Breast cancer is the most common cancer in the UK. About 46,000 women get breast cancer in the UK each year. Most of them (8 out of 10) are over 50, but younger women, and in rare cases men, can also get breast cancer.

Anatomy of the breast

A woman's breasts are made up of fat, connective tissue and thousands of tiny glands, known as lobules, which produce milk. If a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed.

Our bodies are made up of billions of tiny cells. Normally, cells grow and multiply in an orderly way. New cells are only made when and where they are needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably.

Breast cancer can have a number of symptoms but usually shows as a lump or thickening in the breast tissue (although most breast lumps are not cancerous). If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body.

Types of breast cancer

There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types.

Non-invasive breast cancer

Non-invasive breast cancer is also known as cancer or carcinoma in situ, or pre-cancerous cells. This cancer is found in the ducts of the breast and has not developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast and is usually found on a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS).

Invasive breast cancer

Invasive cancer has the ability to spread outside the breast, although this does not mean it necessarily has spread. The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of all cases of breast cancer and is sometimes called 'no special type'.

Other types of breast cancer

Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Paget's disease of the breast. It is possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, it is known as secondary or metastatic breast cancer.

Breast screening

The exact cause of breast cancer is not fully understood, but many factors increase the likelihood of developing it, including age and family history of breast cancer.

Women who have a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women aged 50–70 are invited for breast cancer screening every three years. Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

Breast cancer can be treated using a combination of surgery, chemotherapy and radiotherapy. Some cases of breast cancer may also be treated using biological or hormone treatments.

One in nine women are affected by breast cancer during their lifetime. There is a good chance of recovery if it is detected in its early stages. For this reason, it is vital that women check their breasts regularly for any changes and always get any changes examined by their GP.

Link to local cancer support services (including breast screening)

Online Personal Education and Risk Assessment (OPERA)

If you are concerned about your risk of developing inherited breast cancer, you can use Macmillan's online interactive assessment tool, which is called OPERA.

The tool is based on the National Institute for Health and Clinical Excellence (NICE) guideline for the classification and care of women at risk of familial breast cancer. It is designed to be used by patients and health professionals to assess a person's risk of developing the condition based on their family history of both breast cancer and ovarian cancer. This is because the genes that are mainly responsible for breast cancer are also linked to ovarian cancer.

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast. Most lumps (90%) are not cancerous, but it is always best to have them checked by your doctor.

See your GP if you notice any of the following:

• a lump or area of thickened tissue in either breast
• a change in the size or shape of one or both breasts
• discharge from either of your nipples (which may be streaked with blood)
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast
• pain in either of your breasts or armpits that is not related to your period

Want to know more?

• Breast Cancer Care: Changes to look and feel for.
• Cancer Research UK: Breast cancer symptoms.
• Macmillan: What are the symptoms of breast cancer?

Breast awareness

So that you can pick up any changes as soon as possible, it is important to be breast aware. Get to know what is normal for you. For instance, your breasts may look or feel different at different times of your life. This will make it much easier to spot any potential problems.

Want to know more?

• Breast Cancer Care: Your breasts, your health: throughout your life (PDF, 865Kb). 
• Breast Cancer Care: Your breasts, your health: a quick guide to being breast aware (PDF, 3.12MB).
• Breakthrough Breast Cancer: Breast awareness.

Breast cancer key messages

The Department of Health recently issued key messages on the signs and symptoms of breast cancer. For more information, go to Breast cancer key messages.

The causes of breast cancer are not fully understood. This means that it is difficult to say why one woman may develop breast cancer and another may not.

Some things, known as risk factors, can change the likelihood that someone may develop breast cancer. There are some factors that you cannot do anything about, although there are others that you can change.

Age

The risk of developing breast cancer increases as you get older. Breast cancer is most common among women over 50 who have been through the menopause. Eight out of 10 cases of breast cancer occur in women over 50.

All women between 50 and 70 years of age should be screened for breast cancer every three years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Currently, there are ongoing pilot studies looking at widening the screening age range to 47-73.

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer. However, as breast cancer is the most common cancer in women, it is possible for it to occur more than once in the same family by chance.

Most breast cancer cases are not hereditary (they do not run in families). However, particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. It is possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with increased risk of breast cancer.

If you have, for example, two or more close relatives from the same side of your family (such as your mother, sister or daughter) who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If you are worried about your family history of breast cancer, discuss it with your GP.

Previous diagnosis of breast cancer

If you have previously had breast cancer or early non-invasive cancer cell changes contained within breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again.

