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Stages of Breast Cancer

LCIS - lobular carcinoma in situ
What lobular carcinoma in situ is?
Lobular cancer in situ (LCIS) means that there are cell changes inside the breast
lobes. This is not cancer. Having LCIS means that you have an increased risk
of getting breast cancer in the future. Even so, most women with LCIS will not
get breast cancer.

LCIS does not show up on mammograms and is often diagnosed by chance
when you have a breast biopsy for something else. Or the doctor may spot it
when you have a breast lump removed. LCIS is more common in women who
are pre-menopausal.

Please note: there is a type of breast cancer called invasive lobular breast
cancer, and this is different to LCIS.

Treatment

Doctors used to treat LCIS with surgery to remove the whole breast
(mastectomy). But now doctors know that most women with LCIS will not get
breast cancer. So your doctor is more likely to suggest keeping a close eye on
you with
Breast examination every 6-12 months
A mammogram every 1-2 years
If a cancer does start to develop, the monitoring should pick it up at a very early
stage so that you can have the breast cancer treatment you need as early as
possible.

Your doctor may suggest you take a type of hormone therapy to lower the
chance of breast cancer if you have LCIS. There is a trial looking into using a
hormone therapy called anastrozole to try to stop breast cancer in women at
higher than average risk, which includes women with LCIS. It is called IBIS 2.
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Also, the GLACIER study is collecting blood samples, to try to find out which
genes increase the risk of LCIS, and which women with LCIS are more likely to
develop breast cancer. While these trials are open and recruiting women, we will
list them on our clinical trials database. Choose 'breast' from the drop down
menu of cancer types. Or use the 'advanced clinical trials search page' and
search for 'prevention' under 'types of trial'. Invasive ductal breast cancer What
invasive ductal cancer is
Ductal breast cancer is the most common type of breast cancer. Between 70
and 80 out of every 100 breast cancers diagnosed (70 80%) are this type. You
may also hear your doctor call this ductal carcinoma. A ductal carcinoma of the
breast is a cancer that is growing in the cells that line the ducts of the breasts.

Remember - if your doctor has told you that you have ductal carcinoma in situ or
DCIS, you do not have invasive ductal breast cancer. You can find more
information about DCIS in this section of CancerHelp UK.

Most often, ductal carcinoma is described as being of no special type. You may
see this written as NST or NOS (not otherwise specified). Special type means
that when the doctor looks at the cells under a microscope the cells have
features that makes them different from other types. Breast cancers that are of a
'special type' include lobular breast cancer and some rare types of breast cancer.

Treatment
For ductal breast cancer, you may have
Surgery
Radiotherapy
Chemotherapy
Hormone therapy
Click on these links for more about each of these treatments. You can also look
at the page on which treatment for breast cancer? to find out how each type of
treatment is used for different stages of breast cancer. The stage of a cancer
tells you how big it is and whether it has spread. Doctors generally use the stage
of a cancer to decide on the most appropriate treatment. Invasive lobular breast
cancer What invasive lobular cancer is

About 1 in 10 breast cancers diagnosed (10%) are invasive lobular carcinoma.
This means that the cancer is growing in the cells that line the lobules of the
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breast. Invasive lobular cancer can develop in women of any age. But is most
common in women between 45 and 55 years old. It is possible for men to get
invasive lobular breast cancer, but this is very rare.

Remember - if your doctor has told you that you have lobular carcinoma in situ
or LCIS, you do not have invasive lobular breast cancer. These are two different
things. Look at the page on LCIS in this section of CancerHelp UK.

The outlook for invasive lobular breast cancer is much the same as for ductal
breast cancer. Lobular breast cancer is not a more aggressive cancer, as is
sometimes said. It is more common for it to be diagnosed in both breasts at the
same time. And if you have invasive lobular breast cancer diagnosed in one
breast, there is a slightly higher risk than there is for ductal breast cancer of
getting it in the other breast in the future.
Symptoms and diagnosis
Invasive lobular breast cancer does not always show up as a firm lump. And it
does not form the pattern on a mammogram called calcification. So it can be
difficult to diagnose. Because of this, invasive lobular cancers may be larger
than other types of breast cancer when they are diagnosed. You may have a
thickened area of breast tissue instead of a definite lump. The tests for lobular
breast cancer are the same as for ductal breast cancer.
Treatment
The treatment for invasive lobular breast cancer is the same as for ductal breast
cancer. Usually, you will have surgery, possibly followed by radiotherapy or
chemotherapy, or both. You may also have hormone therapy after surgery, if
your breast cancer cells are oestrogen receptor positive. Look at the which
treatment for breast cancer? page to find out more about how the various
treatments are used.

