Information

Most women who experience problems with their breasts may immediately think they are at risk of cancer. Yet nine out of ten breast problems are benign and in no way related to cancer. Different breast conditions occur at different stages in a woman’s life. This leaflet explains the breast problems which you may experience according to your age, and other factors which may affect breast health.

Age related breast disorders Women of all ages are well advised to be ‘breast aware’ and to examine their breasts at the same time each month, after their period. Any changes should be reported to your GP, who may treat you or refer you to a breast specialist. The chart below shows how your age relates to common breast problems. The incidence of breast cancer rises with age, but is relatively rare in a woman in her 30s. This type of chart helps a GP diagnose your breast problem, taking the important factor of age into account. Lumps and bumps Most breast lumps are not cancerous. For example, young women are particularly susceptible to the formation of fibroadenomas.

These are firm painless nodules of fibrous tissue which, once diagnosed, can be left alone. They may enlarge during pregnancy, but generally disappear without treatment. Cysts are common in the slightly older age group, and again many shrink without treatment. If they become tense and painful, fluid can be drawn off by a doctor. This may need to be done repeatedly. Some women have generally knobbly breasts, known as diffuse nodularity.

This can occur at any age (see chart). Any woman with a breast lump should see a doctor. Either she can be reassured that it is harmless, or she can be referred for further investigation. Breast pain Pain is the most common breast problem suffered by women and can occur on its own or with breast lumps or lumpiness (diffuse nodularity). Many women experience pain in their breasts, especially before a period. For severe cyclical pain, taking prescriptiononly gamolenic acid (GLA) throughout the cycle has been found to help 58 per cent of cases1 . If GLA does not help breast pain, hormone treatments are available. Breast cancer – what are the risks? Breast cancer is the most common cancer in women. It could happen to any one of us, but some women are less at risk than others. There are now effective treatments for breast cancer. Two thirds of women diagnosed are alive and well five years later and beyond. Early treatment of cancer gives the greatest chance of success. The age factor Age is by far the greatest risk factor. Breast cancer is extremely rare under the age of 30, and is unusual up to 40. Over the age of 50, where the incidence of cancer rises, women are offered regular mammograms through the NHS Breast Screening Programme. Family history Because breast cancer is so common, many families will have one or more members who have suffered from it.

This only significantly increases the risk of developing the disease if it arose in a first degree relative – mother, sister or daughter – and depends on age at diagnosis. Cancer family clinics exist where a woman can be referred by her GP or hospital consultant for specialist advice. This might be suggested for a woman who has had one first degree relative diagnosed with breast cancer before the age of 40, or two first degree relatives before the age of 60, or three first degree relatives at any age. Gene testing can indicate the likelihood of developing breast cancer, but less than 5 per cent of breast cancers are associated with the abnormal gene. Advice for higher risk women In general, women who are at increased risk are advised to check their own breasts regularly in the week after each period, and report any changes. From the age of 50, they will be offered NHS mammography. There is controversy about whether younger women in a higher risk group should also have mammography.

The breast tissue is dense so the results may be technically inconclusive, and repeated X-rays themselves may be a risk factor. Women with a seriously increased risk may be offered regular mammography from the age of 40.

Even with a positive family history, the odds are still against you developing breast cancer. The Contraceptive Pill Millions of women have benefited from the effective contraception offered by the Pill over the last 30 years. There has always been concern as to whether giving a woman artificial hormones has a damaging effect on her health. Recently, a major international study examined evidence to see if there is any increase in risk of breast cancer associated with use of the combined oral contraceptive pill2. It found that there Relative frequency of breast disorders Age (yrs) 20 30 40 50 60 DIFFUSE NODULARITY CANCER CYST FIBROADENOMA Redrawn from: Guidelines for Referral of Patients with Breast Problems BREAST C • A • R • E CAMPAIGN When am I at risk? P•R•O•B•L•E•M•S is a slightly increased risk in women who are currently using combined oral contraceptives or have used them in the past ten years. The increased risk disappears ten years after stopping the Pill. The cancers diagnosed were more likely to be confined to the breast, not spread to other tissues, and so easier to treat. Breast cancer is still comparatively rare in women young enough to need contraception, but Pill users would be wise to remember to check their breasts every month, preferably after their period. The Pill also decreases the risk of cancer of the ovary and of the lining of the womb. As with so many cancers, smoking can increase the risk. Hormone Replacement Therapy (HRT) At the menopause, a woman’s natural production of the female hormone, oestrogen, diminishes, and she may experience the uncomfortable effects of flushes, night sweats, and vaginal dryness. Many women are prescribed Hormone Replacement Therapy (HRT) to relieve these symptoms.

The effect on the breast may protect the normal contours against the shrinkage often associated with age. Women over 50 are at greater risk of breast cancer than younger women. However, up to ten years’ continuous HRT does not seem to increase the breast cancer risk. Beyond that there may be a slightly greater risk than in non-users, but this needs to be balanced against the protection given by HRT against heart disease, stroke and osteoporosis. The NHS Breast Screening Service offers free mammography to all woman aged 50-64 and beyond, on request. This detects a cancer before it can even be felt, leading to earlier diagnosis. Mammography is not a substitute for breast awareness, and women on HRT should check their breasts each month after the bleed, and report any abnormality to their doctor. Conclusion Breast cancer is common, and everyone is at some degree of risk. However, the earlier the cancer is detected, the better the chance of curative treatment.

You are well-advised to be aware of your breasts, and check them over each month. If there is any cause for concern, you should see your GP sooner rather than later, either for reassurance that there is nothing seriously wrong, or to get prompt treatment. 1 Gateley CA, et al. Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic. Journal of the Royal Society of Medicine 1992;85:12-15 2 Collaborative Group on Hormonal Factors in Breast Care.Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 1996;347:1713-27 Where to get help Breast Care Campaign Blythe Hall, 100 Blythe Road, London W14 OHB The UK’s leading source of information on benign breast disorders. Provides leaflets and information on benign breast disorders for health professionals and the public Breast Cancer Care Kiln House, 210 New Kings Road London SW6 4NZ Helpline: 0171 384 2344 Nationwide Freeline: 0500 245345 Lines open Mon – Fri 10am – 5pm A national organisation offering free help, information and support to women with breast cancer or other breast related problems The Medical Advisory Service (MAS) PO Box 3087, London W4 4ZP Helpline: 0181 994 9874 Mon – Fri 5 – 10pm Nurse run helplines offering information and advice on a range of women’s health problems The Premenstrual Society (PREMSOC) PO Box 429, Addlestone, Surrey KT15 1DZ PREMSOC provides advice and help for women with premenstrual syndrome

The Women’s Health Concern (WHC) PO Box 1629, London SW15 2ZL Helpline: 0181 780 3007 A registered medical charity offering advice and information to women of all ages on gynaecological conditions, HRT and hormonal problems The Womens Nationwide Cancer Control Campaign (WNCCC) Suna House, 128 Curtain Road London EC2A 3AR Helpline: 0171 729 2229 Mon – Fri 9.30 – 4.30pm Taped breast awareness message: 0171 729 4915 The WNCCC supports and encourages the provision of facilities for the early diagnosis of cancer in women, providing helplines, publications, videos and mobile screening units