A Young Person's Guide to Checking Your Breasts for Cancer

Sorry to begin with a downer ladies, but breast cancer is a disease that no woman (and no man for that matter) can afford to ignore. It is the most common cancer affecting Australian women, with one in eight women receiving a positive diagnosis at some point in their lives. It is also the second highest cause of cancer-related death in women after lung cancer. While the latest stats have yet to come out, it was estimated that in 2015 15,600 women and 145 men would be diagnosed with the disease.

Given that it's such a common and potentially lethal condition, it's important to understand what it is, what to look out for, and what to do if you think you might have it.

What is breast cancer?

Breast cancer most commonly occurs when the cells lining either the breast lobules (the parts that produce milk) or breast ducts (the tubes that carry milk to the nipple) begin to grow abnormally. Rarer forms of breast cancer include Paget's disease of the nipple and inflammatory breast cancer, which is a type that affects the lymphatic vessels in the skin of the breast.

Breast cancer can spread locally within the breast, via the lymphatic system to the lymph nodes in the underarm, but also through the blood to distant sites such as the lungs, liver, and brain.

What are the risk factors and can breast cancer be prevented?

There are many different risk factors for breast cancer, only some of which are avoidable. These include:

• Being female (not as obvious as you'd think—guys can get breast cancer)
• Increasing age (the average age of diagnosis is 60)
• Inheritance of gene mutations such as BRCA1 and BRCA2 (approximately 5-10 percent of breast cancers fall into this category)
• A strong family history of breast cancer
• A personal history of breast cancer
• Being overweight or obese (especially after menopause)
• Drinking alcohol

While there is no definite way to prevent breast cancer, some risk reducing strategies for high-risk women have been trialled. These include taking certain drugs if there is a strong family history, or "doing an Angelina Jolie," which basically means having both breasts removed if there's a genetic predisposition to cancer.

What should I look out for?

Most breast cancers present with a lump in the breast or the underarm (it's important to remember that breast tissue goes all the way up into the armpit). Other symptoms can include a rash or red swollen breasts, dimpling of the breast skin, breast pain, or changes to the nipple such as discharge, inversion, or sores. You can identify these symptoms by regularly checking your boobs.

How to Check

The Royal Australian College of General Practitioners recommends that all women become aware of how their breasts normally look and feel. Becoming familiar with your breasts is easy if your perform regular breast self-checks at home:

• Stand in front of a mirror and raise both of your arms in the air. Look for any changes to the nipple and breast.
• Put your hands on your hips and push your shoulders forward. Again look for any changes.
• In a standing or lying position, roll the breast tissue under your fingers, feeling for any lumps or thickening. Make sure you cover the whole breast and feel right up into the underarm.
• Check your nipples for discharge by gently squeezing the breast tissue adjacent to it.

If you want to watch a thorough but embarrassing clip to help you out, watch this.

I've felt a lump! How do I know if it's cancer?

If you feel a lump in your breast or have any other worrying symptom go see your doctor. They can investigate the lump using an approach called the "triple test." The triple test involves:

Breast examination

A doctor will palpate (feel) your breasts to locate any lumps, as well as feeling for swollen lymph nodes in your underarms. The doctor may also get you to raise your arms or put your hands on your hips (just like in the breast self-exam) as these maneuvers can accentuate some lumps and breast tissue tethering.

Breast Imaging

This can be a diagnostic mammogram (x-ray), ultrasound, or MRI depending on your age and the density of your breasts.

Biopsy

A sample of the lump is obtained to see if the cells are cancerous. This can either be a fine needle aspiration where a thin needle is used to remove cells, or a core biopsy where a small piece of tissue is removed with a needle.

How is breast cancer treated and what is the prognosis?

The standard treatment for breast cancer is surgical removal of the lump and some surrounding tissue, and removal of one or more of the axillary lymph nodes on the same side. If the tumor is very large a full mastectomy—meaning removal of the breast—will sometimes be required.

Following surgery, patients often have a course of radiotherapy to remove any trace deposits of cancer that have escaped surgical removal. Additional therapy such as chemotherapy or hormonal therapy might be needed depending on the stage (spread), grade (how abnormal the cells are), and the presence of certain receptors on the cancer cells.

Like most cancers, if breast cancer is detected early then the likelihood of surviving is much higher. Of the 15600 women and 145 men predicted to get breast cancer in 2015, it was estimated that 3040 females and 25 males would die from the disease that year. Additionally, between 2007-2011 the five-year breast cancer survival rate was 90 percent.

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