Breast Cancer & How to Explore Treatment Options Through a Second Opinion

Breast cancer occurs when cells in the breast tissue begin to grow out of control. This occurs most often in the milk ducts or milk producing lobules of the breast. It is the most common type of cancer in the UK, affecting one in eight women during their lifetime while it also affects 1 in 8 women in the United States.  

Most breast cancers are invasive, meaning they can spread to other parts of the body however early identification and the correct treatment can help prevent this from happening.

Around 1% of small breast cancer cases each year occur in men. For every 55,000 women diagnosed each year approximately 350 men receive a breast cancer diagnosis. Male breast tissue has ducts behind the nipple, but no lobes or lobules where a large number female breast cancer cases form.

If you or a loved one has received a diagnosis for breast cancer, getting a second opinion is widely accepted and can help guide you in making decisions about the next steps you should take by providing additional information and options you may not have thought about. Find out more about getting a second opinion for cancer and the benefits it can have.

What is Breast Cancer?

Breast cancer occurs when there is abnormal growth of the cells lining the breast ducts or lobules. Most often if first occurs in the lining of the breast ducts, but may also start in the glands, and on rare occasions in other parts of the breast.

While this type of cancer is the most invasive for women, the likelihood of recovery is greatly increased if the cancer is caught early and the most effective treatment plan is put in place.

Breast cancer can occur in any part of the breast, and the type and stage of cancer diagnosed will give an indication of the likely recovery rate and best treatment options to look into.

Breast cancer can reappear even after a person has been declared clear, however regular monitoring with your health team and carrying out physical checks at home can help detect any abnormalities early, meaning treatment can begin quickly and effectively.

Breast cancer survival has increased dramatically over the last 40 years. At present, more than 95% of UK women diagnosed with breast cancer survive their first year, and 85% survive for over five years. Almost 76% survive for ten years or more. Early detection plays a large part in prognosis and regular mammogram screening can help detect cancers before a lump appears or symptoms are experienced.

Types of Breast Cancer

Knowing which type of cancer you have been diagnosed with and how it is likely to behave is imperative to finding the most effective treatment for your particular type.

Non-invasive breast cancer

Non-invasive breast cancer is a type of cancer which has formed in the breast ducts or lobules but has not spread into the surrounding tissue. This type of cancer can be hard to detect and is most often picked up by mammogram. Non-invasive breast cancer is less common than the invasive type, which occurs for around 80% of cases.  

Non-invasive breast cancer of the breast duct is also be known as DCIS (Ductal Carcinoma In Situ). This type of cancer may also be referred to as a pre-cancer, as it may develop into an invasive form of In Situ cancer over time.

Invasive ductal breast cancer

IDC (Invasive Ductal Carcinoma) is the most common form of breast cancer. It is a cancer which forms in the milk duct initially but has spread to healthy tissue outside of the duct. This form of cancer makes up around 80% of breast cancer cases in UK women.

Invasive and pre-invasive lobular cancers do exist but are much less common than IDC.

Less common subtypes of IDC can include tubular, medullary, mucinous, papillary, and cribriform carcinomas of the breast. In these cancers, the cells can look and behave somewhat differently than invasive ductal carcinoma cells usually do.

Triple negative breast cancer

Triple negative breast cancer is a cancer diagnosis where the three most common receptors known to fuel breast cancer growth are not present in the tumour.

These three receptors are:

• Estrogen
• Progesterone
• HER-2/neu gene

Triple negative breast cancer occurs in between 10-20% of cases annually worldwide, and are more likely to affect people under 40 years of age, and those with a BRCA1 gene mutation.

Triple negative breast cancers tend to grow quickly and treatment options are often more limited. The right prognosis and rapid treatment are key to ensuring the best prognosis for this type of cancer.

Triple positive breast cancer

Conversely, a triple positive breast cancer diagnosis indicates that all three common receptors are present. This cancer behaves differently to triple negative breast type and responds differently to different treatments. Approximately 10-15% of all breast cancer diagnoses are of triple positive.

Cancers positive for HER2 tend to produce more of a particular protein which makes them a more aggressive form of cancer and requires more specific treatment such as the use of chemotherapy and use of drugs designed to attach themselves to HER2 receptors and block growth signals, thereby slowing or almost stopping growth of the tumour.

Metastatic breast cancer

Metastatic breast cancer is often referred to as stage four, or advanced breast cancer. It means that the cancer has spread beyond the breast and travelled to other parts of the body. This occurs in roughly 20-30% cases of breast cancer diagnoses, and prognosis becomes less positive. Most often this occurs when cancerous cells reach the lymph nodes under the arm, and can travel to any part of the body.

A metastatic cancer diagnosis may come long after the initial breast cancer diagnosis. The risk of breast cancer becoming metastatic varies greatly from cases to case and can be impacted by a number of factors. The symptoms will vary greatly, and regular checks and examinations should be undertaken to keep track of your diagnosis and look for changes.

