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Breast cancer is the most common cancer in women in Australia1 and the second most common cancer to cause death in women, after lung cancer. It is uncommon in males.
Incidence and mortality
In 2009, over 13,700 people were diagnosed with breast cancer in Australia. The risk of being diagnosed with breast cancer by age 85 is 1 in 8 for women and 1 in 724 for men.
In 2007, 2680 women and 26 men died of breast cancer in Australia.
Mammographic screening every two years is recommended for women aged 50-70 years, though it is available to women from 40 years of age. Younger women in high risk groups may be screened by Magnetic Resonance Imaging (MRI).
Symptoms and diagnosis
- new lumps or thickening in the breast or under the arm
- nipple sores
- nipple discharge or turning in
- skin of the breast dimpling
- rash or red swollen breasts.
Pain is rare.
Diagnosis is usually by imaging eg. mammogram, then biopsy by needling or removing the lump.
Staging involves assessing the size of the breast cancer and whether it has spread to the draining lymph nodes under the arm. A CT scan of the chest and liver and bone scan are done to check the sites to which breast cancers most commonly spread.
The causes of breast cancer are unknown, but risk factors include:
- increasing age
- family history
- inheritance of mutations in the genes BRCA2, BRCA1 and CHEK2
- exposure to female hormones (natural and administered)
- obesity (poor diet and inadequate exercise) and
- excess alcohol consumption.
There is also an association with some benign breast disease and past exposure to radiation.
There is no proven method of prevention, however 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.
Treatment depends on the extent of the cancer.
For localised breast cancer, the most extensive surgical option is to remove the breast and lymph nodes under the arm. However, removing the lump and just a section of the breast, followed by radiotherapy, results in the same rate of survival. If the first draining lymph node can be identified using dye or a nuclear medicine scan, it can be sampled and if it is negative, further surgery avoided.
For tumours at greater risk of recurrence ie. bigger, more aggressive cancers, or cancers that have spread to the lymph nodes, additional treatment (adjuvant therapy) can be given after surgery. This can include hormone therapy of aromatase inhibitors or tamoxifen for women whose tumours have hormone receptors on their surfaces, and chemotherapy and targeted therapies such as trastuzumab for those 25% of tumours that are HER2 positive (ie. have the target for trastuzumab on their surfaces).
Patients presenting with locally extensive cancer will have chemotherapy and radiotherapy initially to see if it will shrink the cancer to make it operable.
If breast cancer returns after initial treatment, local disease may be treated with surgery, while more widespread disease will be treated with combinations of similar drugs to those used in adjuvant treatment. Common chemotherapy drugs include anthracyclines and taxanes.
Patients with bone disease can receive bisphosphonates such as zoledronate to slow the erosion of bones, and receive local radiotherapy for pain.
An individual's prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. If the cancer is limited to the breast, 96% of patients will be alive five years after diagnosis; this figure excludes those who die from other diseases. If the cancer has spread to the regional lymph nodes, five year relative survival drops to 80%. In Australia, the overall five year survival rate for breast cancer is 89%.
For more information, contact Cancer Council Helpline on 13 11 20 (cost of a local call).
For more information
- Reduce your risk fact sheets
- Early detection of breast cancer
- Screening for breast cancer
- After a diagnosis of breast cancer
- Australian Institute of Health and Welfare (AIHW) 2012. ACIM (Australian Cancer Incidence and Mortality) Books. AIHW: Canberra.
- Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW.
- Australian Institute of Health and Welfare & Cancer Australia 2012. Breast cancer in Australia: an overview. Cancer series no. 71. Cat. no. CAN 67. Canberra: AIHW.
This page was last updated on: Monday, January 21, 2013