Invasive lobular breast cancer can sometimes be found in more than one area
within the breast. If this is the case, it may not be possible to remove just the
area of the cancer. You may be asked to have a mastectomy. If at all possible,
your breast surgeon will offer you the choice of mastectomy or lumpectomy and
radiotherapy. Inflammatory breast cancer What inflammatory breast cancer is

This is a rare type of breast cancer. Only about 1 or 2 breast cancers out of
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every 100 diagnosed (1 or 2%) are this type. It is called 'inflammatory' because
the breast tissue becomes inflamed. The cancer cells block the smallest lymph
channels in the breast. The lymph channels (or lymph ducts) are part of the
lymphatic system. Their job is to drain excess tissue fluid away from the body
tissues and organs.
Symptoms
Because the lymph channels are blocked, the breast becomes
Swollen
Red
Firm or hard
Hot to the touch
The breast can also be painful in inflammatory breast cancer, but this is not
always the case. Other possible symptoms include
Ridges or thickening of the skin of the breast
Pitted skin, like orange peel
A lump in the breast
A discharge from the nipple
Inverted nipple the nipple is pulled into the breast
Inflammatory breast cancer symptoms can appear quite suddenly. It is often
confused with an infection of the breast (mastitis) because the symptoms are
very similar. You may have been given a course of antibiotics at first, to see if
that would clear the condition up. The same tests are used to diagnose
inflammatory breast cancer as for any other type of breast cancer. In some
cases, it is not possible to do a mammogram because the breast is swollen and
painful.
Treatment
The treatment for inflammatory breast cancer can be slightly different than for
other types of breast cancer. Usually, chemotherapy is the first treatment you
have. This is called neoadjuvant chemotherapy. You have this first to help
control the condition in the breast and reduce the swelling. The chemotherapy
also travels throughout the body and so will treat any breast cancer cells that
have broken away and spread outside the breast.

After chemotherapy, you are most likely to have surgery. Mastectomy is the
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commonest operation for inflammatory breast cancer - this means removing the
whole breast. Or you may be able to have just the affected area removed. This
will depend on
The size of the cancer when you were diagnosed
How the cancer has responded to the chemotherapy
Where the tumour is in the breast
You may also have radiotherapy and hormone therapy after your surgery, to try to reduce
the risk of the cancer coming back. Paget's disease What Paget's disease is Paget's
disease is a rare disease that is associated with breast cancer. It is found in 1 or 2 out of
every 100 breast cancers (1 to 2%).

Paget's disease starts in the nipple or in the area of darker skin surrounding it (the
areola). It usually first appears as a red, scaly rash of the skin over the nipple and areola.
It can be itchy. If it isn't treated, or if you scratch it, it can bleed, ulcerate and may scab
over. It may be mistaken for eczema, both by women and their doctors. It is sometimes
diagnosed quite late, probably because it is often first treated as eczema, before any
cancer investigations are done.

How it diagnosed is
Paget's disease is diagnosed from a biopsy. Your breast surgeon will take a sample of the
affected skin tissue (a biopsy) from the nipple and send it to be examined under a
microscope. If Paget's disease is diagnosed, you will then have a mammogram. In many
cases, Paget's disease is a sign that there is a breast cancer in the breast tissues behind the
nipple. About half the women diagnosed with Paget's disease have a lump or mass
behind the nipple. In 9 out of 10 cases, this is an invasive breast cancer.

About 4 out of 10 (40%) of the women with Paget's disease who do not have a lump also
have an invasive breast cancer. But most just have carcinoma in situ. This means there
are cancer cells in the biopsy, but that they are contained. This is not an invasive breast
cancer and so there is no chance that the cancer cells have spread. If left untreated, a
carcinoma in situ can go on to develop into an invasive cancer, so if you have carcinoma
in situ, you will be offered regular monitoring.




