Breasts change as you age and it is normal to experience some changes during your menstrual cycle. However, some breast changes may be early signs of breast cancer. These include:
• a lump in your breast
• thickening of the tissue or dimpling of the skin covering your breast
• a lump or swelling in either armpit
• a change in the shape or size of your breast
• your nipple turning in (inverted nipple, unless the nipple has always been turned in)
• a rash on a nipple
• discharge or bleeding from one nipple
• pain or discomfort in your breast that does not go away.
Although these changes do not necessarily mean you have breast cancer, any breast change should be checked by your GP.
Diagnosing breast cancer
If you have noticed any changes in your breast you will usually see your GP first. They will talk to you about your symptoms, examine your breasts and ask you about your family history of cancer.
If your GP is concerned that your symptoms may be signs of breast cancer, they will recommend further tests (mammogram or ultrasound) to be done or you may be referred directly to a breast cancer specialist.
If breast changes are noticed on your routine breast screening mammogram, your BreastScreen Aotearoa provider will arrange for further tests to be done or refer you to a breast cancer specialist.
A mammogram is an X-ray of your breast which uses a low dose of radiation. The dose of radiation used is very small and highly unlikely to be harmful. It will give your doctor more information about any lump or other changes noticed.
An ultrasound uses sound waves to show a picture of the breast tissue. It can show if a lump is solid (made of cells) or if it is a fluid-filled cyst. It can also show whether a solid lump is regular or irregular in shape.
An MRI scan uses magnetism to build up detailed pictures of your breast. The MRI scan may show areas that your doctor would like to take a closer look at. Some people may have a second ultrasound and biopsy after the MRI. MRIs are more often used for younger people or those with lobular breast cancer.
A biopsy removes small samples of tissue from your breast where changes were seen. Depending on the procedure, you will be given either a general or a local anaesthetic to help manage any pain. Some people find this procedure difficult and may experience more pain than others. Talk to your treatment team before the procedure about any concerns you may have.
“ If I was more prepared for my biopsy, I wouldhave asked for an anaesthetic or more pain reliefbut I was told it was going to be only mildlyuncomfortable.”Victoria
Tissue samples are looked at under a microscope to see if there are any cancer cells present. If cancer cells are seen in your biopsy sample, the information will help your treatment team to learn more about the type of breast cancer you have.
There are a number of ways to take a biopsy and you may need more than one type of biopsy.
Fine needle aspiration: A very thin needle is placed into the lump and some cells are removed with a syringe.
Core biopsy: A needle is used to remove a piece of tissue from the lump or area of abnormal tissue.
Vacuum-assisted biopsy: A small cut is made in your breast and a needle is put into the lump. The needle is attached to a suction device that gently removes a small piece of breast tissue.
Surgical biopsy A cut is made in your skin and the lump or abnormal tissue is removed. This is usually done under general anaesthetic.
Hook wire biopsy If your doctor cannot feel your lump, a fine guide wire may be inserted into your breast to mark the area of breast to be removed. The tissue is then removed under general anaesthetic.
If breast cancer is found
If any tests you have had confirmation that you have breast cancer, one or further tests may be done to learn what type of breast cancer you have. These tests will help you and your treatment team decide what treatment options will be best for you.
Hormone receptor tests
Hormone receptor tests will be done on the breast tissue that was removed. These tests show whether the cancer cells have hormone receptors on them. If these are present, the cancer is described as ‘hormone receptor positive’. This means the hormones oestrogen and/ or progesterone may increase the growth of your breast cancer. These cancers are more likely to respond to hormone treatment (sometimes called endocrine treatment).
HER2 is a growth factor protein that tells breast cancer cells to grow. Approximately one in five breast cancers makes too much of this protein, which means that the cancer is more aggressive. This is often called HER2 positive breast cancer.Two tests are available to check HER2–IHC and FISH. IHC is used first and if it is not a clear result then the FISH test is used.
If tests show that you have HER2 positive cancer, this will influence future choices of chemotherapy, hormones, or monoclonal antibodies. The most commonly used monoclonal antibody drug is called trastuzumab (Herceptin) which targets the growth factor protein.
A diagnosis of breast cancer
There are different types of breast cancer. Knowing the type of cancer you have helps your doctor to plan the best treatment for you. Breast cancer is usually divided into two types:
• ductal carcinoma in situ (DCIS) – DCIS means that there are cancer cells contained within the milk ducts of the breast but they have not spread in to any of the other breast tissue
• invasive breast cancer – invasive breast cancer means that cancer cells have spread from inside the milk ducts (in ductal breast cancer) or lobules (in lobular breast cancer) into the breast tissue and nearby lymph nodes. Invasive breast cancer that has spread to other parts of your body is called advanced, secondary or metastatic cancer.
A diagnosis of breast cancer can be very stressful, see the pages on support for information that you may find helpful.
Questions you may wish to ask about your diagnosis
You may want to ask your treatment team some questions about:
• the stage and grade of your cancer
• if your cancer is curable
• other tests you might need before treatment starts
• the treatment advised for your cancer
• what side effects to expect from treatments.