I'm Dr. Zoe Williams and welcome back to "Bupa's Inside Health" series.
And today, we're talking about breast cancer.
I'm joined by Dr. Rebecca Rora and Dr. Shiroma De Silva-Minor, and we're gonna be talking about what is breast cancer, what are the common symptoms, How can we check ourselves.
We'll be talking about some of the common myths and also answering some questions that have been submitted by Bupa customers, so we can all be more informed when it comes to breast health.
So Shiroma, let's start off with this term, breast cancer, we hear it all the time, but what does it mean?
What exactly is it?
So breast cancer is cancer that started off in the breast, simply put, but it's actually quite complex because that simple term encompasses a number of different subtypes, depending on where they start off in the breast.
The commonest breast cancers start off in the milk ducts or in the milk globules, so doctoral or lobular cancers.
And when we are thinking of a cancer, it's important to think about the stage or how far it's spread.
So if it's gone to the lymph nodes or further afield, so it can be stage one through till four, and if there is a breast cancer, we also need to think about the grade.
So how aggressive is it on a scale of one to three?
And this is something that's looked at under the microscope and done on the biopsy.
So that term breast cancer is a blanket or an umbrella term that encompasses a lot of different subtypes and it's very complex.
Yeah, it really is.
And that collective term then, breast cancer, we know that it is one of the most common cancers in women in the UK.
Roughly how many people does it affect each year?
So breast cancer is actually the commonest cancer affecting women globally with about 2.
3 million women new cases every year.
Cancer Research UK put the number in the UK at about 56,000 new cases each year in 2020.
So it is incredibly common, with about a lifetime risk of about one in seven or eight.
And that's why, I think realistically, it's likely that we all will know somebody at some point who gets breast cancer because one in seven, that's quite common, isn't it?
And whilst it is a condition that is much more common in women over 50, it's really important to remember that it can affect and it does affect younger women too, and men as well.
Absolutely, so breast cancer, like most cancers, tends to be much commoner as you get older and that's because of defective DNA repair and damage that accumulates over your lifetime.
And so, eight out of 10 breast cancers will be much more common in ladies over 50.
Breast screening in the UK is between 47 and 73, and that's designed to capture that age group that is most at risk.
But the peak instance is at about 65 to 69.
Now, a quarter of all breast cancers will be above that upper age limit, so older ladies in particular need to be much more aware of their breasts, but anyone from 20s upwards really needs to be able to examine themselves and to be aware of any changes, particularly if they fall outside of that screening group and need to keep continuing to monitor.
And of course in men, it does affect men, it's quite rare.
Less than 1% of all breast cancers occur in men and in the UK, there's less than 400 cases annually, but it's much more likely, as men get older, if they're overweight and one in eight will have an underlying genetic cause for their male breast cancers.
I think we always have to be a little bit careful when we talk about lifestyle factors and cancer risk, 'cause we never want people to feel that they cause their cancer through an unhealthy lifestyle 'cause that's not how it works.
But actually, trying to be more healthy can decrease your risk when it comes to breast cancer, can't it?
And it's anticipated that up to 30% of cancers could be attributable to lifestyle factors, which could be amendable.
And so, diet and lifestyle are very important and one of the big ones is alcohol.
I'm always surprised how many of my patients are not aware that alcohol may have had a causative effect in breast cancers and Cancer Research UK predict that up to 8% of cancers could be attributable to alcohol.
And this is related to DNA damage and oestrogen, the impact on estrogens.
And so alcohol.
It's really about making an informed decision, and for breast cancer survivors, we know that as little as three units a week could increase that risk of recurrence.
So, as long as women are making an informed decision about their lifestyle choices, then that's really important.
Diet is obviously important.
Eating healthily, varied, colourful diet, ideally a Mediterranean type diet, minimising processed food.
We know that exercise is really important and consistently over the last 20 years, various studies have shown that increased activity reduces breast cancer risk.
Okay, and it's always a tricky subject, I think, when we talk about obesity because we know that for a lot of people, it's very, very difficult to manage obesity.
But there is quite a significant link between obesity and breast cancer, isn't there?
And it's obesity or being overweight in post-menopausal women seems to increase the risk of breast cancers.
We know that fat cells produce estrogens and they can increase your risk of hormonally-driven cancers, not only breast, but also endometrial cancers.
