Breast cancer

Breast cancer signs and symptoms

Some people have no symptoms and the cancer is found during a screening mammogram or a physical examination by a doctor.

If you do have symptoms, they could include:

• new lumps or thickening in the breast, especially if in only one breast

• nipple sores, change in shape of the nipple

• nipple discharge or turning in

• changes in the size or shape of the breast

• skin of the breast dimpling

• discomfort or swelling in the armpit

• rash or red swollen breasts

• ongoing pain that is not related to your menstrual cycle that remains after your period and occurs in only one breast

Causes of breast cancer

Some factors that increase your risk of breast cancer include:

• increasing age

• family history

• inheritance of mutations in the genes BRCA2, BRCA1 (more common with Ashkenazi Jewish heritage) and CHEK2

• exposure to female hormones (natural and administered)

• starting your period before the age of 12

• a previous breast cancer diagnosis

• a past history of certain non-cancerous breast conditions

Lifestyle factors that can also slightly increase the risk of breast cancer in men and women include:

• being overweight
• not enough physical activity
• drinking alcohol.

There is also an association with some benign breast disease and past exposure to radiation.

Diagnosis of breast cancer

Tests to diagnose breast cancer may include:

After a diagnosis of breast cancer

After finding out you have breast cancer, you may feel shocked, upset, anxious or confused. These are normal responses. Talk about your treatment options with your doctor, family and friends. Seek as much information as you need. It is up to you how involved you want to be in decisions about your treatment.

Find out more about the best breast cancer care:

What should happen next?

This resource can help guide you and your loved ones after your diagnosis. 

Guide to best care for breast cancer

Treatment for breast cancer

Treatment depends on the extent of the cancer.

Managing side effects

Treatment for breast cancer and even the cancer itself, can cause side effects. The types and severity of any side effects you may experience will depend on the type of treatment you have and may vary from person to person.  

Side effects will vary depending on the type of treatment you have but most are temporary and there are ways to reduce or prevent them.  

Outlined below are some of the side effects you may experience.  

Lymphoedema

When lymph nodes have been damaged or removed, lymph fluid may not be able to drain normally, causing a build up in the tissues of part of the body, such as an arm or breast. This swelling is called lymphoedema.

Lymphoedema can occur during treatment or months or years after treatment. Look for swelling, heaviness or fullness in the fingers, wrist or whole arm, a feeling of tightness and aching in the affected area. Some people may also experience fever, redness or pain, caused by an infection called cellulitis. If you have any of these symptoms you should see your doctor as soon as possible as lymphoedema is easier to manage if it is diagnosed and treated early.

Cording

Cording (auxillary web syndrome) can happen weeks or months after surgery and is caused by hardened lymph vessels. It feels like a tight cord running from your armpit down the inner arm and sometimes to the palm of your hand. You may feel and see raised cord-like structures across your arm and these may limit movement.

Cording usually improved over a few months and gentle stretching exercises during the first weeks after surgery can help.

Nerve pain

Mastectomy or surgery to remove lymph nodes can cause nerve pain in the arm. Mastectomy can also cause nerve pain in the chest wall. It may feel like pins and needs but usually settles within a few weeks. If pain persists, talk you’re your doctor about ways to manage it.

Some chemotherapy drugs can damage nerves in the hands and feet and this is called peripheral neuropathy. Peripheral neuropathy can cause pins and needles, numbness and, occasionally, pain. The symptoms are usually temporary but can be permanent. If you have any symptoms, let your health care team know so they can adjust your treatment. Your doctor will also be able to help you manage pain from permanent nerve damage.

Changes to memory and thinking

Some people diagnosed with breast cancer notice changes in how they remember information and the way they think. This is called cancer-related cognitive impairment. It is also referred to as “cancer fog” or “chemo brain”.

While the precise cause is unknown, studies show that think and memory changes may be caused by the cancer itself, cancer treatments, medication given for surgery such as anaesthetic, emotions like depression and anxiety, and treatment side effects like insomnia, fatigue and hormone changes.

For most people, issues with thinking and memory get better within the first year after finishing treatment but others might experience more long-term effects. Talk to your health care team about ways to cope with changes such as maintaining a healthy lifestyle or adjusting your daily routine.

If you have severe or lasting changes to your thinking and memory, you can see a neuropsychologist or clinical psychologist for cognitive rehabilitation.

Breast prosthesis

A breast prosthesis is a synthetic breast or part of a breast worn under clothing or in a bra to replace all or part of your breast. A breast prosthesis can be worn after breast-conserving surgery or a mastectomy.

Most breast prostheses have the shape and feel of a natural breast. They may weight the same or be lighter. Breast prostheses can be attached directly to the skin or inserted into specially made pockets in bras, sleepwear and activewear.

Hair loss

Hair loss is one possible side effect caused by cancer treatments. Not all cancer treatments will cause hair loss – it is mostly associated with chemotherapy and radiation therapy. Treatments like targeted therapy, hormone therapy and immunotherapy are more likely to cause hair thinning or slow growth of hair.

If you lose your hair during cancer treatment, you may like to wear a wig, scarf, hat or turban while it is growing back. Some people are happy to leave their head bare. Some hospitals and cancer care units provide wigs for free or a small free.

Menopause and changes to fertility

Chemotherapy can cause your periods to stop for a time and may affect your ability to become pregnant. If your periods stop permanently (known as early menopause), you will not be able to conceive children naturally. Talk to your doctor before treatment begins if you think you would like to have children in the future.

Symptoms of menopause can include, trouble sleeping, hot flushes, tiredness, mood swings, weight gain, and osteoporosis. Talk to your doctor about ways to relieve symptoms.

You will not necessarily experience all these side effects and you may experience others that are not discussed here. It is important that you talk to your treatment team about any changes to your body during and after treatment.

Treatment Team

• GP (General Practitioner) -

  looks after your general health and works with your specialists to coordinate treatment.

• Radiologist -

  interprets diagnostic scans (including CT, MRI and PET scans).

• Radiation oncologist -

  prescribes and coordinates radiation therapy treatment.

• Medical oncologist -

  prescribes and coordinates the course of chemotherapy.

• Breast care nurses -

  provide information and support to people affected by breast cancer during and after treatment.

• Surgeon -

  surgically removes tumours and performs some biopsies.

• Reconstructive (plastic) surgeon -

  performs any complex reconstructive surgery that restores or repairs the body's appearance and function.

• Lymphoedema therapist -

  educates people about lymphoedema prevention and management, and provides treatment if lymphoedema occurs.

• Other allied health professionals -

  such as social workers, pharmacists, and counsellors

Screening for breast cancer

Women aged between 50 and 74 are invited to access free screening mammograms every two years via the BreastScreen Australia Program.

Women aged 40-49 and 75 and over are also eligible to receive free mammograms, however they do not receive an invitation to attend.

It is recommended that women with a strong family history of breast or ovarian cancer, aged between 40 and 49 or over 75 discuss options with their GP, or contact BreastScreen Australia on 13 20 50.

Preventing breast cancer

There is no proven method of preventing breast cancer, however the risk of breast cancer can be reduced by lowering alcohol consumption and maintaining a healthy weight.

Women who are at high risk because of a very strong family history may benefit from hormones such as tamoxifen, usually administered over five years. Bilateral prophylactic mastectomy can be considered in women at high risk of breast cancer due to gene mutations.

Prognosis for breast cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of breast cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

The most common types of breast cancer have a very good long-term prognosis, especially if the cancer is found early.