Causes of Breast Cancer

Breast cancer is most common in women, and development in men is rare.

The cause of breast cancer developing is unclear, however there are a number of factors which may lead to increased risk of developing it. These include:

• Age – breast cancer is more common in women over 50 years of age
• Family history - A small number of people may have inherited a gene fault that increases their breast cancer risk
• Being overweight or obese
• Ethnicity – Breast cancer is most common in white females, mainly due to lifestyle factors
• Previous experience with cancer – people who have had breast and other types of cancer previously are more prone to receive a breast cancer diagnosis
• Exposure to radiation
• Diabetes
• Age when period started and stopped
• Height – Taller women tend to have a slightly increased risk of developing breast cancer
• Excessive alcohol consumption
• Hormone levels
• Naturally dense breast tissue
• Taking the contraceptive pill (slight increase in risk)
• Undergoing Hormone Replacement Therapy (HRT)
• Being inactive
• Not having children/having them later/having fewer children – Women who have children have a slightly decreased risk of breast cancer; this lessens again for those who have children when young, and those who have a number of children

The Main Symptoms of Breast Cancer

In the early stages breast cancer may present no symptoms at all, and many breast cancers are first detected via routine mammogram checks.

Each type of breast cancer can cause a different set of symptoms, but common changes to help identify the possibility of breast cancer are:

• A lump or hardening in an area of the breast
• Nipple inversion
• Reddened breast skin, with an orange peel complexion
• Discharge from the nipple
• A lump or lumps forming under the arm
• Breast pain or discomfort
• Skin peeling or flaking on breast and/or nipple area
• Change in breast shape or size

It’s highly recommended that you check your breasts regularly so you can pick on any changes and detect any early symptoms. Experiencing symptoms does not mean you have breast cancer, there are a number of other factors and conditions to take into account when a diagnosis is made. Your doctor or specialist will take these and a number of other factors into account when speaking with you.

Diagnosis & Detection of Breast Cancer

It’s important to get a diagnosis early if you think you or a loved one may be experiencing symptoms of breast cancer. The faster the diagnosis, the faster the treatment can begin, which decreases the risk of the cancer spreading and increase both quality of life and prognosis.

People experiencing symptoms of breast cancer or who have a mammogram result which is inconclusive or indicates the presence of potentially cancerous tissue should make an appointment with their GP straightaway. The doctor will carry out an examination and refer you to a breast cancer specialist.

The most common way to receive an initial breast cancer diagnosis is via mammogram screening, which is similar to an x-ray of the breast. Women aged 50-70 are invited for regular mammogram screenings which help identify early stage and pre-cancers which have remained undetected, usually because no lump is present, and no symptoms are being experienced yet.

However, mammography cannot detect all cancers, and 10-15% of the time they are likely to provide a false negative test; that is to say the mammogram shows no cancer when in fact a cancer is present. An ultrasound may also be carried out at this point to help determine any abnormality.

The only way to examine the breast tissue itself is to take a biopsy. There are a number of ways this may be done, and the removed cells will be tested to see how well the cancer is likely to respond to certain treatments.

It isnot uncommon for people with a potential breast cancer diagnosis to begin seeking a second opinion at this time, to ensure the type of cancer and staging has been accurately diagnosed. It is important to have the right diagnosis from the start, to ensure an effective treatment and ensure the best quality of life.

Stages of Breast Cancer

Early detection and an accurate staging diagnosis are imperative to ensure you or your loved one receive the most effective treatment plan for your breast cancer type. Diagnosing breast cancer is a complex process with many potential outcomes. Ensuring you have full confidence in your health team and the diagnosis given to you is key to a successful treatment program and achieving the best quality of life while receiving your treatment. Make sure to speak to your doctor or specialist with any questions you may have, and if you feel at all unsure about your staging diagnosis.

Doctors use a system called TNM to stage breast cancer. This stands for Tumour, Node, and Metastasis.

Tumour or T, describes the size of the tumour. There are four stages within the T stage:

TX – Tumour size cannot be established.

Tis (DCIS) – DCIS (ductal carcinoma in situ) as described above ins a pre-invasive cancer which has  not yet spread into the surrounding tissue.

Tis (Paget) – This diagnosis may be made with the presence of a skin condition associated with a number of breast cancers.

T1 – Cancer is 2cm across or less

T2 – Tumour is more than 2cm but less than 5cm across

T3 – Tumour is larger than 5cm across

T4 – Split into four different groups depending on where the cancer has spread to

Node or N, describes whether the cancer has spread into lymph nodes.

Your specialist will use either pathological staging if you are undergoing surgery, or clinical staging if you are not having surgery to determine whether the cancer has spread to the lymph nodes.