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Treatment

Generally, the treatment for Paget's disease is much the same as for any other
breast cancer. You will have surgery to have either the whole breast removed or
just the affected area removed. Further treatment depends on whether your
results show that you have an invasive breast cancer, or not.
If you have breast cancer
If you are found to have an invasive breast cancer, after surgery, you may have
Radiotherapy
Chemotherapy
Hormone therapy
The exact choice of treatment will depend on the results of your surgery.

Mastectomy may be the only option if you have a large area affected by Paget's
or if there is an area of invasive breast cancer behind the nipple. With a cancer
in the central area of the breast, your surgeon may not be able to leave you with
a good breast shape if you have surgery just to remove the cancer and
surrounding tissue. You may get a better appearance if you have the whole
breast removed and then have breast reconstruction. For some women, it is
possible to just have the area containing the cancer removed, together with a
border of healthy tissue. This will be followed by a course of radiotherapy to the
rest of the breast.

When you have your surgery, the surgeon will take out some of the lymph nodes
under your arm. Overall, almost 4 out of 10 women (38%) with Paget's and an
underlying breast cancer will have cancer cells in one or more lymph nodes. But
we can break this figure down into women who have a lump behind the Paget's
and those who don't. In women who have Paget's with a definite lump, about 66
out of 100 have cancer in the lymph nodes (66%). But in women who have
Paget's without a lump, only 8 out of 100 (8%) will have cancer in the lymph
nodes.

When you think about it, this makes sense. Most women without a lump will
have DCIS. For these women, there is virtually no risk of cancer cells having
spread to the lymph nodes. So far fewer women will have cancer in the lymph
nodes.

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If your breast cancer cells are found to have oestrogen receptors your doctor will
probably suggest that you have treatment with 5 years of tamoxifen (or other
similar hormone treatment). This is to reduce the risk of
The cancer coming back in the same breast
Getting a new cancer in the other breast
Your doctor may suggest further treatment with chemotherapy if there is a
significant risk that the cancer may come back. This could be because
Cancer cells were found in your lymph nodes
You had a large breast tumour
Your cancer cells were high grade (grade 3)
Giving chemotherapy helps to lower the risk of the cancer coming back in the
future.
If there is no breast lump

Mastectomy is still the most commonly used treatment for Paget's disease where
there is no invasive breast cancer. This is because the cells are abnormal and
could develop into an invasive breast cancer if not treated. Your surgeon will
remove some lymph nodes to check for signs of cancer. In 9 out of 10 cases,
there is no sign of cancer in the lymph nodes. But it is best to make sure. In
most cases, the surgery will be all the treatment you need.

If the affected area is not too large, you may be able to have just the Paget's
removed, along with a border of healthy tissue around it. Your doctor is likely to
advise that you have radiotherapy after your surgery. Without it, there is quite a
high risk that the Paget's will come back. Even with only local surgery, your
surgeon will still want to check your lymph nodes to make sure they don't contain
cancer cells. Rare types of breast cancer Grouping breast cancers

Doctors have developed ways of grouping breast cancers into different types.
They sometimes call rarer breast cancers special type and the more common
breast cancers no special type. The most common breast cancer is ductal
carcinoma and this is often described as being of no special type. You may see
this written as NST or NOS (not otherwise specified).

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'Special type' breast cancers have cells with particular features. Aswell as the
rare cancers listed here, lobular breast cancer is also classed as a 'special type'.
Medullary breast cancer

About 5 out of 100 breast cancers (5%) are medullary breast cancers. The
cancer cells tend to be bigger than other breast cancer cells. And when doctors
look at these cancers under a microscope they can see a clear boundary
between the tumour and the normal tissue. This type of breast tumour is also
unusual because it contains white cells.

Doctors treat medullary breast cancer in the same way as other types of invasive
breast cancer. Women with medullary breast cancer generally have a better
outcome than women with other types of invasive breast cancer.
Mucinous (or colloid) cancer of the breast

About 2 in 100 breast cancers (2%) are mucinous breast cancers. This cancer
tends to be slower growing than other types of breast cancers and is less likely to
spread to the lymph nodes.

