Fighting the ladykiller

Lee Rodwell argues that, despite continuing medical advances in the battle against breast cancer, early detection is still vital

Breast cancer is still a lady killer - and the UK has one of the highest mortality rates in the world. Even men don't escape entirely, although numbers are small, with fewer than 200 cases being diagnosed a year. For women, though, the chilling fact is that one in 12 will develop breast cancer at some time in their life.

Now the good news. Although the number of new cases has increased, deaths from the disease are falling. No one is quite sure why there are more reported cases, but it is probably due to a number of factors such as better data collection, an increase in numbers being screened and the fact that people are living longer,, thus increasing the risk of developing the disease. But mortality rates have been dropping significantly due to earlier diagnosis and the improvements in treatment over the past ten years. In fact, the survival rate is now as high as 85 per cent for early- stage cancers.

Work continues into the best ways of treating women, and the order in which they are offered a combination of surgery, anti-cancer drugs, and/or radiotherapy.

At the Royal Marsden's Breast Cancer Unit women have been treated with drugs before surgery (neo-adjuvant chemotherapy) and as a result the mastectomy rate has dropped from 30 per cent to 13 per cent. Half of the women responded so well to tamoxifen and chemotherapy that their tumour virtually disappeared. The head of the unit, Dr Trevor Powles, predicts the day will come when "for most women, surgery won't be required."

The future holds much promise, as the identification of breast cancer genes may lead to an understanding of the mechanisms involved in the development of the disease, and to prevention itself.

On-going trials in tamoxifen - the most widely used anti-cancer drug - should also yield useful information about the best way to prevent breast cancer recurring or spreading, or even developing at all.

Meanwhile, experts can tell women about a number of factors which may increase their risk of getting breast cancer. Many relate to a woman's reproductive history, something fate may play a large part in.

The most significant of all is one over which we have no control - age. Older women can do relatively little to protect themselves against breast cancer, which is why early detection is so important: the earlier breast cancer is diagnosed the better the odds of beating the disease.

October has been designated Breast Awareness month. The aim is to alert all women to the importance of knowing what their breasts normally look and feel like, to seek help as soon as possible if they discover any changes, and - for older women - to take up the invitation to be screened.

You may not yet be able to avoid being the one in 12 who gets breast cancer. However, you can maximise your chances of being one of those who survives.

What exactly is breast cancer?

Breast cancer - like every other kind of cancer - starts with a change in the normal make-up of a cell. The cells in our bodies are constantly multiplying. Parent cells divide to form daughter cells - exact copies of themselves. When they are no longer required, the 'old' cells are programmed to die off. Sometimes, though, the genes which control cell division become faulty or are damaged and the daughter cells cease to be exact copies of the parents.

Such mistakes constantly occur but the cells are usually repaired or the growth of the faulty cells checked by tumour-suppressor genes and other fail-safe mechanisms. It is only when these safeguards fail that cells start to multiply in an uncontrolled way, forming tumours.

Breast tumours can be either benign or malignant. Nine out of ten breast lumps are cysts or benign tumours which will not spread beyond the breast. A malignant tumour, or cancer, is made up of abnormal cells. These cells do have the ability to invade surrounding tissues and breakaway cells may travel through the bloodstream or lymphatic system to other parts of the body. There they may settle, forming new colonies of abnormal cells - secondary growths also known as metastases.

Most cases of breast cancer are caused by genes mutating during the lifetime of an individual. The reasons for this spontaneous change are not fully understood, although it is known that substances, known as carcinogens, can cause genetic faults and researchers have discovered a number of things which put women at higher risk of breast cancer. A disposition of faulty genes may be inherited. However, even if this is the case, other factors need to be involved before the cancer appears. In many instances no one will be able to tell you why one woman develops breast cancer while others do not.

The breast is made of fatty tissue, milk ducts and milk-producing sacs. The lymph system drains from the breast into lymph nodes in the armpit and under the breast bone. Most breast cancers start in the cells that make up the milk ducts. While the tumour is only in the breast it is fairly easily removed; once it spreads to the armpit, or the cancer cells spread more widely round the body, the disease becomes more difficult to treat.

Breast cancer cells do not always begin to form a secondary cancer as soon as they have found a new location. Often they die out or lie dormant for many years. No one yet knows why cancer cells lie dormant or what triggers them, years later, to form secondary cancers. Many cancers never progress beyond the early stages and, even if they do, may do so relatively slowly. The aim of treatment is to remove all the cancer if possible and thereby halt any progression.

However, early detection greatly improves the chances of successful treatment. That is why it is so important to develop personal awareness of your body, so that any worrying symptoms can be taken to your doctor early.

TERMINOLOGY

Mammography

Breast x-rays. Useful for detecting early changes in the breast when it may be difficult to feel a lump.

Ultrasound

Gel is spread on the breast and a small device, which emits sound waves is passed over the area. The echoes are converted into a picture via a computer.

Needle Aspiration

Use of a fine needle and a syringe to take a sample of cells from a breast lump. These are sent to a laboratory to see if it contains malignant cells

Needle Biopsy

This test uses a slightly larger needle than that used for aspiration. Done under a local anaesthetic, a small piece of tissue is removed from the lump and sent for testing.

Excision Biopsy

The whole lump is removed under general anaesthetic and sent to a laboratory for examination.

Lumpectomy

The removal of the breast lump together with some of the surrounding tissue. It leaves a small scar and sometimes a small dent in the breast.

Mastectomy

Removal of the breast. A simple mastectomy removes only the breast tissue. A radical mastectomy (now rare) also removes the muscles on the chest wall. A modified radical mastectomy removes the breast and lymph nodes leaving the chest wall muscles intact.

Metastasis

A secondary tumour that has spread from a primary cancer to affect another part of the body. The term is also used to describe the process by which such a spread occurs.

Adjuvant therapy

Additional treatment given after an operation to decrease the risk the cancer might spread

Radiotherapy

The use of high-energy rays to destroy cancer cells while doing as little harm as possible to normal cells. External radiotherapy is given as a course of treatment in a hospital radiotherapy department, where possible as an out-patient. Internal radiotherapy is given by implanting wires containing a radioactive substance into the breast under a general anaesthetic. This gives as extra dose of radiation to the area surrounding the tumour.

Chemotherapy

The use of anti-cancer drugs to destroy cancer cells. The drugs are sometimes given orally or, more usually, intravenously. Chemotherapy may given as an out-patient or may mean spending a few days in hospital.

Neo-adjuvant chemotherapy

Chemotherapy given to shrink large tumours prior to any surgery.

Prosthesis

Artificial breast replacement.

Mammoplasty

Breast reconstruction. This can be carried out at the time of a mastectomy or at a later date.