So ideally maintaining weight to a body mass index of under 25 is healthy from a breast cancer viewpoint, but also reduces strokes, heart attacks and risk of dementia.
Okay, and then that's lifestyle, which is obviously really important, but genetic risk is something that is talked about quite a lot in breast cancer and I think most people have heard of the BRCA gene.
But can you tell us a bit more about genetics and the links between breast cancer more generally?
So a gene mutation is a change in the DNA sequencing at DNA level, which can cause a cell to malfunction and possibly become cancerous.
We know that there are certain mutations that can be passed on in families and are considered hereditary or germline.
And one of the commonest ones that we know of is the BRCA One and Two mutation.
But there are about seven other gene mutations which are commonly associated with the risk of breast cancer.
The BRCA genes can increase your lifetime risk of breast and ovarian cancer in women and in men, male prostate cancer and male breast cancer.
So it is important to be aware of it particularly if you have a number of family members with breast cancer or cancers at a young age or male breast cancer, prostate cancer or pancreatic cancer.
And I think whilst having one of those defective genes increases your risk, it's always important to say it's not inevitable then that you will get cancer.
But for people who are worried if cancer does seem to run in their family, can they ask for tests?
So if you are found to be a gene mutation carrier, particularly the BRCA One and Two, then it means that there is a 70% lifetime risk of developing breast cancer before the age of 70.
But it's not inevitable.
And of course, if you know that you are a gene carrier, there are risk reductive strategies in terms of monitoring, screening and risk reductive surgeries.
So we know that Angelina Jolie famously talked about her experience with being a BRCA1 gene carrier because sadly her mother and aunt died of breast cancer and that's how it was identified.
And she was a vocal advocate of risk reductive double mastectomies and having the ovaries removed.
And those surgeries reduce risk factors down to very low levels.
So it's really about being armed with that information and amending your risk through those ways.
But having one of these defective genes doesn't mean it's inevitable you will get breast cancer, though the risk is significantly higher.
If breast cancer does run in a person's family, who would qualify for genetic screening?
So that's a great question.
So if you have a significant family history of breast cancer or multiple different cancers or cancer at a very young age, so under 40 for breast or other cancers, or a prostate cancer under 50, then it may be that you have a genetic mutation that runs through your family.
And so you can talk to your GP and they will be able to do a family history questionnaire and refer you on to a geneticist to assess your particular risk.
Now if you've already had a breast cancer, then your oncologist will be assessing all of those risk factors as part of your family history and your personal history.
And again, they may be able to refer you directly, particularly if you have a particular subtype like triple negative breast cancers under the age of 50 or breast cancer in both breasts or cancer at a very young age, So under 30 or 32.
But if you are concerned, then speak to your GP and genetic testing is now easily done on a saliva or blood test and the results can be available within a month.
We're seeing that survival rates of breast cancer over the past few decades are going up and up and up largely due to new technologies and the treatments are getting better.
What are some of the newer treatments and can we allow ourselves to be quite optimistic because this technology just gets better and better?
I think that there is room for a great deal of optimism in the treatment of breast cancers.
And certainly we know that breast cancer survival has doubled over the course of the last 40 years.
And even in my 20 years as a breast oncologist, I have seen amazing advances and that's across the board from imaging techniques that identify cancers at a very early stage.
Surgical techniques which are much less disfiguring and just as effective or more effective.
Technical radiotherapy and image guided radiotherapy, intensity modulated and high precision radiotherapy all add to the ways that we can deliver treatment in a way that is as safe as possible because we know that for the majority of our patients, they are going to be long-term survivors and we don't want to have adverse effects as a result of the treatments, but particularly they're being great advances in systemic treatment.
So targeted therapies, immunotherapies, and biological therapies.
So even as recently as 10 years ago, we used to treat breast cancer very much as a one size fits all and now treatments are very much more bespoke to the individual patient and the tumour subtype.
And we are now seeing great advances in breast cancer outcomes.
I think definitely some cause for optimism there.
Dare we be optimistic enough to think that there'll be a cure for breast cancer anytime soon.
So overall about eight outta 10 patients will be cured from early detection and active treatment.
But because we know that some breast cancers can recur even 25 to 30 years later, only time will tell, but we know that breast cancer survival has doubled over the course of the last 40 years.
And so we are definitely seeing an improvement, but the stage is really important.
So the earlier detection and treatment will mean that the higher the likelihood of cure.
