One of the health stories in the press last week was the announcement that the singer and actress Olivia Newton-John is suffering from a recurrence of her breast cancer at the age of 68, 25 years after recovering from her original diagnosis. Worsening back pain, which had caused her to postpone dates on a forthcoming tour, has been found to be due to breast cancer. The cancer has spread to her lower back and has necessitated further treatment with a form of radiotherapy known as proton beam therapy.
In Britain, one in eight women (and one in 870 men) will develop it at some point in their life. Early detection saves lives and, crucially, death rates are now falling because of this. Breast cancer is the most common cancer in women in Britain, with over 55,000 cases a year, accounting for 11,000 deaths annually — a rate of about 30 deaths each day. The incidence rates for breast cancer are projected to rise by two per cent by 2035.
Four out of five breast cancers occur in women over the age of 50, although I have seen many women in their early 20s or 30s with it too (and men are not immune either, with almost 400 new cases diagnosed a year).
A small percentage of breast cancers are hereditary and we know there are two genes linked to the disease, called BRCA1 and BRCA2. However, if a close relative of yours has had breast cancer it does not automatically mean that there is hereditary breast cancer in your family, and everyone who carries a faulty breast gene does not automatically develop breast cancer either.
An estimated 27 per cent of female breast cancers in Britain are linked to lifestyle factors, including being overweight or obese (nine per cent), alcohol (six per cent), and certain occupational exposures (five per cent).
Breast awareness and self-examination are crucial. This is a point I cannot stress highly enough. The vast majority of breast lumps I am asked to examine have been found by women examining their breasts rather than by a doctor picking up a breast lump during a routine examination. There are five points to remember. Know what your breasts feel like normally, since every woman is different. Know what changes to look for, how to feel for lumps, and to report any unusual lumps detected. If you are aged over 50, regular mammogram screening is important too.
When examining your breasts, look out for some or all of these points. Has one breast become larger or lower recently? Has a nipple become pulled in or changed shape and position? Is there a nipple rash or discharge, or does the breast skin have areas of ‘dimpling’ or puckering around it? Is there a breast lump or thickening that you have never noticed before, a new swelling under your armpit or a constant pain there or in one part of a breast? All these are questions to remember, and if any seem to apply to you, see your GP sooner rather than later.
With improvements in medical treatments over the last two decades, around two-thirds (65 per cent) of women diagnosed with breast cancer in England and Wales now survive their disease for 20 years or more. In the 1970s four in 10 women diagnosed with breast cancer survived their disease beyond 10 years; now it’s about eight in 10.
The terms ‘stage 4’, ‘advanced’ and ’metastatic’ are all used to describe breast cancer such as Newton-John’s, which has spread beyond the breast and nearby lymph nodes to other organs of the body such as the lungs, distant lymph nodes, skin, bones, liver, or brain.
Types of treatment available include hormone therapy to try to shrink the cancer wherever it is in the body, chemotherapy, treatment with biological therapies such as the monoclonal antibody trastuzumab (brand name Herceptin), and radiotherapy (typically used if the cancer has spread to bones, the brain or the skin near the breast.)
The five-year survival rate after diagnosis for stage 4 breast cancer patients is just above 20 per cent — considerably lower than at earlier stages of the disease. But improvements in medical science continue to slowly push this figure upwards, giving more hope to all people suffering from advanced breast cancer.