Symptoms of breast cancer
The most common symptom of breast cancer is a painless lump in the breast. Cancerous lumps are usually firm and hard, and can be attached to the skin or chest wall. The lump may also be painful, the nipple may be inverted, there may be dimpling of the skin, or there may be discharge from the nipple. However, discharge from the nipple is usually benign and rarely a symptom of cancer. On rare occasions, cancer is detected from metastases in the armpit, for example.
80% of breast cancer cases are detected by women performing a breast self-exam. One third of cancer cases in women aged 50 to 59 are detected during mammogram screenings. In these cases the cancer has often been completely asymptomatic.
The majority of breast cancer cases are diagnosed in the early stages as women have good cancer awareness, they know how to examine their breasts and participate in screenings. Breast cancer is usually slow to develop and rapidly growing large tumours are rarely detected.
Diagnosing breast cancer
Breast cancer is diagnosed using the triple test, which includes palpation of the breast and scans, i.e. a mammogram and, particularly in young women, an ultrasound and sometimes an MRI. A tissue sample is also taken from the breast with a percutaneous needle biopsy. These tests are used to evaluate whether the tumour is benign. If one or more of the tests produce a result that suggests cancer, the tumour will be removed.
Treatment of breast cancer
If cancer is detected in the breast, a surgeon will remove the tumour and examine the lymph nodes in the armpit with a sentinel lymph node biopsy. The surgeon will attempt, where possible, to carry out a lumpectomy to avoid having to remove the whole breast. If cancer cells are detected in the armpit, surgery to remove the lymph nodes will be carried out.
Medical treatment is currently recommended to almost all patients, in the event that cancerous cells have spread to other organs. The type of treatment depends on the size of the tumour, whether cancer is detected in the lymph nodes and the cancer’s biological subtype.
Hormone therapy over a period of five years may be sufficient to treat the most common forms of hormone receptor positive breast cancers. Chemotherapy is often needed for other types of cancer and this treatment is administered at three-week intervals over a period of 4-5 months. Biological and radiation therapy can also be used.
The prognosis for breast cancer is good and five years after diagnosis, 90% of patients are alive. Hormone receptor positive breast cancer develops slowly. Half of the cases of recurrence of this type of breast cancer are diagnosed more than five years after diagnosis.
When should I go and see a doctor?
It is a good idea to examine your breasts once a month, after your period. If you notice any changes in a breast then you should always go and see a doctor. Women aged 50 to 69 are invited for breast cancer screenings every two years and it is a good idea to attend these screenings. You can always ask your gynaecologist to examine your breasts when you go for your checkups.
Riikka Huovinen, Docent and Specialist in Oncology, from the Turku University Hospital was interviewed for this article.
The National Guidelines for diagnosis and treatment of breast cancer 2013 published by the Finnish Breast Cancer Group was also used as a source.