The Facts

Breast x-rays are most successful in detecting cancer in women over 50; in younger women breast tissue is usually too dense for accurate screening. Mammograms are offered to:

• all women aged 50-70 every three years
• women over 71 on request
• women between 40 and 49 at high risk annually

• Single, small tumour -- in two-thirds of cases just the affected lump or segment of breast is removed.
• Larger or spreading tumours - mastectomy recommended.

Every woman who has a mastectomy is entitled to a suitable breast reconstruction or prosthesis on the NHS.

Surgeons use breast or other tissue to create a new breast to match the remaining one. It can be done during the mastectomy or later on. Another option is a prosthesis which is worn inside a bra but 25-50% of women who have had a mastectomy choose breast reconstruction.

• Chemotherapy
  Anti-cancer drugs (chemotherapy) aim to track down and kill cancer cells anywhere in the body. They can be given before surgery to shrink a tumour or after surgery to treat spread or recurrence. Most pre-menopausal patients under 50 are routinely offered six courses as out-patients for about six months. Chemotherapy increases survival but side effects may include disruption or cessation of periods, early menopause, tiredness, nausea, hair loss, mouth ulcers, loss of appetite and diarrhoea.
  
• Radiotherapy
  Given post-operatively to the breast and sometimes armpit area. Courses range from three to six weeks or more, with patients usually receiving one dose a day, five days a week. Radiation can cause slight reddening or discomfort in the treated area, tiredness and nausea. Most patients remain pretty well throughout treatment.
  
• Tamoxifen
  A hormonal therapy that works mainly by depriving any remaining cancer cells of oestrogen. It's especially helpful for post-menopausal patients, but recent research suggests pre-menopausal patients may also benefit. Side effects can include vaginal irritation, occasional nausea, hot flushes and irregular menstruation. Tamoxifen is usually prescribed for two or five years.
  
• Herceptin
  A treatment targeted at cancer cells with a large amount of the protein HER2. It's most effective for the 25-30% of women with HER2-positive early breast cancer, an aggressive form of the disease with reduced survival rate. You can read comprehensive information about HER2 on www.herceptin.net

Breast cancer cells are carried in the blood and lymphatic system to other areas of the body such as the lymph nodes, bones, liver, brain, lungs and ovaries. Surgeons will often remove some lymph nodes to check and monitor the spread. The main problem with breast cancer isn't local control; it's the spread to other parts of the body that may prove fatal.

All women who have had breast cancer should be monitored for recurrence with an annual check-up for at least five years after surgery. Cancer returns in 20-30% of women but with early diagnosis and treatment 85% of women will survive at five years.

Breast cancer occurs when cells get out of control and multiply needlessly. It's not a single disease: over 70% are cancers in the milk ducts and 10% -15% in the breast lobules. Left untreated they may spread into surrounding tissue.

Striking differences exist in the incidence of fatal breast cancer. For every 100,000 people there are:

• 24.3 deaths in England and Wales
• 18.9 in Italy
• 8.3 in Japan

Women moving from low incidence to high incidence countries seem to develop the higher risk of their new country, indicating environment, diet and lifestyle play a large role.

Incidence in the UK

Each year:

• Over 45,500 new cases are diagnosed
• 75% of these will be post-menopausal
• 13,000 people will die

Breast cancer is the most common single cause of death in women aged 35-54 years and 1 in 9 women will develop the disease in their lifetime.

• Lumps/thickening in breast or armpit - first sign in 80-90% of cases
• Dimpling or flaking skin
• Nipple discharge or bleeding
• Breast pain
• Change in breast size or shape
• Change in feel of breast

If you experience any of these symptoms you should see your doctor immediately. However, 90% of breast lumps are benign and for those that are not, two-thirds can be initially treated without a mastectomy.