So unfortunately, stage four, where the cancer has spread further afield is still not curable, but there have been some great advances and for certain subtypes, they can have very effective treatment that allow the patients to live for very many years.
So we are entering a new era of stage four disease, almost being like a chronic illness.
So yes, lots of room for optimism there too.
Great, thank you, Shiroma, thank you for sharing all that knowledge with us.
I think that gives us all a better understanding of everything when it comes to breast cancer.
So thank you.
Whilst it's powerful to hear about breast cancer from doctors, it's also powerful to hear about it from somebody who's been through it.
Earlier I sat down with Joe Knight, who's a breast cancer survivor and now a campaigner and I want all of you to hear her story too.
So lovely to meet you.
So you are a breast cancer survivor mom, campaigner, absolute inspiration.
Oh, thank you.
What I'd like to do first of all is just ask where are you at the moment on your breast cancer journey?
Okay, I'm five years this year cancer free.
Yeah, I was diagnosed back in 2017.
Yeah, it's a huge kind of milestone to hit within the cancer world.
It's five years free.
So it's amazing.
But I imagine that five years has been.
Well, I mean you tell me, people describe it as a journey often.
How would you describe that?
Yeah, it's a journey.
It's a real rollercoaster of emotions, physically, mentally, it really is.
It's just a whirlwind, I dunno where the last five years have kind of gone, really.
They've sort of just whizzed you by.
It really has.
It really has.
From sort of the start to now.
It's like in the distance, where did that five years go?
Well, can we go right back to the start?
So how did you first identify that there was something wrong?
So obviously always checked my breasts regularly, probably not as often as I should, maybe every other month.
And I found a lump that I wasn't sure of.
I'd had a breast reduction six years prior.
So I just assumed it was fatty tissue.
Didn't think anything of it.
Left it for a bit, then I checked again and thought, not quite right, I'll go and get it checked out.
So at that point I then phoned and got a doctor's appointment to see myThank goodness.
Yeah, if I hadn't have done that, I think my story could have been a very different one.
I might not been sat here now you don't know.
Well that's the importance, isn't it?
Of self checking.
And you said maybe you didn't do it every month, but you did it didn't you, which is the main thing.
You were checking.
That is so, so important.
So how quickly did you see your doctor and how quickly did you.
How did things progress from there?
I think, 'cause I've mentioned on the phone to the receptionist that I found a lump, I need to see the doctor, I'm not sure what it is.
I was seen within that week.
There was an appointment available and the doctor, she wasn't sure herself, obviously not being a breast expert, she said there is a lump, I'm not sure what it is, but I will refer you.
Don't be alarmed.
I'm gonna put you through on the rapid access, which you'll seen within two weeks.
I was seen within 10 days.
So I wasn't too overly concerned at that point because it was the unknown.
I didn't know what it was.
And that's the message that I always give to my patients.
If you're concerned about something, if there's something there and we're not sure, we need to get you seen within that two week period becauseThat's what you guys are there for.
More often than not, it's not the breast cancer, but if it is, then it's so importantAnd the detection is key.
So how did things progress?
You said you were seen within 10 days at the specialist breast cancer unit.
Yeah, at my hospital.
And then what happened?
So on that day, I was seen by the consultant.
He did an examination, obviously they must have an inkling there and then, because it was a bit like a one-stop shop for me.
So I saw the consultant, I then had a mammogram from there on, I then had a biopsy on the same day.
And after the biopsy, saw the consultant again.
Again, obviously he'd seen the imaging, couldn't say anything because there had to be a few more tests, the biopsies had to go off.
And then I was seen back with him within.
Must have been within two weeks at least.
So it was really quick.
So I guess within a month then, is it?
Yeah, for me it was within a month, yeah.
Which was great.
And I think within a month if people aren't checking or sometimes people might delay for more than a month, they're just thinking, oh I'll just see if it goes away.
But it's really important.
I think that's what I hoped.
I delayed it a little bit.
Not a lot, but I think I was hoping, oh, it's nothing, it'll be okay.
But I'm glad I went when I did.
So then your treatment started.
What treatment did you have?
Pretty soon I had to have, because of the nature of the lump where it was, I had to have chemotherapy first.
So six months of chemo, then a mastectomy, then radiotherapy.
And then because my cancer was hormone related, I had to have a full hysterectomy as well.
