Incidence
Breast cancer is the most common cancer in the UK with 1 woman diagnosed every 10 minutes that’s about 55,000 per year and some 400 men. Breast cancer is the second most common cause of death from cancer in women in the UK, with around 11,500 women and some 85 men are dying from breast cancer every year. Breast cancer also affects men, but it’s rare – around 370 men are diagnosed each year. 1 in 7 women in the UK will develop the disease in her lifetime.
In 2023, an estimated 297,790 of new cases of invasive breast cancer were expected to be diagnosed in women in the US (NCI, 2023). Whilst there is limited data for projecting UK cases we can, from these figures expect to see an increase in diagnosis.
The economic model created by Breast Cancer Now (2024) reveals the total cost of breast cancer to the UK economy to be £2.6 to £2.8 billion.
Over half UK women do not check their breasts regularly for potential signs of breast cancer.
Incidence Worldwide
There are striking differences in the incidence of breast cancer in different places. Breast cancer accounts for 28.4 deaths per one hundred thousand in England and Wales, but only 19.2 in France, and 5.8 in Japan. There are many possible reasons for these differences, for example climate, diet, genetic inheritance, environmental toxins, patterns of birth control or breast feeding and age at first pregnancy. Women moving from low incidence to high incidence countries seem to acquire the higher risk of their new country.
Known Causative Factors
5-10% of breast cancers are believed to involve a hereditary factor. Women with no children or late first pregnancies (aged 30 years+) are more likely to develop breast cancer. Risk increases with early onset of menstruation and late menopause. Exposure to significant doses of radiation increases breast cancer incidence. Most of the factors affecting breast cancer development are still unknown.
Common breast cancer signs and symptoms include:
Breast Lumps
A lump or thickening in the breast or armpit tissue is the first symptom in 80-90% of breast cancers. Other symptoms include dimpling or flaking skin, nipple discharge or bleeding, pain in the breast, change in breast size or shape, or any new difference in appearance or feel of the breast. If any of these symptoms are found medical advice should be sought. Only about 1 in 9 breast lumps seen by a doctor will prove to be cancerous. For every 10 women with cancerous lumps, 5 or 6 can be treated initially without removal of the breast, and 3 or 4 will die of a cause other than cancer.
Mammographic Screening
Mammograms are simply X-rays of the breast. They are most successful in detecting breast cancer in women over 50 years. Breast tissue of younger women is usually too dense to allow cancers to be seen. Currently all women aged 50-64 years are offered a 3-yearly mammograph. Women aged over 64 years are also entitled to screening but must request it.
Dense Breasts
Breasts are made of fat and glands (that make milk), held together by fibrous tissue. The more glands and fibrous tissue present, the “denser” the breast. Breast density has nothing to do with the way breasts look or feel. Dense breasts are normal and common but make it harder for radiologists to see cancer on a mammogram. Dense breasts increase both the risk of a cancer being missed on a mammogram and, also, of developing breast cancer. For more information visit: DenseBreast-info.org/Europe
Surgery
Conservative surgery removing only the lump or segment of breast is now offered to up to two thirds of women with one small tumour. If the tumour is too big or has spread too far mastectomy is more suitable. Also, some women choose mastectomy because it brings them greater peace of mind. Surgery is often followed up by adjuvant therapy (see examples below) to kill stray cancer cells. Every woman who has a mastectomy is entitled to breast reconstruction or a suitable breast prosthesis on the NHS.
Radiotherapy
Radiotherapy is usually given post-operatively to the breast and sometimes armpit regions. Courses range from 3-6 weeks or more, with patients usually receiving one dose a day, five days a week. The side effects of radiation can be slight reddening or discomfort in the treated area, tiredness and nausea. Most patients can expect to remain reasonably well throughout treatment.
Chemotherapy
Anti-cancer drugs (chemotherapy) aim to track down and kill cancer cells anywhere in the body. Most pre-menopausal patients under 50 years are routinely offered chemotherapy, usually with 6 courses of a standard drug regime known as CMF (cyclophosphamide, methotrexate, fluorouracil) given on an outpatient basis over a period of around six months. Chemotherapy increases the survival of patients whose cancer has spread to the lymph nodes, as well as increasing disease-free survival in patients without any node involvement. Possible side effects include the disruption or cessation of menstrual periods, with possible onset of the menopause. Also, tiredness, nausea, loss of hair, mouth ulcers, loss of appetite and diarrhoea.
Immunotherapy
Immunotherapy. Is a newer type of cancer treatment that boosts the body's natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve how your immune system works to find and destroy cancer cells. 15-20% of patients achieve durable results with immunotherapy.
Hormone Therapy
Hormone therapy blocks or lowers the number of hormones in the body to stop or slow down the growth of cancer.
There are several types of hormone therapy, including:
For specific conditions like cancer, there are targeted hormone therapies such as:
Tamoxifen
Tamoxifen is a hormonal therapy that works mainly by depriving residual cancer cells of the oestrogen they require for growth. It is especially effective in protecting post-menopausal patients, however recent evidence suggests it may also be useful in pre-menopausal patients. Side effects are few, but may include vaginal irritation, occasional nausea, and symptoms like those of the menopause, e.g. hot flushes and irregular menstruation. Tamoxifen is usually prescribed for 2 or 5 years.
Breast Reconstruction
Techniques have been developed enabling surgeons to produce a breast that looks attractive and matches the other side. In most cases a cosmetic result that pleases the woman can be produced. 25-50% of women who have had a mastectomy will request breast reconstruction.
Recurrence
All women who have had breast cancer should be monitored for recurrences, usually with an annual check-up for at least five years. Recurrences occur in 20-30% of women who have undergone surgery aimed at cure of the disease. With early diagnosis and treatment 85% of women will survive at least 5 years.
Secondary Spread
Cancer cells are carried from the breast to other areas of the body by the blood supply and lymphatic system. Breast cancer most commonly spreads to the lymph nodes, bones, liver, brain, lungs and ovaries. Surgeons will often remove some lymph nodes to tell whether the cancer has spread and to stage the development of the disease. The main problem with breast cancer is not related to local control of the disease, but rather the distant recurrence elsewhere in the body that may prove fatal.
While it cannot be cured, there are treatments that can help control certain forms of the disease for some time and relieve symptoms to help people live well for as long as possible.
There are an estimated 61,000 people living with secondary breast cancer in the UK. In around 5% of women, breast cancer has already spread by the time it is diagnosed.
Cancer Survival
Generally, cancer survival has doubled in the past 40 years. Today 50% of people with cancer will live with the condition for more than 10 years. However, survival rates vary a lot depending on the type of cancer. Almost 9 in 10 (86%) of women survive breast cancer for 5 years or more.
Breast cancer survival is improving and has doubled in the past 50 years in the UK due to a combination of improvements in treatment and care, earlier detection through screening and a focus on targets, including faster diagnosis.
An estimated 600,000 people are alive in the UK after a diagnosis of breast cancer. This is predicted to rise to 1.2 million in 2030. With improvements in diagnosis, treatment and care, we are also living longer with the disease.
10 Questions Patients Should Ask: