BCNA surveyed 2,000 members who have received a breast cancer diagnosis about the out-of-pocket costs of breast cancer treatment & care. BCNA’s CEO Kirsten Pillatti takes us through the results of this survey.
The Impact Of A Breast Cancer Diagnosis
A breast cancer diagnosis can have a huge financial impact on women and men, and their families.
The diagnosis often comes as a shock and many are financial unprepared and unaware of how much out-of-pocket costs come with treatment.
Breast Cancer Network Australia (BCNA) surveyed 2,000 of its members who have received a breast cancer diagnosis, about the out-of-pocket costs of their breast cancer treatment and care, and other associated costs faced in the first five years after a breast cancer diagnosis.
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BCNA surveyed 2,000 members who have received a breast cancer diagnosis about the out-of-pocket costs of breast cancer treatment & care. BCNA’s CEO Kirsten Pillati takes us through the results of this survey on the BCT Podcast.
Public or Private Health
BCNA CEO Kirsten Pillatti said they found a huge range of costs for treatment and care across the private and public health system.
“We know that from the survey that 12% had no costs from their breast cancer experience which is great.”
“But we know that even if people make a choice to go public that there are out of pocket costs.”
“I think really what the research highlighted was that there was a big range and there is often a shock value to that range and so anywhere from 25% of the 2,000 had out of pocket costs of more $21,000 and those who were in private had an average of $17,500 out of pocket.”
She said previous research found through their State of the Nation reports found that many people were un-informed about the costs associated with public and private care.
“What we heard was that at the point of being told you had breast cancer, either through BreastScreen or your GP, the only question you’re asked is ‘Do you have private health insurance?’”
“I think for many people who have been paying private health insurance for years and now have been diagnosed, they think it’s going to help them be fast tracked through the system and help with a lot of your anxiety,” said Ms Pillatti.
“But actually, what people don’t realise is just how many things have out of pocket costs and how many things are not covered by your private health insurance.”
“The biggest shock of all, being that radiotherapy in breast cancer is not covered by your private health insurer and I think there is an absolute lack of clarity from clinicians to patients around that.”
How Location Impacts Treatment Options
Another discovery of the report was how location can affect treatment options and employment impact.
“In metro areas, 50% of households had a loss of household hours. But if you look regional areas, 70% had a significant loss of household hours.”
“We also found in rural areas their out of pocket costs were the same but actually they were having less treatment options,” said Ms Pillatti.
“So, many people were choosing not to have reconstruction, not to have radiotherapy and really, sadly, not to have some of the follow up tests that are required just because they simply can’t afford it.”
She said the fall-out from this can have a significant impact on the patient’s future health.
“84% of our members report the thing they most fear about is that their breast cancer will return or will, if they’re a metastatic patient, progress.”
“When people are forced to either pay for their electricity or pay for a scan that month,then electricity is going to win, and this is one of the real fundamental problems of the financial toxicity that we have.”
Ms Pillatti encourages anyone who is struggling financially during their breast cancer experience should contact Centrelink, The Cancer Council or BCNA for assistance.
You can read the full Financial Impacts of Breast Cancer in Australia report here.
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SIMILARITIES OF PROSTATE AND BREAST CANCER
The main commonality is that breast and prostate cancers are both hormone dependent cancers. These commonalities mean similar strategies are used to target both diseases.
The Commonalities In Breast And Prostate Cancer
Professor Wayne Tilley has spent his career looking at the commonalities in both breast and prostate cancer.
He is the Director of the Dame Roma Mitchell Cancer Research Laboratories at the University of Adelaide and South Australia and was a guest speaker at the 2019 Breast Cancer Trials Annual Scientific Meeting.
Professor Tilley is renowned for leveraging the commonalities of these two cancers to advance knowledge and treatments for both disease types.
“The main commonality is that breast and prostate cancers are both hormone dependent cancers,” said Professor Tilley.
“In the case of prostate, it requires testicular androgens for its growth, at least in all the initial stages, and the same with breast cancer.”
Androgens are hormones, such as testosterone, which are important for normal male sexual development before birth and during puberty. Men and women have androgens and estrogen.
“Some 70-80% of breast cancers are driven by the estrogen receptor which actually requires the ovarian hormone estrogen,” said Professor Tilley.
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Listen to our conversation with Professor Wayne Tilley a specialist in breast & prostate cancer. He is renowned for leveraging commonalities of both to advance knowledge & treatments.
How These Similarities Can Help Develop Targeted Treatments
These commonalities mean similar strategies are used to target both diseases.
“So, drugs that actually target the androgen receptor in prostate cancer to inhibit its action are similar to drugs such as tamoxifen or an aromatase inhibitors or newer drugs that will actually degrade the estrogen receptor protein, are used to treat endocrine sensitive breast cancer.”
Professor Tilley said they have learnt that both cancers are able to change the requirements for tumour growth.
“Even though it’s the androgen receptor in prostate that’s the main driver and estrogen receptor in breast, they both actually mutate or acquire altered structure and therefore altered function.”
“So, we’ve been able to model how these changes occur and realise if we’re smart and looking at how prostate cancer adapts to a new drug, we might be able to predict something similar in the case of breast cancer,” said Professor Tilley.
“For example, we reported mutations with resistance to treatment in prostate cancer back in the mid-1990s, but it’s taken to this current era in time for people to have realised that similar mutations in the estrogen receptor also cause resistance to current therapies.”
“So, if we’ve been smart, we’d probably could have understood that in breast cancer 20 years ago. It’s just that people tend to work in their own little silos, their own little areas, without trying to understand how changes in another system might inform your own.”
He said he became interested in studying both cancer types to help find these commonalities to further advanced treatments.
He said his research is into how estrogen and androgens work in both men and women.
“What we realised a number of years ago, is this estrogen/androgen balance in women is important, both in normal mammary gland development and in controlling the growth of the breast tumour cell.”
“So, what we actually think based on a number of our studies in women is the androgen receptor is a good player and it acts as a break to constrain the action of the estrogen receptor and if that break was released then the cancers would be more aggressive.”
“But conversely, if we can activate that break, it affords a new opportunity to control estrogen receptor driven growths.”
“So now, with a number of collaborators around the world, we’ve been able to develop new models and test clinically how you could activate this androgen receptor as a potential therapeutic strategy for patients whose tumors have failed with conventional hormone therapies.
“If you can use these drugs, because they actually have many beneficial effects in women, they actually improve bone density and in some cases libido. If we could actually take them back even earlier could we actually prevent the development of endocrine resistance or even could they be used in a prevention setting?”
“So, we’re looking at quite a broad spectrum now of how you might use activation of the androgen receptor in women with breast cancer.”
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BREAST CANCER SURVIVAL DATA EXPLAINED
The breast cancer survival rate is a way of measuring how many people are alive at a certain time after a diagnosis. This overall number changes dramatically depending on what stage of breast cancer you are diagnosed with.
Why Do We Measure Breast Cancer Survival?
The Australian Institute of Health and Welfare keeps track of survival rates for all cancers in Australia. The survival rate is a way of measuring how many people are alive at a certain time after a diagnosis.
For example, an 85% survival rate at five years means that five years after the diagnosis of breast cancer, 85% (or 85 out of every 100) patients are alive. It is a common way of understanding and comparing the outcomes for people with a range of different health conditions.
The chance of surviving breast cancer five years from diagnosis has increased from 73% to 91% in the last 20 years in Australia, thanks in large part to clinical trials research. The uptake in breast cancer screening has also contributed to this increase, with screening allowing for breast cancers to be found earlier.
But this overall number changes dramatically depending on what stage of breast cancer you are diagnosed with.
The Australian Institute of Health and Welfare has released its latest data on five-year survival rates.
It shows that those diagnosed with stage one breast cancer have a 100% five-year survival rate whereas those diagnosed at stage four have a 32% five-year survival rate.
Why Is There A Difference In Survival Rates?
There are a number of reasons why the survival rate decreases from stage one to stage four. When breast cancer metastasises, or reaches stage four, it has spread beyond the breast to other organs in the body which makes it more difficult to treat. In some cases, this is because it has already been exposed to therapeutic drugs and has acquired a resistance to them.
The data from the Australian Institute of Health and Welfare (AIHW) shows that age had little impact upon survival rates for early breast cancer.
Females diagnosed with early stage (stage one and two) breast cancer had similar survival rates across all ages. However, females diagnosed with advanced cancer had lower survival with increasing age.
The data also showed that your postcode has little impact upon your survival, with survivors generally similar by remoteness and socioeconomic status area.
How Is Breast Cancer Trials Research Helping to Improve Survival Rates?
Breast Cancer Trials is actively working to increase survival rates across all breast cancers.
Breast Cancer Trials currently has two clinical trials open to patients with early breast cancer; EXPERTand OPTIMA, three clinical trials open to those with metastatic breast cancer; FINER, and CAPTURE, and one clinical trial open for the prevention of breast cancer; BRCA-P.
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THE BIG 1-98 CLINICAL TRIAL
The BIG 1-98 breast cancer clinical trial was a pivotal clinical trial which helped to stop breast cancer returning and improved survival rates for some women.
What Is The BIG 1-98 Clinical Trial?
If you’re a post-menopausal woman with early breast cancer, you may have been treated with an aromatase inhibitor.
This was proven to be the most effective treatment for endocrine responsive early breast cancer through the BIG 1-98 clinical trial.
Clinical trials are designed to find out if new treatments or prevention strategies are more effective than those currently accepted as the best available standard treatment.
Chair of the Breast Cancer Trials Scientific Advisory Committee, Associate Professor Prue Francis said the BIG 1-98 clinical trial helped to stop breast cancer returning and improved survival rates for some women.
“BIG 1-98 was a pivotal trial.”
“It was studying post-menopausal women with early breast cancer that was hormone receptor positive, so estrogen receptor positive.”
“The standard hormonal therapy at the time, for these women, was to take tamoxifen for five years” said Associate Professor Francis.
“The BIG 1-98 trial was comparing an aromatase inhibitor called Letrozole for five years to tamoxifen for five years, with the hypothesis that Letrozole might be more effective.”
“It was also comparing two other strategies which was to give in the first couple of years, Letrozole and the remaining three years with tamoxifen or vice versa, and the first couple of years with tamoxifen and then switching to the Letrozole.”
“So, it had four different ways of delivering the oral hormones.”
The early results of the clinical trial indicated that Letrozole was the more effective treatment compared with Tamoxifen for women with post-menopausal estrogen receptor positive breast cancer.
“But that’s not to say that every post-menopausal women with breast cancer needs an aromatase inhibitor because there are some women that have relatively good prognosis in their post-menopausal breast cancer who would probably do equally well in terms of their long-term cure rate regardless of whether they got tamoxifen or an aromatase inhibitor like Letrozole” said Associate Professor Francis.
“But for women who have a higher risk situation, the difference between a more effective therapy like Letrozole than tamoxifen could be really quite important.”
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The BIG 1-98 breast cancer clinical trial was a pivotal clinical trial which helped to stop breast cancer returning and improved survival rates for some women. Professor Prue Francis discuses this important clinical trial.
How BIG 1-98 Changed Practice
Combined with another clinical trial, the ATTACK trial which studied anastrozole, the BIG 1-98 clinical trial was pivotal in shifting the standard of care for post-menopausal women with early hormone receptor breast cancer. It is now more common for women with this type of breast cancer to be treated with an aromatase inhibitor hormone therapy than tamoxifen.
It has been a decade since the Big 1-98 clinical trial, with ten year follow up results being published this year.
However, these results are complicated as there was a cross-over that occurred in the trial, after the early results were released which showed the aromatase inhibitor appeared to be more effective.
“When those early results became available, those running the trial then recommended that the women who were randomised in the trial to receive the five years of standard therapy with tamoxifen should have the option to cross over to Letrozole, which was being shown to be a more effective option” said Associate Professor Francis.
“So, the long-term results of the trial became more complicated because there wasn’t a direct comparison of five years of Letrozole to five years of tamoxifen.”
“When we conduct clinical trials, there is monitoring of the trial by independent committees as well as the trial committee to try and look at whether the ongoing treatments of the trial are still appropriate to continue studying.”
“Along the way it was deemed that there was enough information to notify the doctors and women participating in the trial that it should be an option for the people in the control group to no longer remain on their control treatment tamoxifen, should they wish to switch.”
The HERA Clinical Trial
This cross-over has occurred before in the Breast Cancer Trials HERA clinical trial.
“The HERA trial that the group participated in which was one of the pivotal trials that showed that adjuvant Trastuzumab, sometimes referred to as Herceptin, could improve survival and reduce relapse rates in HER2 positive early breast cancer.”
“There were women in the HERA trial who were in the control group and in that trial, the control group was your standard chemotherapy and hormone therapy with no Trastuzumab, no Herceptin, and those women were subsequentially offered a cross over and if they wished to receive Herceptin.”
“But it does make the long term follow up results of trials complex if there’s been a cross over because potentially it can dilute the improvement that might have been seen otherwise.”
“But one of the things with Breast Cancer Trials is they often have a very long natural history, so we will typically be following women usually for at least ten years and sometimes longer. So sometimes there is newer information that might become available either from the trial itself or from other trials that sometimes requires a change in what is considered appropriate for the control group.”
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TYPES OF BREAST CANCER
Breast cancer is not just one disease, but several. There are a number of different breast cancer subtypes and treatments are becoming increasingly personalised for patients.
Breast Cancer Types
Breast cancer is the most commonly diagnosed cancer in Australia. It occurs when abnormal or damaged cells grow in an uncontrolled manner and a tumour is formed. Breast cancer can occur in both women and men, although it is less common for it to occur in men. In Australia the risk of being diagnosed with breast cancer by age 85 is 1 in 7 for women and 1 in 675 for men.
Breast cancer is not just one disease, but several. There are a number of different breast cancer subtypes and treatments are becoming increasingly personalised for patients.
Ductal carcinoma in situ or DCIS is a non-invasive breast condition which affects around 1,200 women a year in Australia. DCIS is the name for abnormal changes in the cells in the milk ducts of the breast.
Although these abnormal changes have the potential to turn into invasive cancer cells, it is not breast cancer as we more commonly understand it. A woman cannot die from DCIS as the abnormal cells are contained within the milk ducts.
DCIS cannot usually be felt but is found on a mammogram or ultrasound. If not treated it can develop into a more serious, invasive breast cancer. Treatment of DCIS usually involves breast surgery and radiotherapy, and occasionally includes surgery to remove lymph nodes and hormonal therapies.
Lobular carcinoma in situ or LCIS is a non-invasive breast condition. LCIS is the name for abnormal cells that are contained to the lobules (milk glands) of the breast.
Like DCIS, although these abnormal changes can turn into invasive cancer cells, it is not breast cancer as we more commonly understand it. A woman cannot die from LCIS as the cells are contained to the lobules of the breast.
LCIS cannot usually be felt but is found in a mammogram or when a biopsy is taken for another reason. LCIS does not require treatment if there are no other abnormal changes to the breast. However, a woman with LCIS should be carefully monitored as having LCIS increases the chance of developing breast cancer in future.
Invasive ductal carcinoma is a broad term used to classify cancer that began growing in a milk duct and has invaded the fibrous or fatty tissue of the breast outside the duct. Invasive ductal carcinoma accounts for around 80 per cent of all breast cancers diagnosed.
Invasive lobular carcinoma the other major histological subtype: a breast cancer that begins in the lobules (milk glands) of the breast, and has spread beyond the lobule, potentially spreading to the lymph nodes and other parts of the body. Typically, invasive lobular carcinoma tumors are associated with a good prognosis, being low grade and oestrogen receptor positive. However, the tumour can be highly metastatic.
Paget’s disease of the nipple is a rare form of breast cancer that affects the nipple and the area around the nipple (the areola). It is commonly associated with an invasive cancer elsewhere in the breast. Around two of every 100 cases of breast cancer involve Paget’s disease of the nipple.
The main sign of Paget’s disease of the nipple is a change in the nipple and/or areola. Treatment can include breast surgery and radiotherapy.
Inflammatory breast cancer is a rare form of breast cancer that affects the lymphatic vessels in the skin of the breast. This type of breast cancer does not present as a lump but rather a redness or rash in appearance, as a result of the lymphatic vessels becoming blocked and the breast becomes red and swollen, similar to an infection. Most women with inflammatory breast cancer will have a combination of treatments that can include surgery, chemotherapy, radiotherapy, hormonal therapies and targeted therapies.
HER2 positive breast cancer is any type of breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2). HER2 positive breast cancer is a more aggressive form of breast cancer compared with HER2 negative disease.
HER2 positive breast cancer is treated using a HER2 targeted therapy. The most common HER2 positive targeted therapy available in Australia and New Zealand is trastuzumab (Herceptin). Herceptin was found to significantly reduce breast cancer returning, as reported in the Breast Cancer Trials HERA clinical trial.
For women with HER2 positive early breast cancer, the current recommendation is to give trastuzumab at the same time as chemotherapy, either before or after breast cancer surgery.
For women with HER2 positive metastatic breast cancer, trastuzumab may be given on its own or with other treatments and will continue so long as the benefit to the patient outweighs the side effects.
Triple negative breast cancer is breast cancer that tests negative for all three receptors – oestrogen, progesterone and HER2. Triple negative breast cancer is a more aggressive cancer that usually occurs at an earlier age. It has a greater chance of developing into a metastatic stage and has poorer clinical outcomes as shown by higher relapse rates and lower survival rates.
Standard treatment of triple negative breast cancer typically consists of surgery, chemotherapy and usually a course of radiotherapy. Often chemotherapy treatment is given prior to breast surgery (neoadjuvant chemotherapy) as it is effective in reducing the size of the breast cancer while providing useful information about the effectiveness of the treatment being given.
Early breast cancer is an invasive breast cancer that is contained in the breast and may or may not have spread to lymph nodes in the breast or armpit. The aim of treatment for early breast cancer is to remove the breast cancer and any cancer cells that may be left in the breast, armpit or other parts of the body but cannot be detected. Treatment can involve radiotherapy, breast surgery, chemotherapy, hormonal therapies and targeted therapies.
Locally advanced breast cancer is an invasive breast cancer that is large or has spread to areas near the breast, such as the chest wall. However, there are no signs the cancer has spread beyond the breast region or to other parts of the body.
Signs of locally advanced breast cancer can include a lump in the breast or armpit that doesn’t move freely but feels attached to the chest wall, a lump at the base of the neck, ulcers on the breast, dimpled skin that looks like an orange peel or a large red, swollen breast. Treatment for locally advanced breast cancer will usually involve a combination of breast surgery, chemotherapy, radiotherapy, targeted therapies or hormonal therapies.
Metastatic breast cancer, also known as advanced, secondary or stage four breast cancer, is breast cancer which has spread to other parts of the body such as the bones, liver or lungs. Many people who are diagnosed with metastatic breast cancer have been diagnosed with breast cancer before. However, for some it can be the first diagnosis of breast cancer.
Metastatic breast cancer occurs when cancer cells break away from the cancer in the breast and move via blood vessels or lymphatic vessels and form a new cancer growth in other parts of the body.
Every metastatic breast cancer diagnosis is different and will therefore require different treatments. Despite the cancer growths being in other organs such as the lung, it is still called ‘breast cancer’ and is treated as breast cancer. The aim of treating metastatic breast cancer is to control the growth and spread of the cancer, to relieve symptoms and improve or maintain quality of life. Treatment options will depend on what is most likely to control the cancer and what side effects the patient can cope with. Treatment for metastatic breast cancer can include hormonal therapy, chemotherapy, targeted therapy, radiotherapy and surgery.
If you have any concerns regarding your treatment or diagnosis, speak with you treating physician.
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TRIPLE NEGATIVE BREAST CANCER: SYMPTOMS, TREATMENT & PREVENTION
Triple negative breast cancer accounts for 15% of all breast cancers. This type of breast cancer does not have the three most common types of receptors known to make most breast cancers grow.
What Is Triple Negative Breast Cancer (TNBC)?
Triple negative breast cancer is a type of breast cancer that does not have the three most common type of receptors known to make most breast cancers grow – oestrogen receptor (ER), progesterone receptor (PR) and HER2 (human epidermal growth factor receptor 2). Triple negative breast cancer accounts for approximately 15% of all breast cancers.
Triple negative breast cancer is a more aggressive cancer that usually occurs at an earlier age. It has a greater chance of developing into a metastatic stage and has poorer clinical outcomes as shown by higher relapse rates and lower survival rates. Because it does not have receptors that can be targeted by medications such as hormone- and HER2-blocking drugs, it has fewer treatment options available.
On this page, we’ll look at some of the symptoms of triple negative breast cancer, as well as treatment and prevention options.
What Are The Symptoms Of Triple Negative Breast Cancer?
The symptoms of TNBC are the same as any other type of breast cancer.Symptoms can include:
New lump in the breast, armpit area or around the collarbone
Change in breast size or shape
Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
Clear or bloody nipple discharge
Changes to the skin including redness, puckering or dimpling (an ‘orange peel’ appearance)
Who Is At Risk Of Developing Triple Negative Breast Cancer?
No one has a definitive answer on what causes breast cancer. Anyone can be diagnosed with triple negative breast cancer and should be aware of their own personal risk factors. You can use the online iPrevent tool to better understand your breast cancer risk and act on it.
There are a number of known risk factors for triple negative breast cancer including:
BRCA Mutations – A BRCA1 gene mutation is associated with a higher risk of triple negative breast cancer. However, most triple negative breast cancers are not caused by a BRCA gene mutation. If you have a strong family history of breast cancer, you may wish to consider genetic testing. This is something to discuss with your doctor.
Pre-Menopausal Women – While the average age of first being diagnosed with breast cancer in Australia is 61, triple negative breast cancer occurs more often in patients who are pre-menopausal or under 50 years of age. The cause of triple negative breast cancer in this young age group is not yet completely known. However, it could be due to breasts of younger women in their childbearing and breastfeeding years is of a different composition to the breast of an older women who has been menopausal for a long time.
African American and African Women – Triple negative breast cancer is more likely to be diagnosed in African American and African women compared with white or Hispanic women. This is thought to be due to genes or mutations that pre-dispose this group of women, particularly pre-menopausal women, to triple negative breast cancer.
Treatment Of Triple Negative Breast Cancer
Standard treatment of early stage triple negative breast cancer (stage 1 and stage 2) typically includes the following:
Surgery
Chemotherapy
Usually a course of radiotherapy
Often chemotherapy treatment is given prior to breast surgery (neoadjuvant chemotherapy), as it can effectively reduce the size of the breast cancer while providing useful information about the effectiveness of the treatment being given.
Prevention of Triple Negative Breast Cancer
For those who have the BRCA1 or BRCA2 gene mutation, there are important considerations for the prevention of breast cancer. Women who carry BRCA1 or BRCA2 gene mutations have an approximate 70% risk of developing breast cancer and up to 40% risk of developing ovarian cancer over their lifetimes.
There are preventative strategies for those with this genetic mutations which include protective surgery via the removal of both healthy breasts and hormonal therapy medicines such as tamoxifen or an aromatase inhibitor. Removal of the ovaries and fallopian tubes helps reduce the risk of both ovarian and breast cancer. The breast cancer benefit is due to a reduction in the levels of oestrogen in the body.
There is no definitive way to prevent breast cancer, however there are a number of risk factors that you can manage to reduce the likelihood of future breast cancer. This includes maintaining a healthy body weight, not smoking and engaging in regular exercise. You can read about breast cancer prevention and how to reduce your risk here.
In one of our recent free online Q&A’s moderated by Author and Journalist, Annabel Crabb, our panel of experts discussed Triple Negative Breast Cancer, including the latest in research, treatments and genetics relating to this disease. If you missed out on this Q&A, you can access the recording below.
What is the Survival Rate of Triple Negative Breast Cancer
Whilst there are no statistics on the specific survival rates for triple negative breast cancer, the relative 5-year survival rate for breast cancer is 92%. This means that those who have breast cancer are, on average, 92% as likely as those who don’t have the disease to live for at least 5 years after their diagnosis.
The survival rate is an estimate across the population, and an individual’s chance of survival is dependent on their specific characteristics and the nature of the tumour, such as the stage of the breast cancer at diagnosis, the age, gender and the subtype of the breast cancer (ER+, HER2+ or triple negative breast cancer).
