Dr Deirdre Duke knows a lot about breast cancer. She works in the symptomatic clinic in Beaumont Hospital – a specialist clinic in one of the eight specialist cancer treatment centres in Ireland. It’s one of the places where women who have noticed a lump or change in a breast are referred to for further investigation.
One of her key messages is to check your breasts once a month.
“Some women get their BreastCheck mammogram result and think: ‘Ah, that’s good, I’m fine for the next two years’, but it’s not as simple as that. Going for a screening test is just a result at a point in time,” she says. “It doesn’t mean that nothing is going to happen, just as when your car passes an NCT doesn’t mean that it won’t develop problems.”
Misinformation
There is a lot of misinformation out there about breast cancer, she believes, with some women worrying more than they need to and others not being aware enough.
“Some women think ‘It can never happen to me’, but it can. One in 10 women will develop breast cancer in their lifetime. Other women check their breasts every day, such is their concern, but that’s not something we would recommend because breasts can change due to hormonal differences, especially coming up to a period. We recommend checking once a month after menstruation. For post-menopausal women once a month also.”
Some women also only believe that you get breast cancer if it runs in the family.
“This isn’t true. Only a small percentage of women would present with that type of cancer (5%). For the majority of people, breast cancer happens sporadically. They don’t have a known gene in their family. Breast cancer can happen to anyone.”
Risk factors
Dr Duke likes to keep it simple when it comes to explaining risk factors.
“The biggest one is being a woman and the other one is ageing. Body systems are very complex and the body’s ability to replace good cells diminishes as the years go on.”
It may not be cancer
The majority of women who come to the clinic she works in do not have breast cancer, she says, but lumps and breast changes have to be checked out.
“There are lots of benign or non-cancerous changes in the breast and GPs have a very low threshold to referring people just in case so the majority of women we see don’t have breast cancer. The GP says ‘I don’t think it’s anything serious but I’ll refer you anyway’ and women think he/she is only saying that so by the time they see us they are terrified that they do have a problem but it may only be a cyst, for example.”
Breast pain can drive women to their doctor, too, she adds.
“We see an awful lot of women with breast pain who are frightened that it means cancer,” she says, “but it’s usually just hormonal in origin and is rarely linked with breast cancer. Smoking and caffeine can aggravate breast pain. In my experience, a lot of women get relief from taking a supplement of Vitamin B6 or Evening Primrose Oil but they should talk to their doctor if they experience breast pain.”
Two main symptoms* of breast cancer
There are two main symptoms to look for when you are checking your breasts each month, she states.
1. A lump – not ‘lumpy’ but an actual lump or discrete mass in the breast.
2. Nipple retraction – a nipple that goes in and stays in.
Improvements
Treatments for breast cancer are improving year on year, she says, so a diagnosis is not ‘the end of the world’ anymore.
“Most people are actually surviving it now because there have been so many advances in last 10-20 years. Internationally diagnostics like mammography and ultrasound are constantly improving so more breast cancers are being picked up. We also have new modalities like breast MRI that we use in some cases.”
Patients going to surgery now have a huge amount of information – unlike years ago, she says.
“There was a time patients went to surgery and were then told they had cancer but now all biopsies are done in advance of surgery. Lots of tests can be done to see what stage the cancer is at – whether it has spread or not.”
Less surgery
There is a move to doing the least amount of surgery necessary also.
“In the past women automatically had a mastectomy. Now a lot of women will have breast conserving surgery – where they just take away enough tissue to remove the tumour.
Even for those who do need mastectomies there are a variety of onco-plastic techniques used now to reconstruct the breast. It’s quite phenomenal what they can do. It is a huge psychological boost to a woman knowing that she won’t look much different afterwards.”
Laboratories are also able to give more information to surgeons now also.
“The labs – pathologists – now give a huge amount of additional information about the receptors of the tumour which can determine the kind of treatment the patient gets.”
Treatments
Chemotherapy, once ‘a blunderbuss approach’, is now all about targeted therapies.
“They are targeting the receptors and killing off just the cancer cells with little or no damage to normal tissue around it. This has less side effects and is a more effective treatment.”
Onco-typing is now being used too.
“This is where tests are done on certain tumours and depending on the oncotype score the patient may or may not need chemotherapy. That is probably the biggest thing in world of chemotherapy, in that there are fewer women needing chemotherapy now. It’s a relief for women in their 40s, who perhaps have young kids, knowing that they don’t have to come in to the hospital for weeks at a time for chemo. Logistically it’s fantastic.”
Radiation is also more targeted now.
“There can be tailored beams of radiation so, because technology has improved so much, there is less impact on surrounding structures like the heart and lungs. Everything is continually improving.
“Earlier diagnosis and better treatment means that more and more women are surviving the disease rather than it being fatal.”
