Breast cancer

Breast cancer is the most common cancer in the UK.

Although many people think it is something that only affects women, it can also affect men. Anyone with breast or chest tissue can develop breast cancer.

Find out more about breast cancer in men.

Most cases are in woman aged 50 and over but younger women can also develop breast cancer. Breast cancer in men is much less common.

About 1 in 7 women are diagnosed with breast cancer during their lifetime. There is a good chance of recovery if detected at an early stage.

It is important to check your breasts or chest tissue regularly for any changes and to get any changes checked by a GP.

Breast screening with mammograms – special x-rays of the breasts – can help to detect early signs of breast cancer before other symptoms develop.

About breast cancer

Breast cancer develops after a change in the DNA of the cells in the breast. (DNA is the genetic material that tells cells what to do.) As these faulty cells divide and multiply, they eventually cause a cancer.

Sometimes a cancer cell from the tumour in your breast can spread to other parts of your body such as your liver, lungs, brain or bones. This is known as a secondary (or ‘metastatic’) breast cancer. It is also sometimes called advanced cancer.

It is not known what causes breast cancer but some things seem to increase the risk, including:

Age – it is more common in woman aged 50 and over
Family history – you might be at more risk if a close relative had breast cancer. Most cases of breast cancer do not run in families. If breast or ovarian cancer run in your family, your GP might refer you for a genetic test or to a breast family history clinic to check if you have inherited cancer-risk genes
Lifestyle – drinking alcohol increases the risk of breast cancer. Being overweight or obese after menopause also increases the risk
Breast type and history – if you have had breast cancer before or non-cancer cell changes in your breast ducts, you might be more likely to develop breast cancer. Some women have dense breast tissue that has more glandular cells than fat cells than average. This can also increase your risk of breast cancer
Hormones and medication – you might be more at risk if you had periods for longer than average (early periods, late menopause) or have never been pregnant. Taking hormone replacement therapy (HRT) for more than one year can increase the risk. The contraceptive pill may also slightly increase the risk.
Radiation – medical procedures that use radiation may slightly increase the risk. Examples include x-rays, CT scans and radiotherapy to the chest area

There are many different types of breast cancer. Find out more about different types of breast cancer.

The most common symptom is usually a breast lump or thickened tissue in your breast but other changes in a breast can also be a sign of breast cancer.

It is important to check your breasts or chest tissue regularly so you know what is normal for you and notice any changes. Most breast lumps are not cancer but you should get any lumps, thickening or other breast changes checked by a health professional.

Symptoms of breast cancer include:

New lump or thickened tissue in either breast that was not there before
Change in the size or shape of one or both breasts
Discharge of fluid from a nipple
Lump or swelling in an armpit
Change in the look or feel of the skin – for example, puckering, dimpling, a rash or redness
Rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple
Change in how your nipple looks – for example, sinking into your breast

Breast pain or pain in chest tissue is not usually a symptom of breast cancer.

It is important to see a health professional if you have symptoms or notice any changes in your breasts or chest tissue.

Know the signs and symptoms of metastatic (advanced or secondary) breast cancer

Breast cancer sometimes spreads to other parts of the body. This is known as metastatic, advanced or secondary breast cancer.

Symptoms vary so it is important to be aware of any unusual changes in your body. Make 2nds Count have created a useful 1-page guide that explains common signs that breast cancer might have spread.

Symptom checker for metastatic (advanced or secondary) breast cancer

Types of breast cancer

There are several different types of breast cancer. Each type responds differently to treatments. Diagnosing breast cancer includes tests to check what type of breast cancer you have to guide treatment.

Non-invasive breast cancer (carcinoma in situ)

Non-invasive breast cancer is in the ducts of the breast and has not spread to surrounding tissue. It rarely shows up as a lump and is usually found during a mammogram (breast screening). This is a pre-cancerous condition but can become cancer if left untreated. This is known as DCIS (ductal carcinoma in situ).

Invasive breast cancer

The most common type of invasive breast cancer is ductal carcinoma. This occurs when the cancer cells have spread to surrounding breast tissue through the lining of the ducts.

Less common types of breast cancer

Other, less common types of breast cancer include:

Invasive (and pre-invasive) lobular breast cancer
Inflammatory breast cancer
Paget's disease of the breast

Hormone and protein receptors

Some cancer cells have receptors for hormones or too much of a protein called HER2. This affects which cancer treatments may be most suitable.

Diagnosing breast cancer includes tests to check whether your breast cancer has receptors for hormones or excess HER2.

Hormone receptors and breast cancer

Breast cancer that is hormone positive has receptors that hormones can attach to. The hormones then help the cancer to grow. Cancers that have hormone receptors often respond well to anti-hormone therapies.

