoclonal antibodies
Trastuzumab, a monoclonal antibody, which is made outside the body is 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. Trastuzumab binds to the HER-2 receptors stopping cell growth and division. This adds to the effects of other anti-cncer tretments including chemotherapy. The most common side effect up to now is a decrease of 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 screening mammography.
- 70% of patients with DCIS will have a recurrence or develop cancer if not treated with radiotherapy after a biopsy.
- The use of 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
- The use of shorter courses of radiotherapy with lower total doses. Trials suggest that radiotherapy treatments using lower doses are 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
- The optimal sequence of radiotherapy and other treatments after surgery.
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