No perfect screening system
Dr Duke speaks very highly of the BreastCheck screening programme in Ireland (free for 50-69 year olds) but says there is no absolutely perfect screening system.
“It’s probably one of the best screening programmes in the world,” she says. “It is so well-run and well-funded and has saved so many lives. It has to be remembered, though, that there is no test for cancer that is 100% sensitive, no matter how good a centre or clinician or equipment is. There will always be some false negatives – where the person has cancer but the test doesn’t show that. With all the tests we do it’s not a yes/no situation. It’s shades of grey and it’s at what point the grey becomes black or the grey becomes white.”
The 50-69 age group is chosen for free screening but it is the group of women where most cancers will be identified.
“As with all screening programmes it’s a risk/benefit situation and you have to think of it on a population basis. That is the group in which we will identify most cancers.”
* Remember that breasts may be affected by changes in your hormones during your menstrual cycle, pregnancy, breastfeeding and menopause.
How often should you check your breasts?
Every woman should check their breasts once a month after menstruation. The five-point code:
Know what is normal for you*.Know what changes to look for.Look at and feel your breasts.Discuss any changes with your GP without delay.Attend routine breast screening if you are aged between 50 and 64.Red-flag symptoms
The symptoms of breast cancer may include any of the following:Change in size or shape – even one breast becoming larger.Changes in the nipple – in direction or shape, pulled in/flattened.Changes on or around the nipple – rash, flaky/crusted skin.‘Orange peel’ appearance of the skin caused by unusually enlarged pores.Swelling in your armpit or around your collar bone.Constant pain in one part of your breast or armpit.Current statystics in Ireland
One in nine women will develop breast cancer in the course of their lifetime.One in 1,000 – the incidence of male breast cancer. 2,890 new cases of breast cancer are diagnosed each year.30% of women are diagnosed between 20-50 years. 34% of women are diagnosed between 50-65 years.36% of women are diagnosed over the age of 65 years.5% of breast cancer cases are hereditary.Breast check app
Breast Cancer Ireland, a charity that Dr Duke is involved with, has two strands to its work – fund-raising for breast cancer research and providing patient information. Breast Cancer Ireland has a phone app to remind you to do a breast examination. Available on Android and iPhone.
Useful websites
If you are now 50 you can register for BreastCheck by calling freephone 1800-455555, or by visiting their website www.breastcheck.ie
www.cancer.ie - Freefone 1800-200700
www.breastcancerireland.com
Dr Deirdre Duke knows a lot about breast cancer. She works in the symptomatic clinic in Beaumont Hospital – a specialist clinic in one of the eight specialist cancer treatment centres in Ireland. It’s one of the places where women who have noticed a lump or change in a breast are referred to for further investigation.
One of her key messages is to check your breasts once a month.
“Some women get their BreastCheck mammogram result and think: ‘Ah, that’s good, I’m fine for the next two years’, but it’s not as simple as that. Going for a screening test is just a result at a point in time,” she says. “It doesn’t mean that nothing is going to happen, just as when your car passes an NCT doesn’t mean that it won’t develop problems.”
Misinformation
There is a lot of misinformation out there about breast cancer, she believes, with some women worrying more than they need to and others not being aware enough.
“Some women think ‘It can never happen to me’, but it can. One in 10 women will develop breast cancer in their lifetime. Other women check their breasts every day, such is their concern, but that’s not something we would recommend because breasts can change due to hormonal differences, especially coming up to a period. We recommend checking once a month after menstruation. For post-menopausal women once a month also.”
Some women also only believe that you get breast cancer if it runs in the family.
“This isn’t true. Only a small percentage of women would present with that type of cancer (5%). For the majority of people, breast cancer happens sporadically. They don’t have a known gene in their family. Breast cancer can happen to anyone.”
Risk factors
Dr Duke likes to keep it simple when it comes to explaining risk factors.
“The biggest one is being a woman and the other one is ageing. Body systems are very complex and the body’s ability to replace good cells diminishes as the years go on.”
It may not be cancer
The majority of women who come to the clinic she works in do not have breast cancer, she says, but lumps and breast changes have to be checked out.
“There are lots of benign or non-cancerous changes in the breast and GPs have a very low threshold to referring people just in case so the majority of women we see don’t have breast cancer. The GP says ‘I don’t think it’s anything serious but I’ll refer you anyway’ and women think he/she is only saying that so by the time they see us they are terrified that they do have a problem but it may only be a cyst, for example.”
Breast pain can drive women to their doctor, too, she adds.
“We see an awful lot of women with breast pain who are frightened that it means cancer,” she says, “but it’s usually just hormonal in origin and is rarely linked with breast cancer. Smoking and caffeine can aggravate breast pain. In my experience, a lot of women get relief from taking a supplement of Vitamin B6 or Evening Primrose Oil but they should talk to their doctor if they experience breast pain.”