Previous benign breast lump

A benign breast lump does not mean that you have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts) or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely.

Breast density

Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with more dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) harder to read because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.

Exposure to oestrogen

In some cases, breast cancer cells can be stimulated to grow by the female hormone oestrogen. Your ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty in order to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen that your body is exposed to. For example, if you started your periods at a young age and entered menopause at a late age, you will have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy.

Being overweight or obese

If you have been through the menopause and are overweight or obese, you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Being tall

If you are taller than average, you are more likely to develop breast cancer than someone who is shorter than average. This may be due to interactions between genes, nutrition and hormones, but the reason is not fully understood.

Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink. Research shows that, for every 200 women who regularly have two alcoholic drinks a day, there are three more women with breast cancer compared with women who do not drink at all.

Radiation

Certain medical procedures that use radiation, such as X-rays and CT scans, may slightly increase your risk of developing breast cancer. If you had radiotherapy to your chest area for Hodgkin's lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. See your GP if you were not contacted or you did not attend a consultation.

If you currently need radiotherapy for Hodgkin's lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT.

It is estimated that there will be an extra 19 cases of breast cancer for every 1,000 women who are taking combined HRT for 10 years. The risk continues to increase slightly the longer you take HRT, but returns to normal once you stop taking it.

Want to know more?

• Breakthrough Breast Cancer: Breast cancer risk factors.
• Breast Cancer Care: Risk.
• Cancer Research UK: Breast cancer risks and causes.
• Live Well: Breast cancer genes.
• Macmillan: Breast cancer causes and risk factors.

Diet and lifestyle

Regular exercise and a healthy diet are recommended for all women as they can help prevent many conditions, including heart disease, diabetes and many forms of cancer.

Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions at the moment, there are benefits for women who maintain a healthy weight, do regular exercise and who have a low intake of saturated fat and alcohol. Use the healthy weight calculator to check if you are a healthy weight.

It has also been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If you have been through the menopause, it is particularly important that you are not overweight or obese. This is because these conditions cause more oestrogen to be produced, which can increase the risk of breast cancer.

Breastfeeding

Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who do not. The reasons are not fully understood, but it could be because women do not ovulate as regularly while they are breastfeeding and oestrogen levels remain stable.

Want to know more?

• Breakthrough Breast Cancer: Breast cancer risk factors. 
• Cancer Research UK: Diet and preventing breast cancer. 
• Cancer Research UK: Screening for breast cancer.

The NHS Breast Screening Programme screens around 1.6 million women a year. Women aged 50 to 70, who are registered with a GP, are automatically invited for screening every three years. You will first be invited for screening between your 50th and 53rd birthday. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. The NHS is extending the breast screening age range in England so that by the end of 2012, all women aged 47 to 73 will be invited.

Screening takes place at a special clinic or mobile breast screening unit. A mammogram (X-ray of the breast) is taken by a female health professional. The mammogram is then studied to look for any abnormalities. The aim is to find breast cancer at an early stage, when any changes in the breast would be too small to feel and when there is a good chance of successful treatment and full recovery. It is estimated that screening saves 1,400 lives a year.

Not all cancers are found during breast screening. Breast cancer can develop between screening appointments. Even if you go to breast screening, it is important to get to know your breasts so that you can spot any unusual changes early on and report them to your GP.

What happens at the screening unit?

Screening is carried out by female staff, who take mammograms to detect abnormalities. The breasts are X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles. Most women find the compression uncomfortable and occasionally it may be painful. However, the compression is necessary to ensure the mammogram is clear. Any discomfort will be over quickly.

The results of the mammogram will be sent to you and your GP. About one woman in 20 will be called back for further assessment. Being called back does not mean you definitely have cancer. The first mammogram may have been unclear. About one in six women who are called back for further assessment are diagnosed with breast cancer.

Screening for women at high risk of breast cancer

You may be eligible for breast cancer screening before the age of 50 if breast cancer runs in your family. Your risk of developing breast cancer is considered to be higher than average if:

• Two or more close relatives (at least one of whom is your mother or sister) on the same side of your family have or have had breast cancer.
• Three of your close relatives were diagnosed with breast cancer at any age.
• One close relative has breast cancer and one has ovarian cancer (one of them being your mother, sister or daughter).
• Your mother or sister were diagnosed with breast cancer before the age of 40.
• Your father or brother were diagnosed with breast cancer at any age.
• Your mother or sister were diagnosed with breast cancer in both breasts and were diagnosed for the first time under the age of 50.