Doctors usually treat mucinous cancers in the same way as other types of breast
cancer - with surgery. If the tumour is smaller than 1 cm, you may not need your
lymph nodes removed. The outlook for mucinous breast cancer is generally very
good. Further treatment is often not needed after the surgery.
Tubular breast cancer

Tubular cancer of the breast is named tubular because the cells have a tubular
shape when looked at under a microscope. Only about 1 in 100 breast cancers
(1%) are tubular cancers.

Treatment is the same as with other types of invasive breast cancer. But you
may not need to have your lymph nodes removed. This type of breast cancer is
also less likely than other types to come back after treatment. So, the outlook is
generally good.

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Adenoid cystic carcinoma of the breast

Fewer than 1 in 100 breast cancers (1%) are adenoid cystic carcinomas. You
may also hear your doctors call it a cribriform cancer. This type of tumour tends
to be slow growing.

Doctors usually recommend surgery to treat adenoid cystic breast cancers. Most
women dont need a mastectomy. Instead, your doctor will just remove the lump
(a lumpectomy). Adenoid cystic carcinoma of the breast rarely spreads
elsewhere in the body. So you don't usually need to have your lymph nodes
removed. And the risk of this type of tumour coming back is low, so the outlook
is good.
Papillary breast cancer

In papillary carcinoma the breast cancer cells arrange themselves in a pattern
that looks a bit like the shape of a fern. Papillary tumours tend to affect older
women. They can also be non cancerous (benign).

Doctors usually treat papillary breast cancer with surgery. These cancers are
usually slow growing, and dont usually affect the lymph glands.
Metaplastic breast cancer

This is a type of breast cancer where the cells are a mixture of two cell types.
The cells have started out as one cell type, such as an adenocarcinoma, but
some of them have changed.

Doctors treat metaplastic cell cancers in the same way as other breast cancers.
You may have surgery, chemotherapy and radiotherapy. But metaplastic breast
tumours tend not to be sensitive to hormone therapy.
Angiosarcoma of the breast

Angiosarcoma is a type of breast sarcoma. A sarcoma is a cancer that develops
from the structural, supporting tissues of the body, such as connective tissue,
bone, blood vessel or nerve tissue. Less than 1 in 100 breast cancers (1%) are
sarcomas. Angiosarcoma (pronounced ann-gee-oh-sar-co-ma) is also
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sometimes called haemangiosarcoma (hee-man-gee-oh-sar-co-ma). It starts in
the cells that line the blood or lymphatic vessels. These cancers are more
common in women in their 30s and 40s who have not yet had their menopause.
The lump is usually at least 4 cm is size, and the skin over it may turn a bluish
colour. The causes are not known but one possible cause in older women
is chronic lymphoedema following a mastectomy and previous radiotherapy to
the area.

Doctors usually treat these tumours with surgery and chemotherapy. There is
more information about breast angiosarcoma in the breast cancer questions
section.
Phyllodes or cytosarcoma phyllodes

Phyllodes (pronounced fi-loi-d-ees) is a type of breast sarcoma that can be either
cancerous (malignant) or non cancerous (benign). If cancerous, they may
spread into the lymph nodes, but this is rare. Doctors usually treat them with
surgery, and sometimes radiotherapy. Chemotherapy is rarely used.
Lymphoma of the breast

Lymphomas of the breast contain both lymphoid tissue and breast tissue. If your
doctor diagnoses lymphoma of the breast, they will arrange further tests for you.
These will check for lymphoma elsewhere in your body. You can find out more
about this in our section about non Hodgkins lymphoma. The treatment for
lymphoma of the breast is usually surgery to remove the lump, then
chemotherapy with or without radiotherapy.
Basal type breast cancer
Basal type breast cancer was first identified in 2003. The breast cancer
cells have particular genetic changes. The p53 gene is damaged (mutated) or
lost. The cells make large amounts of a protein called cytokeratin 5/6. Basal
type breast cancers are often triple negative - meaning that they don't have many
receptors for oestrogen, progesterone, or the Her2/neu protein. So, hormonal
therapies and Herceptin don't work for most basal type cancer cells. Other
treatments are used instead. The mammogram A mammogram is an X-ray of the
breasts. The NHS breast screening programme uses them to screen for breast
cancer in women between 50 and 70 in the UK. You are also likely to have a
mammogram if you have breast cancer symptoms, such as a lump.
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What happens when you have a mammogram

A radiographer helps you to position one breast at a time on a small flat plate,
with an X-ray plate under it. There is another flat plate above your breast. When
the machine is switched on, your breast is pressed down between the plates by
the machine for a few moments. The compression of the breast helps to give a
clear picture for the doctors to examine.

