Early breast cancer care

The NHS breast screening programme has a 5-point plan for breast cancer awareness:

• Know what's normal for you.

• Look at and feel your breasts.

• Know what changes to look out for.

• Report changes without delay.

• Attend routine screening if you're over 50.

Being breast cancer aware - what's normal?

Your secret weapon where spotting changes early is concerned is knowing what's normal for you. That means being 'breast aware' - because early breast cancer rarely causes pain or discomfort, you need to be on the look-out for anything that's different for you. Obviously, if you do find anything suspicious, you should seek help without delay.

How to check for breast cancer

Get into the habit of being 'breast aware'. This includes looking at your breasts - with your arms by your sides, hands on hips and then arms in the air - regularly. Look for any change in the shape, size or outline of the breast - such as an area where the skin is puckered, as if it's being tethered from the inside, or dimpling of the skin like orange peel. Check for nipple changes:

• Turning in of a nipple.

• Persistent eczema, rash or redness of the nipple.

• Bleeding or discharge from the nipple.

Then feel with the flat of your fingers all over your breasts, going right up into the armpits. You're looking for a new lump, bumpiness or thickening. If you find something abnormal, speak with your doctor quickly.

Breast cancer assessment

Since the pandemic, most GP practices have moved to a system of assessing people by phone or video consultation first rather than letting them make a face-to-face appointment automatically. But that doesn't mean you can't be seen if it's needed. Because demand for GP appointments has increased so much and there's a significant shortage of GPs, this process means patients who don't need to be seen face to face can be sorted out more quickly, freeing up time for those who do. If you have a breast problem, it's highly likely your GP will call you in for an appointment to examine you - or they may refer you straight to hospital.

Hospital referrals

Lots of my patients have been concerned about hospital referral since the pandemic. But please don't be worried - hospitals and GP surgeries have gone to huge lengths to ensure they're COVID-safe. Waiting rooms are carefully arranged so they're not overcrowded and hygiene standards have never been higher.

Screening appointments

All women in the UK are invited to have a regular mammogram every three years from 50-70 years old. However, your first invitation will come within three years of you turning 50 rather than on your 50th birthday. Breast screening aims to pick up breast cancer at a very early stage, before it causes any symptoms. That's because the earlier any cancer is caught and treated, the better the chances that treatment will be successful.

The process involves X-raying one breast at a time (done by a female health practitioner). Each breast has to be compressed between a clear plate and the X-ray machine - it's mildly uncomfortable for some but only takes minutes. The appointment is quick and you don't need to take any special steps - you can eat and drink normally and drive straightaway afterwards.

Even though you won't be routinely invited for breast screening once you reach 71, you can continue to access screening every three years by requesting it - your doctor can advise.

At the height of the first wave of the pandemic, screening appointments, including mammography (special breast X-ray screening) were put on hold. But that too has now restarted and clinics are doing their best to catch up with the backlog.

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There are a few known gene changes (mutations) that can increase the risk of certain cancers, and tests available for some of them, including BRCA1 and BRCA2 gene mutations. The BRCA1 and BRCA2 genes normally protect against certain cancers, particularly breast cancer and ovarian cancer. If there is a mutation in one of these genes then this may mean that the protection is lost and that a cancer is more likely to develop.

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How do doctors check for breast cancer?

If your GP does suspect breast cancer, they'll refer you urgently to a specialist clinic. Here, you'll be examined again and offered a mammogram and ultrasound scan of your breasts, usually at the same appointment.

Many women are given the all-clear on the day of this appointment. However, you may also be referred for other tests, including genetic testing, or an MRI scan of your breast and a breast biopsy.

What increases the risk of breast cancer?

There are lifestyle steps you can take to reduce your risk of breast cancer. For instance, being overweight increases your risk of breast cancer, and keeping your weight down to a healthy level can help protect you. So too can avoiding excess alcohol. Although smoking does increase your risk of getting breast cancer, smoking has far more of an impact on the risk of other cancers, such as lung cancer.

While taking hormone replacement therapy (HRT) is known to increase the risk of breast cancer, it's estimated that only about 1 in 50 diagnoses of breast cancer are down to HRT. There are two main female hormones which form HRT - oestrogen and progestogen. If you've had a hysterectomy, you would be offered oestrogen-only HRT - and this is linked to little or no increased risk of breast cancer. Otherwise, you would be offered combination HRT which includes both hormones. The type of progestogen in HRT makes a difference: in research, norethisterone was linked to the highest increases in risk of breast cancer, and dydrogesterone to the lowest risk.

What is the survival rate of breast cancer?

96% of women diagnosed with breast cancer now survive for at least a year and 3 in 4 basically beat breast cancer today - but early diagnosis is key.

With thanks to 'My Weekly' magazine where this article was originally published.