If any of the above applies to you, see your GP, who can refer you to a breast clinic for assessment based on your family history. If you have a high risk of developing breast cancer and you are over 40, you should be offered screening with a mammogram once a year. If you are under 40, you are entitled to screening using MRI scans instead of mammograms because your breasts may be too dense to produce a clear mammogram.

Genetic screening for breast cancer

If, following an assessment at your breast clinic, it is found that you have a family history of breast cancer, it may be because one of the genes that make breast cancer more likely runs in your family. You may be able to have screening for these genes, which are known as BRCA1, BRCA2 and TP53.

To be genetically screened for breast cancer, you must have a living relative with breast cancer. You and your relative will both have a blood test to see if you carry any of the breast cancer genes.

If a breast cancer gene is found and you are under 49, you may be offered yearly MRI scans. If you are 50 or over, you may also be offered yearly mammograms.

Want to know more?

• NHS Breast Cancer Screening Programme: Breast screening: the facts (PDF, 80Kb).
• Breakthrough Breast Cancer: NHS Breast Screening.
• Cancer Research UK: Mammograms in breast screening.
• Read statistics about the number of eligible women who are screened for breast cancer across England (PDF, 144Kb).

Early diagnosis can save lives

What you need to know about breast cancer

• Breast cancer is the most common cancer in the UK with more than 45,500 women diagnosed each year.
• Around one in nine women will develop breast cancer during their lifetime. Most women who get breast cancer are past their menopause (change of life), but around one in five women diagnosed each year are under 50 years old. 
• The good news is that survival rates for breast cancer are improving. Of those who do get the disease, eight out of 10 women will survive for five years or more after diagnosis. Two-thirds are likely to survive for at least 20 years.
• Men can get breast cancer too but it is very rare.
• It is important to diagnose breast cancer early. We know that the sooner breast cancer is diagnosed, the better the outcome is likely to be.

What can increase my risk of breast cancer?

It is difficult to pinpoint definite causes of breast cancer and that’s why we talk about what might increase or decrease your risk. 

• Older women are at greater risk of breast cancer, particularly after the menopause, but it can affect younger women too.  
• You may be more at risk if several close members of your family have had breast cancer, particularly at a young age, although most people with breast cancer do not have any close relatives with the disease.
• Being overweight, drinking alcohol and taking HRT (hormone replacement therapy) can increase your risk of breast cancer.  

How can I reduce my risk of breast cancer?

• Maintain a healthy weight.
• Drink less alcohol.
• Do regular exercise.
• Breastfeeding can reduce your risk of breast cancer, although women who have breastfed their children can still develop the disease.

What are the signs and symptoms of breast cancer?

There can be many reasons for changes in the breast and often they will be harmless. Any unusual change needs to be checked as there is a chance it could be a sign of cancer:

• size and shape: if one breast changes in size or shape
• a new lump or thickening in one breast or armpit that is different to the rest of the breast
• skin changes: puckering, dimpling, inflammation or redness of the skin
• nipple changes: if a nipple becomes inverted (pulled in), changes shape or points differently
• rashes on or around the nipple
• discharge or fluid (not milky) from one or both nipples
• pain or discomfort in the breast or armpit that is not related to your periods
• swelling under the armpit or around the collarbone

Be breast aware

• It is important to be aware of how your breasts normally look and feel at different times. You will then notice if something is different or if you develop any of the signs and symptoms listed above.
• You can become familiar by looking and feeling your breasts from time to time in any way that is best for you.
• You can feel your breasts in the bath or shower using a soapy hand or lying down in bed. Using body lotion can help. It is important to feel the whole breast including the armpit.
• You can look at your breasts in the mirror. Move your arms (above your head, on your hips or by your sides) so that you can see your breasts from every angle, including the underside.
• As older women are at greater risk of breast cancer, it is very important to be aware of any unusual changes after the menopause, when your periods have stopped.
• Breasts may change with age and life events, such as pregnancy, breastfeeding, at different times of the month if you still have periods and after the menopause. This is why it is important to know what is normal for you so you will recognise any changes.

What to do if you find a change

• If you notice any change in your breasts, tell your doctor without delay. Remember, you are not wasting anyone’s time. 
• Even if you are not sure if the changes in your breast are serious, if you are worried, that is a good enough reason to go to your doctor.
• If it is breast cancer, finding it early means treatment is more likely to be successful.
• If there is no cancer, your doctor can reassure you so that you spend less time worrying.
• Even if you have other health worries to think about or family members to look after, if you notice any changes in your breasts, do not put off visiting your doctor.