The 5-year survival rate for Stage 1 (early) breast cancer is, on average, 100% and Stage 2 is 95%. For locally advanced cancers (known as Stage 3) the survival rate is 81%, while the 5-year survival rate for Stage 4 (metastatic breast cancer) is significantly lower at 32%.
Clinical Trials Research on Triple Negative Breast Cancer
Primary results of the CHARIOT clinical trial were presented at the American Society of Clinical Oncology (ASCO) international conference in 2022. This was a world-first Australian clinical trial developed by Breast Cancer Trials (BCT) researchers that was open to both women and men diagnosed with triple negative early breast cancer. The trial recruited 34 patients at eight participating institutions throughout Australia.
The purpose of the CHARIOT clinical trial was to see if using two immunotherapy drugs (nivolumab and ipilimumab) together with standard chemotherapy (paclitaxel) before surgery, was safe and effective and could stimulate the body’s immune system to kill the cancer cells. And, if continuing treatment with one of these drugs (nivolumab) after surgery can keep the immune system active to eradicate any residual cancer cells.
The trial found that in patients with early-stage triple negative breast cancer who did not respond to standard neoadjuvant chemotherapy, the addition of nivolumab and ipilimumab resulted in a promising response rate with 24% of participants achieving a complete disappearance of their cancer within the breast and lymph nodes by the time of surgery. This treatment was able to be delivered safely, with some patients experiencing known and expected side effects of immunotherapy. These side effects were able to be successfully treated.
Professor Sherene Loi is the Study Chair of the CHARIOT clinical trial, Board Director at BCT and Head of the Translational Breast Cancer Genomics and Therapeutics Laboratory at the Peter MacCallum Cancer Centre. She says longer term follow up is needed to help determine the overall effectiveness of this treatment approach and the benefits to patients.
The Neo-N clinical trialaims to identify more effective treatment options for early stage triple negative breast cancer patients, by combining an immunotherapy drug (nivolumab) together with chemotherapy (paclitaxel and carboplatin) prior to surgery.
Often cancers can avoid detection and attached from the body’s immune system. This study will help us understand if nivolumab given for a short period on its own, before commencing treatment with chemotherapy, can effectively activate the body’s anti-cancer immune response and contribute to better outcomes for triple negative breast cancer patients. Patients who respond well to this treatment may be able to avoid the short and -long-term effects of anthracycline-based chemotherapy that would often be used for this type of breast cancer.
Your donation will help us to conduct research into triple negative breast cancer, like the studies described above, and provide more treatment options to patients.
Long-Term Triple Negative Breast Cancer Survivors
Diane Barker was diagnosed with locally advanced triple negative breast cancer in December 2020, at just 44 years of age.
“I do remember feeling incredibly tired, like more tired than I had ever felt in my entire life. And yes, I’ve got a busy job, but I just thought maybe something was going on. And actually, my GP and I were about to start a process of, you know, a sleep clinic and doing a sleep study to see what was happening,” Diane said.
“But I was also, going through a process of having regular mammograms and ultrasounds, because my mum had had breast cancer when she was 59. So, when I turned 40, my GP said we should start doing this for you. So, I’d been doing that for a few years, and everything was fine.”
“I went to my regular scan and that process with the mammogram and the ultrasound and some red flags started appearing. I thought that maybe something might be going on when the technician called the radiographer into the room to have a look herself and I could just see the look of concern that she couldn’t entirely mask on her face. I had to go back for a biopsy, which is when I started to really think that maybe something serious was going on.”
“Then when I got the result from my GP, I was in the middle of a meeting at work and she said, I’m afraid it’s cancer. That was when everything changed for me. It was quite shocking. I was preparing myself for that news, but really nothing can prepare you for news like that. It’s devastating. It’s absolutely devastating.”
Triple negative breast cancer tends to be a more aggressive disease than some other breast cancers which means it grows faster, and has fewer effective treatment options. Triple negative breast cancer is also more likely to recur within two to three years of diagnosis, as opposed to 10 to 15 years for those with oestrogen receptor – positive breast cancer. Early detection is therefore vital. If you have a strong family history, you should consider discussing your prevention and testing options with your doctor.
Breast Cancer Trials is a unique collaboration of researchers, trial participants and YOU, our valued supporters working together to save and improve the lives of every person affected by breast cancer. Help find the newest breakthrough in breast cancer research.
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HOW BLOODYWORK IS USED IN CANCER CARE (LIQUID BIOPSY)
A liquid biopsy is a simple and non-invasive alternative to surgical biopsies, which enables doctors to discover a range of information about a tumour through a simple blood sample. Professor Rik Thompson discusses how liquid biopsy relates to breast cancer treatment and why it’s important in metastatic breast cancer.
What Is Liquid Biopsy?
A liquid biopsy is a simple and non-invasive alternative to surgical biopsies, which enables doctors to discover a range of information about a tumour through a simple blood sample.
This includes searching for cancer cells from a tumour that are circulating in the blood or for pieces of DNA from tumour cells in the blood.
It’s a research focus for Professor Rik Thompson, who is the Associate Director and a Professor of Breast Cancer Research at the Institute of Health and Biomedical Innovation and School of Biomedical Science at Queensland’s University of Technology.
Professor Thompson said blood work is an important part of treating the disease.
“Breast cancers use the blood system to escape and move around.”
“It uses the lymphatics as well, and there is an interchange between the blood and the lymphatics.”
“In women with a higher amount of breast cancer burden, more of their breast cancer cells find their way into the blood” he said.
“Over the years we’ve been able to develop techniques to find those needles in the haystack, to find those very small numbers of breast cancer cells in the blood and increasingly to look for cancer DNA in the blood.”
He said liquid biopsies are a window into how breast cancer can spread and metastasise.
“You can get an idea of what’s going on all around the body by having a look in the blood.”
“It’s very convenient, but it’s difficult and technically very challenging because you might have nearly a billion leucocytes in 10mls of blood and you might only have three of four breast cancer cells.”
“But one breast cancer cell amongst all those leucocytes has proven prognostic value.”
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Professor Rik Thompson discusses how liquid biopsy relates to breast cancer treatment and why it’s important in metastatic breast cancer.
How Liquid Biopsy Could Be Used In Breast Cancer Treatments
Professor Thompson said it’s hoped liquid biopsy will be used in the future to tailor breast cancer treatments and therapies.