So been through the mill .
You have, you have.
And tell me a little bit about your family.
I'm a single parent to a 15 year old daughter.
So she was eight at the time when I was diagnosed.
Yeah, I'm a mom and dad, sister, brother.
Breast cancer isn't in the family history.
My dad had prostate cancer but he's in remission now, which is great.
Everything that you've been through, how does that impact you or how did it impact you?
But also how did it impact your daughter?
Yeah, it's hard isn't it?
Because your world just comes.
You're told, I'm really sorry you have cancer.
You become numb, your world comes crashing around and you just panic.
And for me, I'm an incredibly positive person.
I always have been.
But my fear initially was everybody else, not me.
It was how are my parents gonna cope?
How's my daughter gonna cope?
Am I gonna die?
That's your initial reaction.
Do you think most people think that when they hear the word cancer.
Do you think most peopleWithout a doubt, yeah, I think I'm gonna die and that's what the scary thing is.
And I think until you know exactly what you are dealing with and you get your head round it in the diagnosis and the worst thing that people do is go home and they'll Google it.
Do not Google your diagnosis and it's the hardest thing not to do.
It's really hard because you feel that you need that information.
You get so much negativity and I think exactly until you know what you are dealing with, and your.
I didn't know there were different types of breast cancer.
I just thought there was breast cancer, that was it.
But there's so many different grades, so many different types of breast cancer that are treated in different ways.
And was yours.
Were you told that yours was a particularly aggressive form of breast cancer?
Or were you given those statistics that I think sometimes people want, what are the chances of survival, et cetera?
It's hard, isn't it?
Because you want to know, yeah, am I going to die?
What's my lifePersonal questionBut I was scared to kind of ask that.
But because mine was a grade two, if my consultant said if I'd left it any longer, it would've been that next step, next further slightly different treatment.
It wasn't as aggressive as others.
So in that respect, I was lucky, if lucky is a word you use when you've got cancer.
But to me, I was lucky I'd gone early enough andBut you had to, like you say, through the mill with the treatments, chemotherapy, surgery to remove your hysterectomy as well.
So my cancer was hystero-receptive.
And did you have your ovaries removed as well?
That's instantly into menopause as well.
So not easy.
No, not easy.
And hence I think that's been.
My hair hasn't grown back properly, so people may be thinking, why is she still wearing a head scarf?
Why she's not got a lot of hair?
That's probably, my hair hasn't grown back properly.
I kind of expected a full head of hair after five years.
But now you're at this five year point, five years cancer free.
That is a massive milestone.
Because that's like, you can now think about moving on with the rest of your life.
How do you feel about the rest of your life now?
I can't be any other way.
And when you're going through treatment, you're at the hospitals, you're seeing your nurses, you're seeing the specialist.
It's like you've got a comfort blanket.
And you're seeing somebody all the time.
When you finish your treatment and you'll see bye off you go, go your treatment's finished now.
That's when the scary thoughts come in.
You've lost that comfort blanket.
You're not seeing anybody regularly and that's when the kind of fear comes in of recurrence.
And interesting that you decided to not have reconstructive surgery.
Can I ask you about that?
Because when I finished my treatment after radiotherapy, I was left for a year with having had a double mastectomy.
So living with no breast.
I kind of got used to it.
I think I decided not to.
I just didn't want any more surgery.
And for me having had a breast reduction then going to having nothing, I felt comfortable in my own skin, in my body.
And I want other women to understand and to be happy with who they are.
And that boobs don't define you as a woman.
They don't define.
They didn't define me and I just want to promote body positivity and it is okay to remain flat and I want that to be an option for other women who are going through, 'cause you automatically think you're gonna have reconstruction.
And do they talk to you about reconstruction as if it's what's gonna happen.
It's not talked about massively at the time of the appointment.
I think it's just initially all your treatment you're gonna have and I just assumed that I would have reconstruction, immediate reconstruction with my surgery, but because I had to have radiotherapy afterwards, They wanted me to heal properly before if I decided to have reconstruction and it's a huge surgery.
Well your positivity is contagious.
I think the body positivity, your positivity of mind, it's amazing.
What would be the one message you would want to share with other people?
Is just to not be scared of your body.
Check yourselves regularly.
And early detection is key and it's all about educating from the younger generation.
My daughter's 15, so it's so important for me to educate her and the younger generation, not to scare them, but to know their body.
