Breast Cancer Awareness Month

October is breast cancer awareness month. I want to tell you in this post some information about breast cancer symptoms, diagnosis and treatments. I have worked in various areas of breast cancer research in the last 5 years, most notably my PhD is focused on understanding diabetic drugs in order to prevent breast cancer. It's an area close to my heart.
 
Breast cancer is the most commonly diagnosed cancer in the UK. About 55,000 new cases are diagnosed every year and 7% of all cancer-related deaths can be attributed to breast cancer. There is some good news and bad news about breast cancer survival. The overall 5-year survival is around 86% but when you break this down by stage of the cancer type, this value falls dramatically for those with higher stage cancers. 5-year survival for women with stage IV cancer is approximately 15%. The survival rate has doubled in the last 40 years due to better preventative measures, better diagnosis and better therapies. 

Image 1: Breast cancer statistics. Image from http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer

Breast cancer types:
I've already spoken a bit on the different cancer types and how tumours can be classed by their origin but also molecular differences ("What the Hell? - Cancer Part 2).

Image 2: Types of breast cancer

I've also talked before about risk factors, which are lifestyle or genetic factors that can increase or decrease the likelihood of developing a certain disease. There are a number of risk factors associated with breast cancer (some are in image 3).

Image 3: Risk factors associated with breast cancer

Symptoms:
Most women know the symptoms of breast cancer:

• Lump in the breast
• Change in size, feel, shape or skin (e.g colour/rash or puckering/dimpling) - this is sudden and not due to usual hormone fluctuations during periods etc.
• Fluid leaking from nipple
• Breast pain
• Swelling in the armpit
• Nipple placement has changed

If you or someone you know experiences these symptoms you should talk to your doctor about them. 

Diagnosis:
There are a number of ways a breast tumour is identified:

1. Mammogram: this is basically an x-ray where they look for a lump and physical changes associated with breast cancer. 
2. Ultrasound: alternatively to a mammogram, patients may receive an ultrasound 
3. ​Biopsy: a section of the tumour is taken for analysis. There are a number of different types of biopsy depending on the symptoms e.g. fine needle aspiration, needle biopsy, punch biopsy, vacuum assisted biopsy or wire guided excision biopsy. 
4. Pathology: staining of the tumour sample and visualisation under the microscope helps define tumour type ("What the Hell? - Cancer Part 2)
5. Hormone receptor tests: hormones are detected either by genetic tests, looking for the protein or FISH (fluorescent in situ hybridisation - for Her2+. If the gene is present it will glow when exposed to UV light).

Treatment:
​Treatment depends on the stage/grade of your tumour, the molecular subtype and the willingness of the patient. There are the standard treatment practices (1-3) but also more personalised therapies (4-5)

1. Surgery
2. Chemotherapy
3. Radiotherapy
4. Hormone therapy: hormone therapy targets the hormones and receptors that can contribute to cancer growth. The most well know of these therapies is Tamoxifen (targets the oestrogen receptor). Other therapies such as Anastrozole, Exemestane and Letrozole all target oestrogen, reducing the levels of oestrogen in the blood and thereby reducing the amount of oestrogen the cancer cell can use to grow. All of these hormone therapies are for ER+ breast cancers only. Tamoxifen is also used following cancer treatment once the cancer is in remission. It's been shown that taking tamoxifen for about 10 years after having your primary tumour can reduce the risk of recurrence or a secondary breast tumour.
5. Targeted therapy: targeted therapies are for ER- tumours (mainly Her2+). The most commonly used is Trastuzumab (Herceptin) which targets HER2 receptors, preventing the cells from getting key growth signals. Another drug, Pertuzumab, also targets Her2+ breast tumours. 

Prevention:
Prevention is key. You will hear my harp on about prevention is the cure to cancer but really it's one of the key areas we as individuals can look after for our own health. In fact it’s estimated that about 27% of all breast cancers could be prevented and there are a number of prevention techniques you can adopt

• Checking your breasts: by far the easiest thing you can do. It's quick, simple and non-invasive. Below is a handy video from Coppafeel! to show you how. You should never be embarrassed to keep yourself healthy!! 
• Mammogram: this a country-wide screening programme typically offered to women over 50 years of age that is commonly adopted in countries across the world. In the UK the age you are offered your first mammogram is 47 and typically you are asked to return every 3 years if nothing is detected. 
• Genetic testing: familial breast cancer can affect both females and males. The most common familial breast cancer is caused by BRCA1/BRCA2 mutations. BRCA proteins are involved in DNA repair. If these proteins are functional DNA repair becomes less efficient, meaning cancer causing mutations are more likely to occur and won't be fixed. Genetic testing if there is a history of breast cancer in the family is an effective way of identifying individuals at high risk of developing breast cancer and taking the necessary steps to prevent this from occurring. 

All rights to this video belong to Coppafeel!.org

And let's not forget the men here! Men can suffer with breast cancer. While only about 400 men are diagnosed each year that is still a significant number. Male breast cancer is quite similar to female breast cancer in terms of risks (though an additional risk factor is Klinefelter's syndrome), diagnosis,  symptoms and treatments. 

Finally I would like to talk to you about a charity which inspires me to keep doing the work I do. This charity was set up by a young woman who was diagnosed with breast cancer in her early 20's. Instead of wallowing in her diagnosis of metastatic breast cancer she decided to set up a charity to better educate young women to CHECK YOUR BREASTS! That charity was set up over 8 years ago and despite multiple metastatic tumours Kris is still alive and more vibrant than ever. This charity is called Coppafeel! (a genius name). If you have time please check out their website https://coppafeel.org/ and check out Kris's story (https://coppafeel.org/our-charity/kris-story/). A truly inspirational woman backed by the most incredible fundraisers and supporters. I haven't had the chance to work with coppafeel but it is one of the charities I would most like to get involved in. 

For more information on any of the areas I've discussed visit:
about-cancer.cancerresearchuk.org/about-cancer/breast-cancer
www.breastcancernow.org