ER-positive: About 70 in every 100 breast cancers have receptors for a hormone called oestrogen – this is known as oestrogen receptor-positive breast cancer. It is usually shortened to ER-positive breast cancer. (In the United States, oestrogen is spelt as ‘estrogen’)
PR-positive: Some breast cancers have receptors for a hormone called progesterone – this is known as progesterone receptor-positive breast cancer. It is usually shortened to PR-positive breast cancer
ER-negative and PR-negative: Breast cancers that do not have receptors for these hormones are known as oestrogen receptor-negative (ER-negative) and progesterone receptor-negative (PR-negative) breast cancer

HER2 and breast cancer

HER2-positive: HER2 is a receptor protein that helps cancer cells to divide and grow quickly. Some breast cancers have high levels of HER2. This is known as HER2-positive breast cancer. Some cancer treatments can block the HER2 protein from helping cancer cells to divide and grow

Triple-negative breast cancer

Cancers that do not have receptors for oestrogen, progesterone or HER2 are known as triple-negative breast cancer. This is sometimes shortened to TNBC

Treatment depends on a range of factors including the type, size, stage and location of your tumour. It may also depend on your age, general health and genetic factors (linked to the DNA changes in your cells) that tell us how your cancer developed.

Treatment options can include one or more of the following:

Surgery – this may be before, during or after other treatments
Drug therapies such as chemotherapy, endocrine therapy, targeted treatments and immunotherapy. The general term for these is systemic anti-cancer therapy (SACT)
Radiotherapy

When you are diagnosed, your care will be discussed at a multidisciplinary team meeting (MDT) where different specialists will consider the best treatment options for you. Your doctor will discuss this with you so you can decide what is right for you.

Genomics and cancer

Genomics is the study of a person’s genes (or ‘genome’) – the material in DNA that makes each person unique. Cancer is caused by changes in the DNA of a cell and tell it to multiply out of control.

Understanding where this change has occurred – for example, which gene is faulty – can help us know which treatment will give you the best chance of killing the cancer cells and stopping new ones from growing.

A number of genetic changes can increase your risk of breast cancer. This area of medicine is developing rapidly and experts are learning more about genetics and breast cancer all the time.

Your clinical team will explain this to you in more detail at your appointment.

If you think you or your family might need genetic testing, ask your clinical team (if you are a patient of ours) or your GP.

Our treatments

At The Clatterbridge Cancer Centre, we provide specialist non-surgical treatment for breast cancer. Our treatments include systemic anti-cancer therapies (such as chemotherapy, targeted therapy, immunotherapy, hormone therapy) and radiotherapy.

We also work closely with surgical teams in other hospitals to plan and coordinate your care every step of the way. You are unlikely to have surgery if your cancer has already spread to other parts of the body when you are diagnosed.

You might be referred to us for:

Adjuvant therapy – if you have surgery before coming to The Clatterbridge Cancer Centre for further treatment
Neo-adjuvant therapy – if you come to The Clatterbridge Cancer Centre for treatment to treat the tumour before your surgery

Treatment aims to reduce the risk of your cancer coming back locally (in the breast and axilla) or in another part of your body such as your lungs, liver, bones and brain.

Neo-adjuvant therapy might also be recommended by surgical teams as it sometimes means you can have a smaller, lower-risk operation.

Systemic anti-cancer therapy (SACT)

SACT is a term used to describe the different drug therapies for cancer. These include:

Chemotherapy – which aims to kill cancer cells
Immunotherapy – which aims to train your immune system to attack cancer
Targeted therapies – which specifically target and interfere with processes inside cells that help cancers grow
Total neodjuvant therapy – where you receive systemic anti-cancer therapy before surgery
Bisphosphonates – which reduce the risk of breast cancer recurring by making bones less susceptible to secondary cancer
Hormone (endocrine) therapy – which targets oestrogen to prevent it from stimulating cancer cells to grow

Find out more about systemic anti-cancer therapy at The Clatterbridge Cancer Centre.

Radiotherapy

We use different types of radiotherapy, depending on the type, size, location and stage of the cancer.

Radiotherapy after surgery for breast cancer is delivered using external beam radiotherapy – this is where radiation is delivered from outside the body using high energy x-ray beams.

Find out more about radiotherapy at The Clatterbridge Cancer Centre.

Treatment side-effects and complications

Treatment for breast cancer can cause side-effects or other health issues. Your clinical team can help with this. Tell them about any side-effects or complications you develop.

Hair loss – cool caps

Some cancer drugs can cause hair loss. This can be difficult to cope with. Your clinical team will explain your options and can offer advice and support including:

Cool cap (scalp cooling) – we may ask if you would like to wear a cool cap if your treatment is suitable for this. This cools the scalp while your chemotherapy is being delivered. It can help to reduce hair loss but it can feel unpleasant and it does not work for everyone
Wigs – we can tell you about wig vouchers and local wig providers
Scarves

Lymphoedema (swelling from excess fluid)

Lymph fluid can build up and cause swelling if surgery and radiotherapy affect the lymphatic drainage system in your armpit.

Chemotherapy side-effects

Chemotherapy can cause side-effects. Common side-effects include:

Feeling sick (nausea) or vomiting
Bowel issues
Mouth ulcers
Changes to the feeling in your fingers or toes (‘peripheral neuropathy’)
Reduced immunity

We will tell you about side-effects linked to any cancer drugs you are on. We will also give you written information about this.