Women in the UK have 2 pictures taken: one from above and one from the side.
This is to make doubly sure that nothing is missed. Researchers reckon that
taking a 2 view mammogram each time could increase the breast screening
programme's cancer detection rate by 25% or more. That means, for every 100
cancers we'd pick up with single view mammograms, we are likely to find 125
with double view mammograms. So more women will have their cancers found
early when they are easiest to cure.
How it feels

It isnt surprising that women worry about whether a mammogram will hurt. For
some women it is just uncomfortable. But it really depends on your breast size
and pain threshold. Other women do feel some pain. But it only lasts while you
are having the test, so it is only a few moments. A Cochrane review carried out
in 2004 reports that having control over your breast compression during your
mammogram will reduce any pain. Taking aspirin or paracetomol before the
procedure doesn't help. If you would like to, you can read this review on pain in
mammography in the Cochrane Library. It is written for researchers and
specialists so is not in plain English.
What happens after the mammogram

A doctor will look at your mammogram and see if there are any signs of cancer.
You should get your results within 7 to 14 days. In very busy clinics, this can
take longer, so dont worry if you dont hear for up to 4 weeks. If there is any
doubt at all about your mammogram, they will call you back for more tests.


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What getting called back means

There is no reason to panic if you are called back for more tests. About 1 in 20
women (5%) are called back in the UK breast screening programme. But only 1
in 8 of these will turn out to have cancer. That's only about 7 out of every 1,000
women having breast screening.

So out of every 8 women called back, 7 will be fine. These women will have had
some unnecessary anxiety. But the doctors have to err on the safe side
otherwise they would increase the risk of missing cancers. Cancers that are
picked up by the screening programme tend to be diagnosed very early on in
their development. This usually means they are easier to treat, need less
treatment and are more likely to be cured.
What a mammogram shows




Well developed breast cancers nearly always show up clearly on mammograms.
Unfortunately, there will always be the odd one that is missed or doesnt show
up. No medical test is perfect, but the screening programme organisers do make
every effort to pick up as many cancers as possible.

With early stage breast cancer, there may be no lump, but you can usually see
patterns on the mammogram that suggest a breast cancer may be there.

You may hear your doctor talk about calcification. Calcification is small areas of
calcium within the breast tissue. Sometimes the calcium makes spots and
patterns on the mammogram that can suggest a cancer. But you can also have
calcification due to non-cancerous changes in the breast. The skill and
experience of the technicians and doctors helps them to read the different
patterns and decide which might be due to cancer.

Some cancers do not show these clear signs on the mammogram. So, if you
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find any suspicious lump in your breast, always tell your doctor, even if you
recently had a mammogram.
DCIS
Your mammogram may show DCIS. This stands for 'ductal carcinoma in situ. It
is changes in the lining of the breast ducts that may go on to become an invasive
breast cancer. Some doctors call it a pre-cancer. The breast cancer cells are
stuck inside the ducts of the breast. The ducts are the tubes that carry milk
within the breast.



Because they haven't broken out of the ducts, the cancer cells can't have spread
to the lymph modes or other parts of the body. So there is very little risk of DCIS
coming back once it has been removed.
Possible risks

Like all X-rays, having a mammogram exposes you to some radiation, but only a
small amount. Scientists have worked out that there is less than a 1 in 25,000
risk of a mammogram causing breast cancer.

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About 7 cancers are found for every 1,000 women screened. And the women
whose cancers are found are generally diagnosed at an earlier stage, when their
cancer is more likely to be curable. People are bound to be concerned about
radiation risk. But, as with many things in life, it is a question of weighing up one
risk against another. For breast screening, we think the benefits of finding breast
cancer early far outweigh the small risk of radiation.
Breast cancer and overdiagnosis

There has been quite a debate in the medical press about the breast screening
programme picking up a breast cancer when there isnt really one there. Or
picking up an early breast cancer that was never going to develop any further.
Obviously that would expose women to potentially damaging cancer treatments
that they didnt need.