“There are many studies with these initial technologies called the cell search technology, that continue to reinforce the prognostic value (of liquid biopsy) and the fact that if you’ve got more cells in the blood you have a higher risk of relapse.”
Professor Thompson said tumour DNA is becoming increasingly important in this area of study.
“The tumour DNA is becoming very important in a couple of ways. One is that it’s easier to see, rather than looking for one or two cells in 10mls of blood, you’re looking for probably thousands of copies of DNA.”
“It’s a little bit of an easier target.”
“So, those thousands of copies are hidden amongst billions of copies of DNA of normal cells that are circulating in the blood etc and are coming apart.”
He said researchers are getting better at being able to predict and measure DNA changes occurring in a tumour. He said this has implications for new treatment types like Immunotherapy, which has found success in other cancer types such as lung cancer and melanoma.
Research into immunotherapy for breast cancer is continuing.
“Triple negative breast cancer is more amenable to immunotherapy and there’s some terrific trials going on” said Professor Thompson.
“Tumour mutational burden is a key issue in how well immunotherapy can work and so monitoring the mutational state, the DNA level in the blood, is going to have some great benefits in immunotherapy.”
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Professor Rik Thompson is the Associate Director and a Professor of Breast Cancer Research at the Institute of Health and Biomedical Innovation and School of Biomedical Science at Queensland’s University of Technology.
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MENTAL HEALTH, BODY IMAGE & BREAST CANCER
How kind were you to yourself during and after your breast cancer treatment? Two women who have experienced a breast cancer diagnosis, Leslie Gilham and Leonie Young, speak about their experiences with mental health, body image and breast cancer.
The Impact A Diagnosis Has On Your Self-Esteem
Going through a breast cancer diagnosis can have a devastating impact on your physical health and your mental health.
Your body can go through many changes during treatment which can be hard to adjust to.
This can include the impact of chemotherapy or other treatments, or adjusting to your body with a mastectomy, bilateral mastectomy, lumpectomy or a reconstruction.
So how kind were you to yourself during and after your treatment?
The current Chair of Breast Cancer Trials Consumer Advisory Panel Leslie Gilham and the former Chair Leonie Young, both experienced changes to their mental health and body image throughout their treatment.
Leonie Young said she had to adjust to the changes to her body after breast cancer surgery.
“I had a mastectomy, so that was very obvious. But it’s no less important for women who have a lumpectomy, but it’s just a little more obvious when you have a mastectomy.”
She said even those who have undergone a reconstruction are left with scaring.
“It’s one of the biggest issues that women have to face going through this sort of surgery.”
“So, then it raises a whole array issues around sexuality and partnerships and marriages can struggle at this time because people don’t feel like they’re good enough.”
Leslie Gilham said it can be hard to adjust to the permanent reminder of your disease.
“For almost all women and men who’ve had a diagnosis, there’s a constant reminder every time you look at your own self-image, whether that’s because you’ve had a mastectomy, a lumpectomy or none at all.”
“You might have had radiation therapy, but you’ll still have some sort of marking or you’ll have tattoos, to remind you of the radiation, even down to chemotherapy, hair loss and that sort of thing” she said.
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Consumer Advisor Panel Chair Leslie Gilham, and former Chair Leonie Young discuss the impact their breast cancer diagnosis has on their self esteem, body image and mental health.
She said de-escalation trials being conducted by Breast Cancer Trials, such as EXPERT and POSNOC, could help to lessen these impacts.
“Some of these issues could be alleviated a little bit by clinical trials.”
“For example, some of the treatments might cause lymphedema, which creates a whole different range of body issues as well.”
The Impact A Good Support System Can Have
Leslie said she felt very supported while undergoing treatment, thanks to her clinical trial team.
“I tended to have a whole group of people supporting me, not only my family and friends but also a whole team at the clinic.”
“I guess because I was on that trial, I had to attend the clinic more often, so I had that support around my well being, probably more than those people who weren’t on trials.”
“So, for me personally, I can say I had a lot of support for my mental health.”
Leonie said others receive less support.
“I’m a little different to Leslie because I wasn’t on a trial and I was diagnosed a long time ago and everything has certainly changed in that area and there’s a lot more support around these days.”
She said there is still gaps in the system, with some in regional areas missing out on support.
“For some women, depending on where they live, that support is not there and it’s really important for them to access it somehow.”
“I come from Brisbane and there’s a lot of good support around there but there’s some people who live in rural and regional areas who feel very isolated” she said.
“There are ways, thankfully with modern technology, that people can keep connected but that still keeps them isolated in some ways. So, there are still some people struggling in that area.”
Both women agreed that finding a group of people who have undergone a similar experience will help to support those undergoing treatment.
“If you’ve got a group of friends who all have got something similar going on, you don’t have to explain yourself around it. People get it. And you start to feel good about yourself after a while” said Leonie.
Leslie agreed.
“The more that you can surround yourself with people that have been through the same situation as yourself the better, because you don’t have to explain yourself, they get what you’re going through.”
“It’s actually interesting, you might raise something that is happening, or something that is concerning you and someone else will go ‘oh, that happened to me’.”
“So, it puts you at ease” she said.
“Because quite often you’ll find that if you speak to someone who hasn’t been through a diagnosis or someone who hasn’t got the medical background to deal with your concerns, then all you’re going to do is make those concerns worse because they’ll start to create the anxiety that you don’t necessarily need at that time.”
Practical Ways To Help Boost Self-Esteem
Leonie also suggested other practical ways to lift the self esteem of those undergoing treatment, such a breast forms and getting fitted for nice lingerie.
“Breast care nurses are really vital in steering people in the right direction to know where to go and where to find out some of those things.”
“A lot of people don’t know that those things are available for them and they struggle and feel they have to wear something that’s not very attractive at all. I guess it’s getting into the right information sources.”
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HOW REAL BREAST CANCER EXPERIENCES INFLUENCE TRIALS
Breast Cancer Trials was the first clinical trials group to invite people with a lived experience with cancer to comment and guide the planning and conduct of clinical trials research. These women make up our Consumer Advisory Panel. Former chair of the panel, Leonie Young, discusses the importance of this perspective in the clinical trials research process.
