BREAST cancer might be the UK’s most common form of cancer but more than eight out of 10 women diagnosed with it will be cured thanks to the wide range of treatments available.
Our bodies are made up of billions of cells which multiply as they are needed. Cancer is formed when these cells start to increase uncontrollably. The reasons for this aren’t fully understood but breast cancer risk factors include age, a family history of the disease, being overweight and the amount of alcohol individuals consume.
Symptoms include a lump or pain in the breast or armpits, changes in size or shape of the breasts and nipple discharge.
No matter what stage the cancer is at it is important to know your treatment options.
The oldest type of treatment for breast cancer, surgery is the cornerstone for tackling the disease. It involves having an operation to take away the primary tumour in the breast.
Today a lumpectomy, where the cancer is removed rather than the entire breast (a mastectomy), can be performed. In a quadrantectomy the cancer is taken away with about a quarter of the surrounding breast.
The last decade has seen the development of the sentinel node biopsy where a special dye is injected into the skin around the cancer to locate the axillary lymph node – part of the system of glands in the armpit – nearest the tumour.
This is the sentinel lymph node and is removed. If it shows no signs of cancer it indicates the other nodes are unaffected and so no further surgery is needed. If the gland shows evidence of cancer, however, a further operation will be required to clear the axillary lymph nodes.
If you have a mastectomy you often won’t need radiotherapy after the surgery whereas a lumpectomy or quadrantectomy is almost always followed by radiotherapy to minimise the risk of cancer returning in the remaining tissue.
Radiotherapy uses ionising radiation to kill cancer cells.
When given after surgery for early breast cancer the machine used is usually a linear accelerator (Linac), which produces very high energy X-rays which destroy cancer cells.
Like surgery, this is a local treatment that affects only one part of the body. A major US clinical trial over 25 years showed that women who had undergone radiotherapy following a lumpectomy had a greatly-reduced chance of the cancer returning in the same breast.
Radiotherapy after surgery used to involve five days of treatment weekly over a period of six or seven weeks but new research shows shorter courses, with as few as 15 treatments over three weeks, are as effective. There is still a lot of variation depending on the oncologist. Some will recommend 15 radiotherapy treatments while others can advise up to 30.
The use of cytotoxic drugs for early breast cancer has done more than anything over the past 30 years to boost the chance of a cure.
In 1970 if a woman was told she had early breast cancer she had a 50 per cent chance of surviving five years. Now that figure is approaching 90 per cent and rising.
Along with the use of hormonal treatments, cytotoxic drugs have been the main reason for this huge improvement. These drugs work by interfering with the process of cell division. Unfortunately they cannot tell the difference between cancerous and normal cells so both are damaged during treatment causing side effects such as hair loss, nausea and a large decrease in the number of white blood cells, the body’s main defence system.
Cytotoxic therapy is given intermittently as the intervals allow normal cells to recover. It is usually delivered via a drip but can be given as capsules or tablets. In early breast cancer four to eight cycles of treatment are usually given over four or six months.
Hormone therapies Most breast cancers carry oestrogen receptors. These ER+ tumours rely on the hormone to stimulate growth.
Hormone therapy is effective at reducing oestrogen in the bloodstream or interfering with the receptor so oestrogen no longer bonds to it.
Tamoxifen tablets taken once a day after surgery are the most commonly used drugs to work this way.
The drug is effective with pre and post-menopausal women but there are risks. About one in 500 women on tamoxifen for more than two years is at risk of developing a cancer of the womb so any unusual vaginal bleeding should be reported at once to doctors.
Some women can also experience menopausal symptoms.
Other effects include severe hot flushes, vaginal dryness, loss of sex drive, mood swings, memory problems and loss of concentration.
The drugs are taken for five years so changing the brand or taking it at a different time of day can reduce symptoms.