Pathological Node Staging

pNX - Lymph nodes cannot be staged

pN0 - No cancer in nearby nodes

Isolated tumour cells (ITCs) - Groups cancerous cells less than 0.2 mm across are present in one area of a lymph node

pN1

pN1 is divided into 4 groups.

pN1mi - One or more lymph nodes contain cancerous cells larger than 0.2mm

pN1a – Cancerous cells have spread into 1-3 lymph nodes, one or more is larger than 2mm

pN1b -  Cancerous cells in the lymph nodes behind the breastbone

pN1c - Cancerous cells in 1-3 lymph nodes in the armpit and behind the breastbone

pN2

pN2 is divided into 2 groups.

pN2a - Cancerous cells in 4-9 lymph nodes in the armpit. At least one is larger than 2 mm

pN2b - Cancerous cells in lymph nodes behind the breastbone

pN3

pN3 is divided into 3 groups.

pN3a - Cancerous cells in 10 or more armpit lymph nodes, at least one is larger than 2mm, or there is cancer present in the lymph nodes below the collarbone

pN3b - Cancerous cells in lymph nodes in the armpit and behind the breastbone

pN3c - Cancerous cells in lymph nodes above the collarbone

Clinical Node Staging

cNX - Not possible to assess the lymph nodes

cN0 -  No signs of cancer in the lymph nodes from scans or examination carried out

cN1

cN1 isdivided into 2 groups.

cN1 - Cancer has spread to one or more lymph nodes in the lower half of the part armpit

cN1 - Cancerous cells in the lymph nodes are larger than 0.2mm, but no larger than 2mm

cN2 is divided into 2 groups. 

cN2a - Cancerous cells in the armpit are stuck together or fixed to other areas of the breast

cN2b - Cancer cells identified in the lymph nodes behind the breastbone

cN3

cN3 is divided into 3 groups. 

cN3a - Cancerous cells are seen in one or more lymph nodes below the collar bone

cN3b - Cancerous cells found in one or more lymph nodes around the armpit and breastbone

cN3c – Cancerous cells found in one more lymph nodes above the collar bone

M, or Metastases, describes whether the cancer has spread to other parts of the body.

cMo(i+) - No sign of metastases on physical examination, scans or x-rays, but cancer cells are present in blood, bone marrow, or lymph nodes distant from the breast

cM1 - Cancer has spread to another part of the body

pM1 - Tumour measuring more than 0.2 mm across has spread to another part of the body It’s an important to get an accurate diagnosis of the stage of breast cancer as this may impact the type of treatment you receive.

Coping with a Breast Cancer Diagnosis

Receiving a breast cancer diagnosis can come as quite a shock and may leave you feeling confused and fearful of the future. It is important to get the right information about the type of breast cancer that has been diagnosed, the stage it has reached, and look into all treatment options available to you in order to give you or your loved one the knowledge and information you need to make the best treatment decisions.  A second opinion can help you to explore all your options so you can make the right choices for you. 

Your doctor or specialist will help guide you and your family and provide you with support and further information. It is important to give yourself the time and space you need to get your head around your diagnosis and the best path forward. Some people find it helpful to discuss their feelings and experience with other people with breast cancer, either in person, via telephone service, or online.

You may find it hard to share your diagnosis with close friends and family, but there is a wealth of information available to help you do this, and how to talk to your loved ones about your progress. The ability to discuss a breast cancer diagnosis can be a big help in helping you deal emotionally with your cancer journey, as well as help those around you understand and support you.

Second Opinions for Breast Cancer

It’s widely encouraged for patients to get a second opinion about their diagnosis and/or treatment options for any cancer diagnosis.  As breast cancer is particularly varied with a wide range of stages and prognoses, you may wish to get confirmation of your diagnosis, or investigate a second opinion for peace of mind. Oncolomed can help facilitate second opinions with breast cancer specialists from leading hospitals globally. Find out more about how we can help you obtain a second opinion for breast cancer.

Breast Cancer Treatment Options  

There are a number of treatment options for breast cancer depending on the type and stage you have. The treatment or combination of treatment you are recommended will depend on a number of factors. It is important to clarify that you should be in control of your treatment at every step and have access to all available options to make an informed decision about how to proceed.

The type and stage of your breast cancer will determine the treatments offered to you. Common treatments include surgery to remove the breast or part of the breast and surrounding tissue, radiotherapy, drugs created to target cancerous cells, and chemotherapy however with research there are innovative treatments that are now available globally, some of which can be offered through OncoloMed's network of hospitals. Learn more about some of the innovative cancer treatments we can facilitate.

How OncoloMed Can Help

Oncolomed can guide and support you through every step of your cancer treatment journey. Take a look at our patient stories to find out how we help or view our service pages to find out more about how we can help.