Not to be scared to touch your body, to feel it, to know your normal.
It's so, so important that once a month us women are checking and men too 'cause men get breast cancer too.
And it's important we do it in front of our children, don't we?
We brush our teeth in front of our children.
It's so important.
And this is no different, it's just part of self-care.
So important not to be embarrassed about your body.
We're all different.
It's your body.
It's my body.
It's your body.
Be proud of who you are.
Well, thank you so much for sharing your radiance and positivity with us.
Oh, thank you for having me.
But also hopefully for inspiring lots of people out there.
I hope so.
To check themselves.
To look after themselves.
And people, you're not alone.
There are hundreds of women, men out there who have been diagnosed.
If you are struggling, get help and just if you find a lump, get it checked.
Joe, thank you so much for sharing.
I think it's so important, as Joe said, that we're checking regularly and if we find anything we're concerned about, we act on it straight away.
When it comes to cancers, breast cancer is one of the types that does not always but often give us clues that it's there.
But in order to pick up those clues, we need to be regularly selfchecking.
We need to know what we're looking out for and also attend any screening mammograms that are offered to us.
So to find out a little bit more in detail what the signs and symptoms are and what to do about it.
I'm gonna have a chat with Rebecca.
So firstly, what are the signs and symptoms of breast cancer?
I think the one that people are most aware of is a lump or swelling in the breast.
Important to remember that that might not be in the breast itself, it might be in the upper chest or even in the armpit.
So important to examine those areas as well.
Also a change in the size or the shape of the breast or a change in the appearance or the consistency of the breast.
So skin changes like dimpling or puckering, really important to speak to your GP about.
In addition, any rashes or redness and inflammation of the breast itself is also a reason to speak to a doctor.
And finally, I think changes to the nipple.
So a pulling in of the nipple, an inversion of the nipple, rash or or crusting around the nipple, and even discharge from the nipple itself are also reasons to seek help.
I think people become very concerned about breast pain.
Actually, that's a really uncommon symptom of breast cancer.
But if it's bothering you and if you've got kind of persistent pain in the breast, in the armpit or in the chest, then that's also a reason to see the doctor.
And as we've mentioned before, also really important to remember these aren't just symptoms for women, they're also symptoms for men as well.
So important to put that in mind.
And I think, on the one hand, it's a positive that breast cancer can give us these clues.
So it's important to know the signs and symptoms, but I think what's really important is that people are just familiar with their own breasts so that they're checking their own breasts regularly.
And then anything that is a change that seems unusual, rather than remembering all of that, if you can remember it, great.
But anything that's unusual, get it checked out.
Yeah, I couldn't agree enough.
This is about women and men understanding what is normal for them, particularly for women at different stages in the breast development, during puberty, in their young life, before and after children, before and after the menopause, at different points in their cycle, really important that they understand what the breasts look like, breasts feel like, and also what's normal in terms of the feel and the appearance of the armpits as well.
So I think it's just about understanding what's normal for you now, checking in regularly about it and knowing that if you do notice something different, to go and ask for help and that there's no such thing as a stupid question.
And your GP absolutely wants you to go and see them or speak to them at least straight away.
So being breast aware and checking is our main defence against breast cancer.
But what's also really important is our defence for people who are eligible in the right age bracket is the screening programme.
So that's mammograms.
Yeah, so mammogram is the type of breast X-ray and people might have one of those either as part of the National Screening Programme, as you mentioned, or if they've been referred by their doctor to a specialist appointment.
Now the mammogram itself, important for women to know what to expect during that 'cause it can be a source of anxiety for people.
They'll be invited into the room by the mammographer and you can ask to see a female mammographer if that's important for you.
You'll be asked to undress down to the waist and will be positioned in front of the mammogram machine.
What they'll want to be doing is taking a couple of images of both breasts and to do that, they'll position one of the breasts onto a firm plate, put a clear plate above it and take one image top to bottom and one side to side, including some of the armpit area as well.
Now it's important that people stay still during that.
It can be a bit uncomfortable because the breast is compressed between those two plates, but it only takes a couple of seconds.
I think because it's an X-ray, people can become a bit concerned about the radiation.
Actually in reality, that's a really low dose.
It's about the same as going to Australia and back in terms of radiation dose and the benefits of doing the mammogram tend to out outweigh the risk of doing that.