The NHS Breast Screening Programme

It is important to detect breast cancer as early as possible. In the early stages, breast cancer may not have symptoms. This is why the government has introduced the NHS Breast Screening Programme. Screening is free. 

Women are invited for screening between the ages of 50 and 70. You will be offered mammograms every three years. A mammogram is an X-ray of the breast. It can detect breast cancer at a very early stage.

From 2009, this age range began to be extended. Women in their late forties and up to the age of 73 are also starting to be invited. It will take a few years for this to happen everywhere in England.

NHS breast screening is not usually available for younger women as mammograms are not as effective on younger breasts. If you are below screening age and worried about breast changes, or have a family history of breast cancer, speak to your GP.

Women over 70 (73 in some parts of England) are not sent invitations for breast screening. This does not mean that older women can’t develop breast cancer. Women over 70 are still at a higher risk of breast cancer. If you are over the screening invitation age range, you can ask for free breast screening every three years. Contact your local breast screening unit to make a free appointment.

Breast awareness five-point code

1. YOU should know what is normal for you.
2. KNOW what changes to look for.
3. LOOK and feel.
4. TELL your GP about any changes straightaway.
5. GO for breast screening when invited.

Make a plan

You may find it helpful to make a plan of how you will become breast aware.

• Work out how you will get to know how your breasts normally look and feel, perhaps in the bath or shower or when getting dressed.
• Decide what you will do if you find a change in your breasts, such as seeing your doctor straightway.
• As soon as your invitation to breast screening arrives, plan how you will keep the appointment.

The above information was produced by the Department of Health.

Emma Duncan, 33, has been diagnosed with breast cancer twice in the past four years, once in each breast.

Her first treatment was a lumpectomy with chemotherapy and radiotherapy. Her second treatment included a full mastectomy, removing both breasts, followed by reconstructive plastic surgery.

"I asked my GP if there was any screening programme they could put me into when I was 25 because my mother had died from breast cancer when she was 32. They referred me to the Royal Victoria Infirmary and I used to come once a year just for a check-up.

"A few years later I was in the bath and I noticed a lump under my left armpit. I didn’t quite know what to make of it. I was quite worried at first. I went to see my GP the next day and he suspected that it might just be a cyst as I was only 28 at the time. But because of my family history, he referred me to a specialist.

"At the hospital, I had an ultrasound, a mammogram and a needle biopsy. When I returned a week later for the results, they confirmed that I did have breast cancer and that I would need to come in for lumpectomy surgery 10 days later.

"I had chemotherapy for six months after my first diagnosis, followed by five weeks of radiotherapy. It was really hard. All my hair fell out and it made me feel so ill.

"My husband Graham was great and tried to support me as best he could throughout it. My sister-in-law was never off the phone and my best friend Claire was lovely.

"My sister handled it in a very different way. She had watched my mum become very poorly, and then her older sister was diagnosed. She found it hard to deal with and she just couldn’t handle coming to see me. She later admitted being terrified that it might be her next.

"The second time I was diagnosed, I had a bigger operation: a double mastectomy. The decision to have a mastectomy was quite easy to make. For me, it was the only decision having had cancer twice.

"The reality after the event was very different. With the reconstructive surgery as well, I knew it would be a long recovery, but I don’t think anything prepared me for just how long. I cried every single day because I was so uncomfortable.

"I was referred to a psychologist who told me I wasn’t going mad. Anybody who had been through what I had would be expected to have a few tearful days. Things settled down, then it was just a case of trying to get back to normal.

"Looking back at everything, I wouldn’t have changed my decision at all. It was definitely for the best.

"I now have check-ups every six months with my oncologist, breast surgeons and at the family clinic. I see my plastic surgeon, my geneticist and have an ultrasound once a year, plus a blood test every four months as part of the ovarian screening programme. The Macmillan breast care nurses ring me up every once in a while to keep me up to date and to check that I’m all right. I’m very well looked after.

"Now I just want to stay cancer-free. I’ve done as much as I possibly can to prevent it from coming back or getting a new cancer. I didn’t quite make it after my first diagnosis, but I’d like to get through the next five years without the cancer returning.

"My advice to other women would be to speak to your breast care nurse or go on the Cancer Research UK or Breast Cancer Care websites. There are so many recognised sources of information. The internet is full of horror stories, so make sure you get as much information as you can from reputable sources."

In this video, people who have been through cancer treatment talk about what kept them going and the practicalities of treatment.