The breast cancer journey (page 1)

What is invasive breast cancer?
Breast cancer is a malignant tumour that starts within the breast tissue. If breast cancer spreads, it usually first appears in the lymph nodes in the armpit. Beyond this it tends to go to the bones, liver and lungs and becomes known as metastatic disease (see Figure 1 and Figure 2 PDF files).

What is DCIS?
‘In situ’ cancer (ductal carcinoma in situ, DCIS) in the breast refers to cancer that is still within the milk ducts. The cancer cells have not moved through the walls of the milk ducts; they are in the same place where they first formed.

How common is breast cancer?
Breast cancer is the biggest cancer killer of Australian women. About 10,000 new cases are diagnosed each year, about 3000 in New South Wales. The good news is that breast cancer can be detected early, when the tumour is quite small, through greater awareness, self-examination and regular mammograms (the BreastScreen Australia Program offers free mammograms to women over the age of 40). If found while localised in the breast, over 90 per cent of women diagnosed with breast cancer will be alive five years later.

How did I get it?
Changes (mutations) in our genes cause breast cancer. In about five per cent of women, those genes are inherited but in 95 per cent of women, the cause of the mutation is unknown. Researchers believe that many factors are involved in the development of breast cancer but currently cannot assign risk levels to them (unlike the relationship between smoking and lung cancer). While age is a fairly strong predictor of risk, the others are quite weak and are the subject of on-going research.

Pre-diagnosis
A diagnosis of breast cancer follows a path that usually begins with your general practitioner (GP) after you find a lump or an abnormality through a mammogram (see Figure 2). If there is any possibility of your symptoms being connected with breast cancer you will be referred for further tests. Tests could include a mammogram, ultrasound and a biopsy. Your GP, with the help of this Directory, may then refer you to a surgeon in private practice or at a public hospital.

Towards a diagnosis
After referral to the surgeon, you will be examined and further tests may be undertaken in order to establish a diagnosis. You should be provided with information about the tests that you are to undergo, the availability of results, and by whom and how you will be informed of the results. This information should be provided by your GP or the surgeon who organises the tests.

Waiting to go for tests, or to get the test results, is often a tense time, however people and organisations can provide support and information before it is confirmed that you have breast cancer. Call the Cancer Helpline 13 11 20.

Some diagnostic investigations or tests may involve surgery to obtain a small piece of tissue (this procedure is called a biopsy) which will be assessed by a pathologist. Some biopsies can be done by using low-invasive procedures, others may require more complex and exploratory surgery, requiring a general anaesthetic.  (See ‘Glossary’—FNA, ABBI, Core biopsy)

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