COMMON MISCONCEPTIONS

HOW BREAST CANCER PRESENTS:

Cancers are the size of a pea. A cancer can be of any size when it presents, however it is usually 1-2cm in size before the average person can feel it. They are seldom round like a pea.
If I have a painful lump, it can be breast cancer. This is not usually true, however, some tumours may be painful. You should check every lump.
If I have lumpy breasts I will not be able to identify a lump if it is present. If you examine your breasts regularly you will be more aware of any early changes. In many cases, the size of a lump at presentation is quite large and could certainly have been felt a lot earlier with more regular self examination.

Breast cancer is a disease in women over 50. This is not the case. Although cancer more commonly occurs in older women, 1/3 of cases are in women under 50.

This is one of the greatest risk factors in developing breast cancer. There is widespread misunderstanding in the community that family history plays a large part as a risk factor in the development of breast cancer. Of the women who develop breast cancer, 5-15%, at the most, have a family history of the disease. Therefore, 85% of breast cancers will present without a specific family history. Women should not be lulled into a false sense of security in the presumption that a lack of family history is a lesser risk. Genetic screening or counseling may be worthwhile if there is a strong family history

HORMONES:

Use of the pill significantly increases breast cancer risk. Not totally true. The oral contraceptive pill slightly increases the risk of developing breast cancer when exposure
- is for more than five years in the absence of a pregnancy, or
- is for more than 10 years if there has been a pregnancy during this time

IVF increases the risk of breast cancer. This was thought to be the case, however, there is currently no evidence to indicate that there is a significant risk associated with this treatment.

If I take HRT my breast cancer risk increases. There is a marginal increase in risk, approximately 5-10%, once exposure to HRT exceeds 5 years. In the 10,000 women examined in a recent study, the risk increased from 30 women who were not taking HRT to 38 women on HRT. Exposure of less than 5 years probably has no significant risk factor effect.

If I become pregnant after I have had breast cancer, this will increase the chance of recurrence. There is no firm evidence in multiple studies that pregnancy increases the risk of the development of a breast cancer, however, if a cancer is present, a pregnancy will cause the lump to enlarge significantly as the breasts become engorged.

Ultrasound is more effective in diagnosing breast cancer than mammogram. Mammogram is the best test to pick up 'obvious' cancers. The value of an ultrasound is in differentiating the appearance of a cancer from other causes of densities seen on the mammogram. It is only used if there is some question as to what a lump is. Of the lumps that do not show up on mammogram (about 10%), a small proportion will be demonstrated on an ultrasound. However, there are lumps that are invisible on both a mammogram and an ultrasound. If you can feel a lump and its cause cannot be definitely established by either mammogram or ultrasound, then a biopsy should be undertaken.

Complete diagnosis of any suspicious lump should include a mammogram, an ultrasound and some form of histological biopsy. A fine needle biopsy is a very good method of determining the nature of the cells within the lump. More recently, a core biopsy has been used, usually with ultrasound guidance, and this will always give a definite diagnosis. Other tests, such as a CT, MRI or PET scan, have not been proven to be any better than a good mammogram.

Cysts can lead to cancer. If cysts are found on ultrasound they are rarely associated with a cancer. If a cancer is found in the same area as a cyst, it is probably coincidental. Sometimes, when a cyst is aspirated it can reveal a cancer behind it, which is another reason to have all cysts checked.

There is a 'correct' treatment for my type of cancer. Every person is an individual and the options of treatment vary widely depending not only on the type of tumour, but also its site, the size of the breasts and the nature of the cancer. Use of treatments such as chemotherapy, radiotherapy or hormone therapy depend on the assessment of the final pathology of the primary tumour. A final decision on which treatment will achieve the best results for each individual patient is made during a full informative consultation once the patient has recovered from surgery. This ensures that a statistically sensible and accurate assessment can be made of the risk of the primary tumour (high or low grade, large or small, and where it was situated) and this can dictate the other forms of management.

I may not need surgery if the cancer is small. Virtually all cancers have to be treated by surgical management (exceptions are in the very sick or the very old).

Reconstruction is best done at the time of the cancer operation. The timing and type of reconstruction is dependent on many factors, including: the type of cancer, the patient's general health, and her wishes. Many are better delayed.

There is a period after which my risk of future recurrence goes away. Within the first three to five years there is a higher risk of recurrence of the tumour in the local area. This decreases after five years. The risk of recurrence elsewhere in the body also falls slowly as time passes. The general risk of recurrence elsewhere in the body is linked to the nature of the primary tumour and whether there was original spread to the local lymph nodes. Beyond the five year period, risk will gradually approximate the normal lifetime risk of an average woman of the same age. The positive side is that breast cancer, in general, has a very good prognosis when compared to many other cancers.
With breast cancer (as distinct from many other cancers) there is a 'window of opportunity' where early diagnosis can result in an excellent prognosis. However, if the diagnosis is significantly delayed, such as when a lump has been present for six or more months, then the chances of spread having occurred at the time of diagnosis are far greater and the prognosis is then not as good.