The Importance Of The Patient Experience
For those signing on to participate in a clinical trial, it can be reassuring to know that women who have a history of breast cancer have been involved in the planning of any new research.
CAP is made up of women who have received a breast cancer diagnosis, and some have participated in a clinical trial.
Leonie Young is the former chair of Breast Cancer Trials Consumer Advisory Panel.
She said CAP is involved with Breast Cancer Trials research from concept development right through to patient care.
“Anybody considering a trial, especially if it’s badged with Breast Cancer Trials, should have a certain degree of confidence that people who’ve had that lived experience, who have been there done that, have actually looked at it and given their feedback on it.”
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Former chair of the Breast Cancer Trials Consumer Advisory Panel, Leonie Young, discusses the importance of the patient perspective in the clinical trials research process.
The Benefits Of Participating In A Clinical Trial
Ms Young said there are many common misconceptions regarding clinical trials.
“Nobody is disadvantaged on a clinical trial.”
“If you’re not on the treatment arm, you will still receive the golden standard treatment that everybody will receive if they’re not on a trial and when you think about it, if you go back a number of years, those drugs and those treatments were determined through the clinical trials research process” she said.
“Now what they’re looking at is the next step up, or the next phase. So, everything has gone through that clinical trials process. So, everyone should feel safe.”
One of the main benefits of participating in a clinical trial is being able to potentially access a new and better treatment. However, there are many other benefits according to Ms Young.
“It’s knowing that you’re part of a team, and knowing you are being monitored so closely and very regularly.”
“One of the fears that people diagnosed with cancer have is ‘how do I know that it hasn’t come back’,” she said.
“There is a real comfort in knowing that experts are keeping an eye on you and asking you questions and if people make a mention of a side effect, it triggers them to look at something. So, they’re being really closely monitored all the time.”
“I wasn’t on a trial when I received treatment a very long time ago, but I received the benefit of women who’d been on clinical trials before me and you know that your contributing to the future and to our daughters, and granddaughters and future women and men.”
Ms Young recommends anyone given the opportunity to participate in a clinical trial should consider it.
“You are monitored really carefully and you’re safe, and you have a chance of having access to the new drug that’s gone through scrutiny before humans are allowed to be trialled, maybe a step ahead of everybody else who has to wait maybe five or 10 years or more to get the treatment available.”
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IMMUNOTHERAPY AND THE PANACEA CLINICAL TRIAL
Immunotherapy allows cancer to become more visible to the immune system so the immune system can then attack it. The PANACEA clinical trial was Breast Cancer Trials first immunotherapy trial, and it has lead to further clinical trials research into this area of treatment.
Immunotherapy – An Emerging Treatment
The number of clinical trials using immunotherapy is increasing.
Immunotherapy drugs allow the cancer to become visible to the immune system, so the immune system can attack it. It has shown incredible success in melanoma, lung and bladder cancer, which previously had limited options for treatment.
Breast Cancer Trials currently has two open immunotherapy clinical trials, CHARIOT and DIAmOND.
However, before this came PANACEA.
The PANACEA Clinical Trial
PANACEA was Breast Cancer Trials first immunotherapy clinical trial, which paved the way for trials like DIAmOND.
Led by Professor Sherene Loi, PANACEA was studying women who had HER2-positive advanced breast cancer who had already received standard therapy such as trastuzumab or Herceptin based therapy, possibly alongside chemotherapy.
Professor Prue Francis is a medical oncologist and Chair of the Breast Cancer Trials Scientific Advisory Committee. She said PANACEA was exciting, as it was venturing into a new area of breast cancer research.
“The PANACEA trial was going into a new area for HER2 positive in breast cancer. It was looking at trying to introduce new immunotherapy into the treatment for women with HER2 positive breast cancer.”
It studied the most suitable dose of pembrolizumab and trastuzumab when these drugs are used together and to assess if their combined use is an effective treatment and can be used without chemotherapy.
“What was very exciting was there was some evidence of activity for this combination and so there will be future studies with immunotherapy as a result of this.”
“One of the things from the PANACEA trial that was learned was that the women who, when they studied their tumour and they found that their tumour had some expression of this marker called PDL1 or if they had a tumour infiltrating lymphocyte which are immune cells, that these were the women that potentially could benefit from that strategy.”
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Professor Prue Francis discusses the PANACEA clinical trial.
The DIAmOND and CHARIOT Clinical Trials
Two of these future immunotherapy studies are the Breast Cancer Trials clinical trials; DIAmONDand CHARIOT.
The PANACEA study led to the DIAmOND clinical trial.
“In the DIAmOND trial we’re studying women with HER2 positive advanced breast cancer and combining two immunotherapy drugs with the trastuzumab.”
“We’ll also be looking at women slightly earlier in the course of their advanced disease when they haven’t had quite so many therapies, because we think the immune system actually may be more receptive to these immune type treatments earlier in the course of the disease rather than waiting until there are no other therapies left.”
Professor Francis said although she is excited about the future of immunotherapy treatments, they still need to find what disease types will benefit most.
“I think it will become an important part of breast cancer, but I think that we will need to learn exactly which patients will be the ones who might benefit from immunotherapy.”
“At the moment the clues that we have is that there may be some patients with triple negative breast cancer that could benefit. So, that’s where there’s no oestrogen receptor, no progesterone receptor, no HER2 over expression” she said.
“Also, some with HER2 positive breast cancer.”
“At the moment for the most common type of breast cancer, which is oestrogen receptor positive, HER2 negative, it’s less clear what role immunotherapy will play because hormone therapy has been a very important treatment for that group.”
“But I think even amongst that group there will be women who could benefit from immunotherapy.”
“I think it’s a very exciting time at the moment in the immunotherapy field, to try and learn which women can benefit and how and in what context.”
Professor Prue Francis
Professor Prue Francis is a Breast Cancer Trials researcher and Clinical Head of Breast Medical Oncology at the Peter MacCallum Cancer Centre
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YOUNG WOMEN & BREAST CANCER
Being diagnosed with breast cancer as a young women comes with its own set of unique challenges. The disease can have different characteristics in young women and have poorer survival outcomes when compared to older women.
Breast Cancer In Young Women
Being diagnosed with breast cancer as a young women comes with its own set of unique challenges.