Immunotherapy side-effects

Immunotherapy helps your immune system to recognise and attack cancer cells. Sometimes the immune system reacts too strongly to immunotherapy, causing side-effects. These side-effects are different from those we see with chemotherapy.

The most common side-effect from immunotherapy is inflammation as your immune system responds to the treatment. When this happens, the immune system can attack normal cells causing inflammation and a change in how the cell works. This can cause many conditions – for example, arthritis, colitis, dermatitis and hepatitis.

Steroids are used to treat immunotherapy side-effects.

We will tell you about side-effects linked to any cancer drugs you are on. We will also give you written information about this.

Hormone (endocrine) therapy side-effects

Hormone (endocrine) therapy can cause menopausal side-effects including hot flushes, aching joints and brain fog. This usually improves within 3 months. If it does not, we can offer help with the side-effects or change your treatment if needed.

Bisphosphonate side-effects

Some patients have bisphosphonates – drugs that can help to strengthen bones and reduce the risk of them breaking – as part of their cancer treatment.

Bisphosphonates can cause flu-like symptoms for about 72 hours afterwards.

Very rarely, bisphosphonates cause a condition called osteonecrosis of the jaw where bone cells in the jaw die. If you are on bisphosphonates, we will tell you to let us know if you have any jaw pain. We also advise having a dental check-up every six months.

If you need invasive dental treatment such as an extraction (removal of a tooth) or root canal treatment, you will need to stop taking bisphosphonates for six weeks before your dental treatment and six weeks afterwards. This helps the bones in your jaw to recover.

Targeted HER2 therapy side-effects

The most common side-effects are:

Loose stools for 72 hours after your injection
Bone aches
Heart problems (cardiac issues) – you might have regular heart check-ups, to check for this

Radiotherapy side-effects

Common side-effects include:

Redness in the area that has been treated
Skin problems – sometimes the skin can break down. We will give you dressings to use in case this happens
Fatigue (persistent tiredness) for up to six weeks after your treatment

Talk to your clinical team if you experience these or any other long-term effects of treatment.

Clinical trials

Research and trials of new cancer treatments are an important part of our work. Your consultant will tell you about any clinical trials that may be suitable for you.

You are also very welcome to ask us about clinical trials during your appointments. We will be happy to answer any questions you have.

Find out more about clinical trials.

Treatment locations

We have a multi-site model where we visit hospitals across Cheshire and Merseyside to provide treatment and consultations closer to patients’ homes.

We provide systemic anti-cancer therapies (e.g. chemotherapy, targeted therapies and immunotherapy) for breast cancer at the following sites:

We provide radiotherapy for breast cancer in our three specialist sites:

Clinical trials for breast cancer are delivered at most of our sites. Some trials may only be available at our main hospital: Clatterbridge Cancer Centre – Liverpool.

The team consists of clinical oncologists, medical oncologists, a nurse consultant, consultant radiographers, consultant pharmacist, advanced nurse practitioners, advanced specialist pharmacists, clinical nurse specialists, radiographers, research practitioners, administrative support and cancer support workers.

Our operational and senior management team ensure the service runs smoothly.

Consultants

Medical Oncologists

Dr Eliyaz Ahmed
Dr Jenny Cotton
Dr Jo Cliff
Dr Helen Innes
Prof Carlo Palmieri

Clinical Oncologists

Dr Allison Hall
Dr Farida Alam
Dr Zulfiquar Ali
Dr Jill Bishop
Dr Jane Dufton
Dr Clare Hart
Dr Sheena Khanduri
Dr Zaf Malik
Dr Shaveta Mehta
Dr Raj Sripidam
Dr Shaun Tolan

Nurses

Nurse Consultant

Jane Lomas

Advanced Nurse Practitioner

Donna McKeown (St Helens)
Danielle Davies (Liverpool)
Helen Whiting (Wirral)
Clare Baxter (Halton)

Clinical Nurse Specialists

Early breast cancer

Heather Vasey (Liverpool)
Sarah O’Donnell (Wirral and Aintree)
Kerry Ireland (Aintree)

Metastatic breast cancer

Jo Francis (Liverpool)
Phil Walker (Liverpool and St Helens)
Rachel Lewis (Aintree)
Heather Stephens (Wirral)
Jo Bygroves (Wirral)

Cancer Support Workers

Imogen Eames (Liverpool and Wirral)
Alex Donnelle-Brown (St Helens)
Maureen Williams (Wirral)

Consultant Radiographers

Dawn Ledsom
Katie Williams
Louise Hughes

Pharmacists

Helen Flint – Consultant Pharmacist
Lisa Dobson
Gabriella Langton

Virtual tour of Radiotherapy unit (CCC-Liverpool)

Our Cancer Information and Support Centres can provide individualised help and support for patients and families affected by cancer. The team’s main base is in Clatterbridge Cancer Centre – Liverpool but they also work at our Aintree and Wirral hospitals.

There are also local Macmillan services in other hospitals across our region.

External sites that offer extra support and information about different types of breast cancer include:

Advanced / metastatic / secondary breast cancer: