The truth about breast cancer

Despite breast cancer being the most commonly diagnosed cancer in women in the UK, there are still lots of misconceptions about people’s risk of being diagnosed, the treatment offered and whether you can do anything to lower your own risk. Here Mr Richard Johnson, Consultant Breast Surgeon at The Wilmslow Hospital in Manchester, part of HCA Healthcare UK, provides his expert opinion on some of these issues, separates fact from fiction and explains why it’s so important to see your GP or breast specialist if you have any concerns.

Whilst the size of your breasts has no impact on your risk of being diagnosed with breast cancer, having denser breasts can put you at a higher risk. Dense breast tissue is when the breast is mostly made of glandular and connective tissue, with very little fatty tissue.

If you have dense breast tissue and very little fatty tissue, then breast cancer can be more difficult to identify during a mammogram. Younger women are more likely to have denser breast tissue, as it’s only during the menopause when oestrogen levels decrease, and you lose breast tissue, that your breasts become less dense and fattier.

In the vast majority of cases, a mammogram will be sufficient enough to screen for breast cancer, but in some cases, using other diagnostic technology is required.

When attending your mammogram, your consultant radiologist will be able to measure the density of your breasts. If the mammogram comes back as clear but your breasts are deemed as dense, the radiologist may suggest that you have an ultrasound or MRI scan to get a closer look at the breasts and be able to confirm if there are any signs of breast cancer.

There is no proven link between a man having gynaecomastia, or ‘man boobs’ as they’re most commonly referred to, and male breast cancer. Gynaecomastia is an enlargement of male breast tissue and is a common, non-cancerous condition. The symptoms of gynaecomastia can vary from a small, firm enlargement of breast tissue behind the nipple to a larger, fuller looking breast. True gynaecomastia (caused by an enlargement of breast tissue) is different from pseudogynaecomastia (an increase in fatty tissue).

This isn’t to say that men aren’t at risk of breast cancer. About 1 in 100 of breast cancer cases in the UK are in males, so it’s important that men still check their breast tissue. If you notice any concerning symptoms such as a lump, you should see your GP or a breast specialist. In the vast majority of cases, the lump won’t be cancer, but it’s important that it is checked. 

Breast cancer in women of any age most commonly develops by chance and is not linked to a known genetic abnormality. Only 5-10% of all breast cancers have a known genetic abnormality that can be detected. Two of the genes which significantly increase the risk of breast cancer and can be tested for are BRCA1 and BRCA2.

If you have a family history of breast or ovarian cancer, then it may be beneficial to see a specialist genetics team to understand your risk. A consultant geneticist can provide you with all the information you need on genetic risk factors, testing for an inherited genetic risk, appropriate surveillance such as increased screening and risk-reducing treatment options.

Some risk factors for breast cancer are naturally occurring and therefore can’t be altered, but there are some things you can do to minimise your risk. Risk factors for breast cancer include:

• Age – this is the strongest risk factor for breast cancer. Around 80% of women diagnosed with breast cancer are over the age of 50.
• Dense breast tissue – denser breast tissue can mean that tumours can be more difficult to identify.
• Hormonal factors – taking hormone replacement therapy (HRT) for more than five years, especially if you’re taking combined HRT, can increase your risk. Similarly, taking the contraceptive pill can also heighten your risk. However, the risk reduces for both of these after you stop taking the medication.
• Family history – although rare, sometimes breast cancer can run in families. It could be beneficial to see a genetics team to check your family history and understand your risk.
• Lifestyle factors – these are risk factors that you are able to change. By maintaining a healthy weight, regularly exercising, keeping alcohol consumption low and stopping smoking, you can minimise your risk of breast cancer.

If you’re diagnosed with breast cancer, then a team of breast cancer experts, known as your multidisciplinary team, will come together to review your diagnosis and recommend the best individual treatment plan for you. 

Treatment options will vary depending on your diagnosis and can include a lumpectomy to remove the tumour and some surrounding breast tissue, a single or double mastectomy, chemotherapy, radiotherapy or hormone therapy - or a combination of treatment options. Many patients who I have seen believe that treatment for breast cancer automatically means a mastectomy, which isn’t always the case and will depend on your diagnosis.

Importantly, breast cancer survival is improving. In the last 40 years, breast cancer survival has doubled in the UK due to people being more breast aware and presenting to their GP or breast specialist with early symptoms, as well as the improvements in treatment and care.

If you have any new or concerning symptoms, it’s important you see your GP or breast specialist. In most cases the diagnosis won’t be cancer, but it’s important that you get checked. 

We know some people may have put off screening or seeing their GP with symptoms, but the sooner we diagnose breast cancer, the more effective treatment can be. It is never too late to see a specialist about changes to your health. We’re here with the expertise to help, the most important thing is to come forward if you have any concerns.