Also because if it's an X-ray, really important to mention if there's a risk that you could be pregnant or if you are pregnant.
It can be a really worrying time for people if they are referred to be investigated further because they have breast symptoms.
But actually the majority of the time actually turns out to not be breast cancer and be nothing or be something else.
What other things can give breast symptoms that aren't breast cancer?
That's absolutely right.
I mean the majority of women attending for these assessment days will end up being diagnosed with a benign breast condition.
So a non-cancerous breast condition.
In terms of lumps and swellings, one of the really common causes of that might be a fibroadenoma, which is a lump that develops in the breast often during puberty, but it can develop at any age.
In addition, breast cysts can develop.
Those are fluid-filled sacs that often develop in the breast with changes that happen because of age.
So particularly around the menopause, those can start to present themselves.
I think, also really important that people remember that some of those nipple symptoms, so nipple discharge can actually be caused by benign conditions like duct ectasia, which can cause a milky discharge.
Again, something that can happen as a result of age-related changes.
So lots of causes of breast symptoms.
I think the underlying message is to anyone out there, if you notice anything that's unusual, get it checked out sooner rather than later because the chances are it's not breast cancer anyway and you're worrying without any reason.
And if it is breast cancer, the sooner it's diagnosed and the sooner it's treated, the better the outcomes.
And it's really important, Rebecca, that we remind people, even if you're having your mammograms every three years, you still need to self-check in between.
And if people do find something concerning, what should they do?
I think a lot of people's first point of call will be their GP.
Their GP will ask some information about the signs, the symptoms, a bit about the medical history, they might ask about the family history as well.
They'll also want to examine the breasts and the armpit areas.
If they feel that a specialist appointment is necessary, it's important that women know what to expect at that.
So the specialist consultant will also want to examine the breasts and the armpit.
Many women will then go on to have imaging that might be a mammogram, but it might be an ultrasound.
It depends on the age and and the nature of the symptoms.
In addition to that, a small sample of breast tissue might be required to help make that diagnosis.
That can be done under a local anaesthetic very quickly, usually there and then, sometimes with imaging.
When that's all done together.
So the examination, the imaging and the biopsy, that's called a triple assessment or a one-stop shop.
And often that's enough to make a diagnosis on the day.
Where that isn't enough, sometimes women might be referred for something else, for example, some more detailed imaging.
I think it's really important that women remember that everybody who is doing those assessments is aware that this is a really anxiety provoking time.
And Bupa really tries to support people through that.
Firstly through direct access so people can call with symptoms.
There are a couple of straightforward questions with no claims impact that are assessed against national guidance and if that's passed then that's enough for a referral to a consultant.
Also really important that people remember that we have 14 specialist centres for breast cancer care and that allows a very fast, very frictionless access to diagnostics, often within a few days.
And if cancer is diagnosed, then onwards to treatment.
And at the moment, we know that people typically start treatment in about half the time of the national waiting time of about 31 days.
And that all helps to alleviate people's concerns in terms of that period of uncertainty before a diagnosis can be made.
And I think also really important thing to add is that if people detect something that seems unusual for them, don't delay, go and see your doctor.
Usually, it doesn't turn out to be breast cancer, it's fine to monitor it for a couple of weeks, but if it's not going away, really important to get it checked out, because those delays, if you leave it for months and months, it can actually make a really big difference to the outcome.
Thank you for sharing all of that.
I think that means we're all much more aware to what to do, what to look out for, and also what will happen if we do go down that path of investigation.
When it comes to being breast aware, the most important thing to do is get to know your normal because this means you are well equipped to identify if anything changes and then you can get it checked out straight away.
And if you're wondering how to check, here's a little something I made earlier.
Here's a quick demo of one way you can self check.
So starting off by looking with your top half, looking from the front, different hand positions, hands behind your head and also pushing onto your hips.
And then do the same from one side and the same from the other side.
And next you're going to feel.
So start with one breast, use the pads of the fingers and use whatever technique works for you.
This is the spiral technique.
So as long as you feel every single area of the breast, it doesn't matter how you do it, some people use the lawnmower technique, some people imagine the breast is in four quarters and fill one quarter at a time.
To complete the examination, you're gonna also feel the front of the chest wall all the way up to the collarbone.
It doesn't matter which hand you use, whatever is easiest.
And then also feel all of the areas in the armpit.
