Condition
Breast cancer
Breast cancer is one of the most common cancers in women. It is also one of those with the widest treatment options when it is found early — which is why not putting off an assessment is the single most important part of the subject.
On this page
Symptoms
In its early stages breast cancer often causes no symptoms at all — which is exactly why screening matters. When symptoms do appear, they can include:
- A firm lump you can feel in the breast or in the armpit
- A change in the shape or size of the breast
- Skin dimpling, puckering or an “orange peel” appearance
- The nipple pulling inwards or changing direction
- Nipple discharge, especially one-sided and bloody
- Persistent redness, scaling or ulceration
- Lasting firmness in one part of the breast
None of these signs means cancer on its own — most of them have benign causes. But each of them needs to be examined.
Benign or malignant nodule
Nodules that are smooth, well-defined, mobile under the fingers and change with the menstrual cycle are more often benign; nodules that are hard, irregular, fixed and painless, with skin retraction or an enlarged node in the armpit, raise more concern. These are orientation points only: the answer comes from imaging and a biopsy. Read more on benign breast disease.
Risk factors
- Increasing age
- Breast or ovarian cancer in the family
- Certain inherited gene changes
- Having had breast cancer before
- Early onset of periods and late menopause
- Long-term hormone replacement therapy
- Obesity and a sedentary lifestyle
- Alcohol consumption
Having risk factors does not mean the disease will develop; not having them is not complete protection. Most women diagnosed with breast cancer have no family history.
How the diagnosis is made
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Clinical examination
The breasts and the armpits are examined, and the history of the symptom and the family history are established.
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Imaging
Depending on age, ultrasound, mammography or both are used. MRI and elastography add information in some cases. Ultrasound is usually more informative in younger women, mammography in older age groups.
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Biopsy
A tissue sample is taken from the suspicious finding. The diagnosis is confirmed only by pathological examination — imaging alone is not enough.
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Characterising the disease
Pathology establishes the type and grade of the tumour along with hormone receptor and HER2 status. These directly shape the treatment plan.
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Assessing spread
Where needed, further imaging is used to check whether the disease has spread.
What the stage means
The stage expresses the size of the tumour, the state of the lymph nodes and whether there is spread to distant organs, taken together. The stage determines the order of treatment — in some cases surgery first is more appropriate, in others drug treatment first.
The stage alone does not determine the outcome. The biology of the tumour, its response to treatment and the patient's general condition all matter too. For that reason, generalised figures about prognosis do not reflect an individual situation.
Treatment options
Treating breast cancer has several strands and requires several specialties working together. Surgery is only one part of that plan.
- Surgery — breast-conserving surgery or mastectomy; assessment of the axillary lymph nodes
- Radiotherapy — most often after breast-conserving surgery
- Chemotherapy — before or after surgery, as indicated
- Hormone therapy — where the tumour is hormone receptor positive
- Targeted therapy — according to the molecular features of the tumour
The order and combination are decided by the multidisciplinary team. More about the surgical stage.
Do not delay if you have
- A newly appeared, rapidly growing firm lump
- Bloody discharge from the nipple
- Ulceration of the skin or a wound that will not heal
- A newly appeared firm lump in the armpit
- Severe redness and swelling with a fever
For general emergencies, call 103.
Frequently asked questions
Is breast cancer curable?
When found early, the treatment options in breast cancer are wide and many patients achieve a long disease-free period. The outcome depends on the stage, the biology of the tumour and the response to treatment, so it is assessed individually for each patient.
If a lump is not painful, is it safe?
No. Lumps associated with breast cancer are often painless. The absence of pain is not a reason to skip an assessment.
Is it possible to keep the breast?
In many cases, yes. Breast-conserving surgery depends on the size of the tumour, its position in the breast, the number of foci and the volume of the breast. Radiotherapy is usually required after this operation.
Is mammography harmful because of the radiation?
The radiation dose used in mammography is low. In the appropriate age group, the benefit of early diagnosis from regular screening is considered to outweigh the risk of that dose. A schedule that suits you is set at the consultation.
Does breast cancer occur in men?
Yes, although it is rare. Any lump found in the breast area in a man needs assessment, and because it is rare, men often come late.
There is breast cancer in my family — what should I do?
Women with a family history may be advised to start screening earlier and to be followed up more closely. Genetic counselling is helpful in some situations. A suitable plan is set individually at the consultation.
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