Two main symptoms* of breast cancer
There are two main symptoms to look for when you are checking your breasts each month, she states.
1. A lump – not ‘lumpy’ but an actual lump or discrete mass in the breast.
2. Nipple retraction – a nipple that goes in and stays in.
Improvements
Treatments for breast cancer are improving year on year, she says, so a diagnosis is not ‘the end of the world’ anymore.
“Most people are actually surviving it now because there have been so many advances in last 10-20 years. Internationally diagnostics like mammography and ultrasound are constantly improving so more breast cancers are being picked up. We also have new modalities like breast MRI that we use in some cases.”
Patients going to surgery now have a huge amount of information – unlike years ago, she says.
“There was a time patients went to surgery and were then told they had cancer but now all biopsies are done in advance of surgery. Lots of tests can be done to see what stage the cancer is at – whether it has spread or not.”
Less surgery
There is a move to doing the least amount of surgery necessary also.
“In the past women automatically had a mastectomy. Now a lot of women will have breast conserving surgery – where they just take away enough tissue to remove the tumour.
Even for those who do need mastectomies there are a variety of onco-plastic techniques used now to reconstruct the breast. It’s quite phenomenal what they can do. It is a huge psychological boost to a woman knowing that she won’t look much different afterwards.”
Laboratories are also able to give more information to surgeons now also.
“The labs – pathologists – now give a huge amount of additional information about the receptors of the tumour which can determine the kind of treatment the patient gets.”
Treatments
Chemotherapy, once ‘a blunderbuss approach’, is now all about targeted therapies.
“They are targeting the receptors and killing off just the cancer cells with little or no damage to normal tissue around it. This has less side effects and is a more effective treatment.”
Onco-typing is now being used too.
“This is where tests are done on certain tumours and depending on the oncotype score the patient may or may not need chemotherapy. That is probably the biggest thing in world of chemotherapy, in that there are fewer women needing chemotherapy now. It’s a relief for women in their 40s, who perhaps have young kids, knowing that they don’t have to come in to the hospital for weeks at a time for chemo. Logistically it’s fantastic.”
Radiation is also more targeted now.
“There can be tailored beams of radiation so, because technology has improved so much, there is less impact on surrounding structures like the heart and lungs. Everything is continually improving.
“Earlier diagnosis and better treatment means that more and more women are surviving the disease rather than it being fatal.”
No perfect screening system
Dr Duke speaks very highly of the BreastCheck screening programme in Ireland (free for 50-69 year olds) but says there is no absolutely perfect screening system.
“It’s probably one of the best screening programmes in the world,” she says. “It is so well-run and well-funded and has saved so many lives. It has to be remembered, though, that there is no test for cancer that is 100% sensitive, no matter how good a centre or clinician or equipment is. There will always be some false negatives – where the person has cancer but the test doesn’t show that. With all the tests we do it’s not a yes/no situation. It’s shades of grey and it’s at what point the grey becomes black or the grey becomes white.”
The 50-69 age group is chosen for free screening but it is the group of women where most cancers will be identified.
“As with all screening programmes it’s a risk/benefit situation and you have to think of it on a population basis. That is the group in which we will identify most cancers.”
* Remember that breasts may be affected by changes in your hormones during your menstrual cycle, pregnancy, breastfeeding and menopause.
How often should you check your breasts?
Every woman should check their breasts once a month after menstruation. The five-point code:
Know what is normal for you*.Know what changes to look for.Look at and feel your breasts.Discuss any changes with your GP without delay.Attend routine breast screening if you are aged between 50 and 64.Red-flag symptoms
The symptoms of breast cancer may include any of the following:Change in size or shape – even one breast becoming larger.Changes in the nipple – in direction or shape, pulled in/flattened.Changes on or around the nipple – rash, flaky/crusted skin.‘Orange peel’ appearance of the skin caused by unusually enlarged pores.Swelling in your armpit or around your collar bone.Constant pain in one part of your breast or armpit.Current statystics in Ireland
One in nine women will develop breast cancer in the course of their lifetime.One in 1,000 – the incidence of male breast cancer. 2,890 new cases of breast cancer are diagnosed each year.30% of women are diagnosed between 20-50 years. 34% of women are diagnosed between 50-65 years.36% of women are diagnosed over the age of 65 years.5% of breast cancer cases are hereditary.Breast check app
Breast Cancer Ireland, a charity that Dr Duke is involved with, has two strands to its work – fund-raising for breast cancer research and providing patient information. Breast Cancer Ireland has a phone app to remind you to do a breast examination. Available on Android and iPhone.
Useful websites
If you are now 50 you can register for BreastCheck by calling freephone 1800-455555, or by visiting their website www.breastcheck.ie
www.cancer.ie - Freefone 1800-200700
www.breastcancerireland.com
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