And once you've done one side, the same on the other side and then you're done.
So there you go.
A self check is quick, it's easy and you really can't do it wrong.
The most important thing is just do it.
If you are a mom, do it in front of your daughters.
Talk to your gran about it, your aunties, your sisters, your friends.
And remember that men should be checking too.
This is the best defence we have against breast cancer.
So let's get everybody checking.
There's just so much to talk about in this topic.
And as always, we've asked you to submit some questions for our experts prior to this event.
So we're gonna cover some of the topics and some of the areas that we haven't covered already.
So Rebecca, I'm considering HRT, but I've read it makes my breast cancer risk worse.
Is this true?
HRT is hormone replacement therapy.
It's a treatment used to treat the symptoms of menopause by replacing the hormones that naturally decline with age.
HRT has a fantastic effect on alleviating some of those really concerning symptoms that impact people's quality of life.
But it's important to understand the risks and the benefits of it.
HRT does increase the risk of breast cancer, but it is complicated and it's much related to how long you take the HRT for and the kind of HRT that you take.
There's still lots of research going on in this area and it's been proposed that that increase in risk might be to do with oestrogen and the fact that some breast cancers need oestrogen to grow.
Now we know that the longer you take HRT, the higher the risk of breast cancer, but also the type of HRT.
If you take combined HRT, which has oestrogen and progesterone, then that has a slightly increased risk as well.
What I would say to women is it's really important to balance the impact of those menopause symptoms on the quality of their life together with the other benefits of HRT, such as on bone and heart health and to talk to their doctor, talk to their gynaecologist, talk to their oncologist about any questions they have so that they can make a balanced decision.
Okay, and it's tricky isn't it?
Because actually that that risk benefit equation will be different for different people.
And we've already talked about how things like drinking too much alcohol, not being physically active, having a poor diet, these things can increase your risk and we know that actually the symptoms of menopause can make drinking more likely and so there's a lot of weighing up to do.
The next question is, I have regular breast pain and I'm worried it's cancer, could it be something else?
So breast pain is really common as a symptom, but it's a very uncommon symptom of breast cancer.
I think lots of women have pain around certain times of the month.
We call that cyclical breast pain.
It may not necessarily be pain, it may be a burning sensation, a singing sensation, a sense of heaviness that might include one breast, it might be across both breasts.
But in cyclical breast pain, it does tend to be often before the period so that once a woman's period starts, then that pain will go away.
Often we see that pain stopping around the time of menopause, although of course it can continue afterwards, especially in women who are taking HRT.
I think pain that's there all the time, non-cyclical breast pain can also occur and that that's not at particular times of the month.
What we would say is if you are bothered by a pain, if you are worried about a pain, even if you've been having it for a long time or if it's a new pain, then please ask for help.
So it's not just about minimising and saying, "Oh, it's nothing to worry about.
" If you are worried about it, we'd rather that you spoke to a doctor.
I completely agree.
Shiroma, a question for you.
I've had cosmetic surgery on my breast, do my implants put me at higher risk?
So implants per se don't increase the risk of breast cancer, but it can be associated with a very rare type of aggressive lymphoma known as anaplastic large cell lymphomas.
Now these are incredibly rare.
And actually I have a question that sometimes I've been asked is if somebody has breast implants, then when it comes to doing self-checks and self examinations, does it change anything?
Does it make it more difficult?
So there are two types of implants.
So they can either be subpectoral, so behind the muscle or in front of the muscle, but at the back of the breast tissue.
So usually the breast tissue is still in front of the implant and so it shouldn't really cause a problem with self-examination and absolutely you should continue to examine and really look for any changes to the norm.
Okay, that's great.
Thank you very much.
Question for you, Rebecca.
I've been on the mini pill for more than 10 years.
Should I change my contraception now and what's best to lower my breast cancer risk?
So the mini pill is the progesterone only pill.
We sometimes call that the POP or the pop.
And there's still lots of research about whether taking a progesterone only pill increases the risk of breast cancer or not.
And that also goes for some of the other progesterone only contraceptives available like coils and implants and injections.
We do know that the combined oral contraceptive does increase the risk of breast cancer, but it doesn't increase it by a lot.
And once you stop taking it, then that risk does reduce down to normal after a couple of years.
However, we also know that breast cancer is rare in younger women and that the combined oral contraceptive is a really safe, really effective form of contraception.
