Breast Awareness

1. Breast Awareness Evelyn Poynter Clinical Nurse Specialist, Nightingale Centre.

2. More people are surviving breast cancer than ever before. In the 1970s around 5 out of 10 women with breast cancer survived the disease beyond five years, now it is 8 out of 10. Almost 2 out of 3 women with breast cancer now survive beyond 20 years. Around 9 out of 10 women diagnosed with stage I breast cancer survive the disease beyond five years whereas this is only 1 in 10 diagnosed with stage IV. How many people survive breast cancer?

3. How common is breast cancer? Breast cancer is the most common cancer in the UK and the lifetime risk of being diagnosed with breast cancer is 1 in 8 for women. 49,560 women are diagnosed with breast cancer in the UK each year – that’s around 135 women a day. 400 men are diagnosed with breast cancer in the UK each year. 80% of cases are diagnosed in women over 50.

4. Regular screening prevents deaths from breast cancer. Screening can find cancer early, before you know it is there. The earlier breast cancer is found, the better your chance of surviving it. If a breast cancer is found early, you are less likely to have a mastectomy (your breast removed) or chemotherapy. Benefits of breast screening

5. Success of the programme The NHS Breast Screening Programme was the first of its kind in the world. It began inviting women for screening in 1988 and national coverage was achieved by mid 1990s. In total, 1.94 million women aged 45 and over were screened within the programme in 2011-12. This compares with 1.88 million in 2010-11 and 1.27 million ten years ago in 2001-02. A total of 15,749 women aged 45 and over had cancers detected by the screening programme in 2011-12, a rate of 8.1 cases per 1,000 women screened. This compares with 8,545 women with cancers detected in 2001-02 (a rate of 6.7 cases per 1,000 women screened) It is estimated that the NHS breast screening programme saves around 1,300 lives each year Why screen for breast cancer?

6. Screening: new report • An independent review (2012) has found that around 1300 lives are saved every year by mammography, but 4000 women undergo unnecessary treatment. • The review says that some breast cancers are so small they would never pose a threat to a woman’s health. • It judged screening reduces the risk of dying from breast cancer by 20%, preventing one death per 235 women invited for screening. • It recommends that screening should continue.

7. Are you Breast aware?

8. What is breast awareness? Understanding what is normal for you. Being aware of any normal changes to your breasts and being confident about the ability to notice any change from what is normal.

9. Why? Early detection improves survival from breast cancer. Early detection can mean simpler, more successful treatment. 90% of breast cancers are found by women themselves or their partners. Risk increases with age.

10. Estimated risk of developing breast cancer by age Source: Cancer Research UK; http://www.cancerresearchuk.org/cancer-info/cancerstats/types/breast/riskfactors/breast-cancer-risk-factors#Age

11. Breast Cancer Average Number of New Cases per Year and Age-Specific Incidence Rates, Females, UK, 2008-2010 Age-specific incidence rates rise steeply from around age 35-39, level off for women in their 50s, then rise further to age 65-69, drop slightly for women aged 70-74, then increase steadily to reach an overall peak in the 85+ age group

12. Established Risk Factors. Age Gender Family history/Genetic Starting Periods early/Late menopause Hormone Replacement Therapy Contraceptive pill Weight

13. Deodorants, antiperspirants and shaving Mobile phone masts, TVs and computers Breast implants Underwired bras Bumping or bruising the breast Stress

14. Reducing your risk. • Eat a well balanced diet – fruit and vegetables. • Regular exercise. • Limit intake red meat, animal fat sugary or fatty foods. • Limiting the amount of alcohol. • Maintain a healthy weight.

15. The Breast Awareness 5 Point Code

16. The Breast Awareness 5 Point Code Know what is normal for you. Look at and feel your breasts. Know what changes to look for Report any changes without delay. More than 50? Go for screening.

17. Know what is normal for you Woman of all ages should be aware of the normal appearance and texture of their breasts. The following can be normal: One breast bigger than the other Nipple inversion Accessory nipple Lumpiness Tenderness or pain

18. 2. Know what Changes to Look for… • Changes in shape, size, symmetry. • Puckering, dimpling or ‘orange peel’ appearance of the skin. • Veins which stand out more than normal. • Rashes around the nipple. • Discharge from the nipple. • Change in position of the nipple (pulled in or pointing in a different direction).

19. …and feel for Any lump or thickening that feels different in the breast or armpit. Enlarged glands in the armpit. Swelling in the upper arms. Change in sensation, pain or discomfort that is persistent and different to premenstrual tenderness.

20. 3. Look and Feel. Bathing or showering. Dressing or undressing Applying body lotion.

21. 4. Report any changes to your GP without delay The majority of changes will be normal. Most changes are not cancerous but simple cysts or benign lumps. See your doctor promptly if you have any doubts at all. Remember the earlier breast cancer is diagnosed the better the outcome.

22. 5. Attend routine breast screening if you're 50 or over Between breast-screening appointments, it's important that you continue to be breast aware and follow the five-point code.

23. The post-surgery breast Radiotherapy: Reddening and soreness of the skin - • Use of creams advised by the radiotherapy team • Breast can feel firmer • Breast can shrink in size over months or years

24. Reconstruction • Becoming familiar with the new breast shape • Implant can feel tight • Port

25. Cording • Hardening of the lymphatic vessels caused by trauma following removal of some or all of the lymph nodes. • Causes pain, tightness and restricted shoulder movement. • Treatable with physiotherapy and massage