There is no evidence for overdiagnosis of invasive breast cancer in the UK
screening programme. But there may be overdiagnosis of some types of DCIS.
Screening may pick up a proportion of DCIS that wouldnt get any worse if it was
left alone. We cant really know for sure which ones those are, or how many
women are affected. As we cant tell at the moment which types of DCIS are
going to carry on developing into an invasive cancer, the safest option is to treat
them all.

Cancer Research UK researchers estimate that up to 1 in 3 cases of DCIS found
by breast screening might not develop into invasive cancer if they werent
treated. That is about 1 in 20 (5%) of all women diagnosed with either DCIS or
invasive breast cancer by the UK breast screening programme at their first visit.
For women who have already had some breast screening, fewer than 1 in 100
women are diagnosed whose DCIS would not develop into cancer if it was not
treated.

So some women may be having surgery they dont need, but many more will be
having potentially life saving treatment. All we can do is continue the research to
find out more about how to identify the groups of DCIS that wont develop into
cancer. We are learning more about the different grades of DCIS and that
should help in the future. A clinical trial is currently looking into the detection and
treatment of DCIS.. While it is open this tral will be listed on our clinical trials
database. Type DCIS into the free text search box.

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Screening and anxiety

Some people say that women are caused unnecessary anxiety and distress by
the screening programme. This is true in the sense that 7 out of 8 women called
back for more tests turn out to be fine. Other people think that some upset can
be forgiven because the programme diagnoses breast cancer early and so saves
other women and their families much more distress. This is a decision that we all
need to make for ourselves. We are trying to help here by explaining that being
called back does not mean you have breast cancer. And many women find
having regular breast screening very reassuring. Who is screened for breast
cancer? Who is screened

The breast screening programme uses a mammogram to screen all women
between 50 and 70 who are registered with a GP in the UK. Everyone in this
age group is sent an invitation to come for the test every 3 years.

We are sometimes asked why women of 52 or 53 havent had a letter. This is
because each local screening unit works through their area over 3 years on a
rolling basis. This means that by the time 3 years has gone round, they will have
covered their whole area and will then start at the beginning again. So everyone
will have had at least one invitation before they are 54. The Government is
planning to expand the breast screening programme to cover women between 47
and 73 by 2012. Each unit will still follow a 3 year rolling programme, so
not every woman will be screened when she is 47. But once this expansion is
complete, everyone will have at least one invitation before they are 51.

If you move house before you have had your appointment, your invitation could
be delayed if women in your new area have recently been screened. It may be
worth contacting your local screening service in your new area and letting them
know that you might have been missed.

About three quarters of women (75%) go for their breast screening
appointments. In 2004-5 over 1.7 million women were screened for breast
cancer in the UK. Only 5 out of every 100 (5%) are asked to go back for more
tests.

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How often you should have screening

Research is looking into this at the moment, comparing mammograms once a
year to mammograms every 3 years. With 3 yearly mammograms there is a more
of a risk that cancer could develop between tests than there is with yearly
mammograms. But with mammograms every year, women are exposed to 3
times the radiation that they would be with 3 yearly screening. And of course it
costs 3 times as much.

If there is the slightest doubt about your mammogram, but no real sign of cancer,
you will be asked to come back for another test after 6 -12 months anyway. 3 out
of every 100 women who are asked to do this need to have further tests after
their second mammogram. So this early recall acts as a sort of fail safe. If you
find a breast lump or have any other symptom that is worrying you, always tell
your doctor, even if you recently had a normal mammogram.
The age range
You can ask to have a mammogram every 3 years if you are over 70. In fact it is
helpful to do this. There is a lot of debate about whether the screening
programme should be expanded to include older women. The older you are, the
more at risk you are of getting breast cancer. So it makes sense to keep having
mammograms.

If you are younger than 50, your risk of breast cancer is much lower. And
mammograms are more difficult to read in younger women because the breast
tissue is denser, so the patterns don't show up as well. There is little evidence
that regular mammograms for most women under 50 can prevent death from
breast cancer.

If you are at higher risk than average because you have breast cancer in your
family, you can talk to your GP about starting screening younger. NICE (the
National Institute for Health and Clinical Excellence) now recommend that
women who have a moderate or high risk because of their family history should
start having mammograms for screening in their 40's. They recommend a
mammogram every year. NICE say women in this situation should enter the joint
NHS and Cancer Research UK study into mammography for women in their 40's
with a significant family history of breast cancer. You have to be between 40 and
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44 to join the study. You can also find information about this trial by going to our
searchable database of clinical trials and choosing 'breast' from the drop down
menu of cancer types.