And so again, that goes back to that risk-benefit discussion.
For most women, the benefit of taking the oral contraceptive massively outweighs the slightly increased risk of breast cancer.
But again, if you have questions then please speak to your GP, your nurse, your family planning clinic gynaecologist or oncologist who can help you to kind of understand how your particular circumstances fit.
Yeah, so it comes down to that individualised risk versus benefit and also taking the combined oral contraceptive pill, whilst it does have a slight increased risk of breast cancer, there's an actual slight reduction in risk of some other cancers.
So colorectal cancer and I think endometrial cancer.
Overall I believe there is no increase or decreased risk of cancer across the board.
So the next question is for Shiroma.
My mom has recently been diagnosed with triple negative breast cancer.
Can you explain what this is?
So triple negative breast cancer is one of the four main subtypes of breast cancer.
And the triple negative part refers to the fact that it's oestrogen, progesterone and HER2 receptor negative.
And effectively these are cell surface receptors on the surface of a breast cancer cell.
And where we don't have those receptors to target, it means that chemotherapy and possibly immunotherapy becomes much more important in their management.
They do tend to be more aggressive cancers, but there's still treatable and curable at an early stage and they're much more likely to be associated with an underlying genetic cause.
So a 20% risk of an underlying gene mutation compared to the overall breast cancer risk, which is about 5%.
So would it be fair to say then if it's triple negative, so it's lacking those three different receptors that you spoke of, there'll be certain treatments, breast cancer treatments, that won't be effective.
So perhaps there's less choice of treatments in that particular scenario.
So you're right.
So ordinarily most patients would be treated with endocrine treatment, which are anti oestrogen tablet medication.
Of course that would beLike Tamoxifen is one of, I think people have heard- Exactly.
And that haven't and that would be ineffective in that patient group.
But we've now identified triple negative breast cancer as a very distinct group with different outcomes and different treatments which can be very effective.
So there are specific immunotherapy.
So immunotherapy and breast cancers only works in triple negative breast cancers.
So although there are some treatments that aren't suitable, immunotherapies can only work in triple negatives.
Where are we going to next?
Shiroma I've never had children and was told this makes my risk of breast cancer higher.
So different hormonal exposures throughout the course of a woman's lifetime can impact on her risk of breast cancer.
And this particularly relates to the total number of lifetime menstrual cycles.
And they can expose the breast tissue to certain hormonal changes which are associated with breast cancer.
And so you have an increased risk if you've got an increased number of total lifetime exposures, whereas your risk is reduced if the total number of menstrual cycles is less.
So for instance, during pregnancy and breastfeeding reduces your menstrual cycles and breastfeeding for 12 months reduces that risk by about 4%.
And pregnancy to term reduces that risk by about 7%.
So overall, if you have a baby and breastfeed for a year, you've had a 11% risk reduction.
And then if you compare that to two or three pregnancies, then you can see that your risk of breast cancer is significantly reduced compared to someone who unfortunately hasn't had a baby or breastfed.
So would it be true to say then if you started your periods at a later age, you'd have less periods over the course of your life and that would also reduce your risk?
And conversely, we know that starting puberty early and going through menopause late also increase that overall lifetime duration and increases the risk.
Shiroma breast cancer can also be confused with an infection of the breast known as mastitis or on the other hand not picked up because the symptoms are very similar.
Can you explain a bit more about this?
So mastitis is when the breast can be swollen, red and painful and maybe related to an infection.
So most commonly this occurs during breastfeeding with a blockage of the milk ducts, but it can occur in in ladies who aren't breastfeeding and also in men.
But it's important to know that these symptoms of a red, swollen, painful breast could also be a sign of a very aggressive type of breast cancer known as inflammatory breast cancer.
And it's important to differentiate between the two.
So if you do have any of those symptoms, really important to see your GP.
And if antibiotics aren't having a significant improvement in symptoms within seven days, then you'd normally be referred up to a specialist breast clinic so that you could have a biopsy of the skin, which could make a definitive diagnosis and differentiate between those two.
And unfortunately that's all we have time for.
So thank you Dr. Rebecca.
Thank you Dr. Shiroma and also thank you to Jo.
I think, hopefully that's really raised your awareness of the importance of self checking, attending screenings and also if you do notice anything that's not quite right don't delay and get it checked out.
Thank you for joining us.