In October 2006 NICE updated these guidelines, recommending that women in
their 40's, assessed to be at high risk of developing breast cancer, should be
offered yearly MRI scans. You still need to talk to your GP first to get a referral to
a specialist breast clinic.

If you are younger than 40, NICE recommend that you should still be referred to
a specialist breast service, but will not necessarily have mammograms. For
women under 40, NICE say that mammograms should only be used as part of
clinical trials into screening and that they shouldn't be used under age 30 at all.
This is because they are not as reliable at picking up breast cancer in younger
women. The updated NICE guidance now recommends MRI scans for certain
women between the age of 20 and 40, depending on results of genetic testing or
their estimated risk of getting breast cancer. There is more about the NICE
guidance on MRI scans for breast screening in this section of CancerHelp UK.
Breast awareness

You should still make sure you know how your breasts normally look and feel,
even if you are having mammograms every 3 years. Most breast cancers are
still found by women themselves. This is partly because the screening
programme only includes women between 50 and 70. But it will also be because
cancers can show up between mammograms. This is known as an 'interval
cancer'. If you notice any symptoms dont wait until your next mammogram. See
your GP straight away. There is information on how to check your breasts in the
early detection section of CancerHelp UK. Breast cancer risks and causes
Possible breast cancer protective factors Being physically active

We know from research that physical activity can help to prevent breast cancer.
Studies that have looked at this have found a protective effect of about 30 -
40%. So being active may lower your risk by about a third.



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Breastfeeding

Statistically, if you breastfeed (particularly if you have your children when you are
younger) you are at less risk of developing breast cancer. The longer you
breastfeed your baby, the more you lower your risk. We don't know exactly why
this is. It may be because you don't ovulate so often when you are
breastfeeding. Or because breastfeeding changes the cells in the breast and
may make them more resistant to the changes that lead to cancer.

Diet

A healthy diet may help prevent breast cancer. Look at the CancerHelp UK
section on diet and preventing breast cancer for more information.
Using drugs to prevent breast cancer

Research is looking into drugs that may prevent breast cancer.

Tamoxifen is a drug that has been used to treat breast cancer for more than 20
years. It works by stopping oestrogen from getting to hormone receptors on
breast cancer cells. Oestrogen works on some types of breast cancer by
triggering the cells to divide and multiply, so the cancer grows. Some women
who are at high risk of breast cancer have been taking tamoxifen to see if it can
stop them developing the disease. Trials have been carried out worldwide.
Cancer Research UK have looked at the results of all these trials together. They
show that tamoxifen can lower your risk of breast cancer if you are at high risk of
the disease. Tamoxifen seems to help to prevent breast cancers that have
oestrogen receptors. It does not protect against oestrogen receptor negative
cancers. There are also concerns about side effects for otherwise healthy
women. The trials show clearly that there is an increased risk of blood clots and
of womb cancer for women taking tamoxifen.

The latest results from one of these trials, IBIS1, show that the benefits of
tamoxifen in preventing breast cancer seem to last for at least another 5 years
after the 5 years of tamoxifen treatment has ended. But the side effects mostly
go once you stop taking the drug. A small number of women were diagnosed
with womb cancers after the treatment period, but these can be successfully
treated. The risk of clots only lasted while women were taking tamoxifen.

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Other hormone drugs are being investigated for preventing breast cancer.
Doctors hope that these other drugs may have fewer side effects than
tamoxifen. These are raloxifene and anastrozole.

Raloxifene is a drug used to treat bone thinning (osteoporosis) in women who
have had their menopause. Some doctors think it may help prevent breast
cancer too and recent research has shown it may help prevent breast cancer in
post menopausal women.

Anastrozole (Arimidex) is a drug that has mostly been used to treat secondary
breast cancer. It is also licensed in the UK to treat early breast cancer.
Anastrozole is being tested for preventing breast cancer in a trial called IBIS 2.
While it is open, this trial will be listed on our clinical trials database. Choose
'breast' from the drop down menu. Or type 'ibis' into the freetext search.