The disease can have different characteristics in young women and have poorer survival outcomes when compared to older women.
Medical Oncologist and Chair of the Breast Cancer Trials Scientific Advisory Committee, Associate Professor Prue Francis said although it is more uncommon, breast cancer still occurs in younger women.
“About a quarter of women with breast cancer might be pre-menopausal or under the age of 50” she said.
“In breast cancer literature, very young women are often considered under the age of 35 and that’s less common.”
Around 800 young women will be diagnosed with breast cancer each year in Australia.
How Outcomes Can Differ In Young Women
Associate Professor Francis said although it is a smaller percentage, a diagnosis at a young age can have different implications than if you receive a diagnosis at a later stage in life.
“That’s the time of life when they might be building their career, building their family, building relationships and to be affected by breast cancer at that time is clearly devastating and plus we know that’s a group in which the cure rate has not been as high as in older women with breast cancer.”
She said the biology of the tumour could be to blame for these poorer outcomes.
“So, younger women are known on average to have more aggressive tumors biologically. These can be, in some instances, fast growing.”
Being Breast Aware
Younger women are typically diagnosed with more aggressive breast cancers and are at a higher risk of the disease spreading to other parts of the body.
Therefore, being aware of the normal look and feel of your breasts is just as important for young women as it is for older women according to Associate Professor Francis.
“Sometimes there is the perception that somebody might be too young to have breast cancer.”
“So, a women who’s in her early 20s might go to her GP with a breast lump and everybody might think ‘well she’s in her early 20s and she can’t have breast cancer’, and certainly that would be uncommon to have breast cancer at that age, but it can occur even in that age group” she said.
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Medical Oncologist Professor Prue Francis discusses breast cancer in young women on the Breast Cancer Trials podcast.
Treatments For Young Women
As younger women are often diagnosed with more aggressive breast cancers, the treatments can be more intense and aggressive. There are also a number of medical and pyscho-social challenges that some young women are faced with being diagnosed at an early stage of their life said Associate Professor Francis.
“Fertility is a big one because nowadays, particularly in western countries, as childbearing is often occurring later than it did in earlier decades. So, someone may be diagnosed with breast cancer in their thirties before they’ve commenced their child bearing. So, there’s all those issues about how to best protect their future fertility so that when the time is right, they can have the option for childbearing.”
She said surgery options also cause a lot of anxiety for young women.
“Sometimes when women are diagnosed with breast cancer at a young age, they’re so afraid of recurrence, that they feel like they just want to have all their breast tissue removed which is obviously a very big procedure for somebody at a young age.”
The cause of a young women’s breast cancer may also be investigated further.
“Genetic aspects come into it, because if somebody is diagnosed with breast cancer at a young age then it would be standard to consider whether there’s a genetic aspect” she said.
Research Into Treatments For Young Women With Breast Cancer
Breast Cancer Trials is committed to finding new and better treatments for young women with breast cancer.
Past Breast Cancer Trials clinical trials, the SOFT and TEXT clinical trials, helped to improve the treatment and survival for pre-menopausal women with oestrogen receptor positive or hormone receptor positive early breast cancer.
Previously, the hormone treatment given to these women post-surgery, and if required, after chemotherapy, was five years of tamoxifen.
Previous studies have shown that this treatment was not as effective for young women under 35, as compared to older pre-menopausal women.
“In trying to think about why that was we were thinking about oestrogen, which comes from the ovaries in pre-menopausal women” said Associate Professor Francis.
“When pre-menopausal, you have oestrogen produced from your ovaries every month and we noticed from previous trials when women were pre-menopausal and given adjuvant chemotherapy that the very young women were less likely to have their periods stop after they got chemotherapy compared to the older pre-menopausal women.”
“So, the closer you are to the natural age of menopause the more likely you are to go into menopause with chemotherapy, that might be temporary, or it might be permanent” she said.
“So if you’re 48, when you get chemotherapy your periods will probably stop, whereas if your 28 your periods are very unlikely to stop and so we wondered if the adverse outcomes in the younger women were the fact they were not getting this effect of their periods stopping and that their ovaries were continuing to produce oestrogen every month and perhaps that oestrogen could be effecting the growth of any remaining cancer cells.”
Associate Professor Francis said the most recent follow-up of the study has show there is an improvement in survival for women by suppressing the ovarian oestrogen for five years to tamoxifen.
“We feel that this treatment is going to be most beneficial in very young women or women with more high-risk features to their cancer. For example, several lymph nodes involved, more aggressive tumors.”
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THE SYMPTOMS OF BREAST CANCER BESIDES A LUMP
The most well-known symptom associated with breast cancer is finding a lump in the breast area. However, there are a number of physical signs or symptoms that could potentially indicate breast cancer.
What Are The Symptoms Of Breast Cancer Besides A Lump?
The most well-known symptom associated with breast cancer is finding a lump in the breast area. However, there are a number of physical signs or symptoms that could potentially indicate breast cancer. It is therefore important to be aware of the regular shape and feel of your breasts throughout the month and be aware of how your menstrual cycle can affects this. Pregnancy, weight and age can also alter the shape, feel and size of your breasts.
If you find one of the following symptoms, it’s important not to panic. Nine out of ten breast changes aren’t due to cancer. However, you should consult your doctor if you find any changes in your breasts.
It is also important to note that some breast cancers will not cause any symptoms at all. It is therefore important to get regular screening mammograms. BreastScreen Australia recommends women aged 50-74 without breast cancer symptoms should have a screening mammograms every two years. In New Zealand, women aged between 45 and 69 years are able to receive a free mammogram every two years.
Changes to Skin
Most changes to the skin of the breast are due to benign conditions, like allergies. However, changes in the look and feel of the skin of the breast, such as persistent skin redness, a rash, a scaly appearance, puckering, unusual redness or other colour changes, or dimpling (an ‘orange peel’ appearance) should be investigated further.
Changes to Breast Size and Shape
It’s quite common for your breasts to change due to hormone changes. Pregnancy can cause the breasts to increase by an average of two cup sizes, and your monthly period can also cause your breasts to change including feeling swollen, tender or lumpy before a period begins.
It’s important you are familiar with these changes. Most changes to the breast shape and size are not cancerous, however if you are concerned or have additional symptoms, speak with your doctor.
Changes to the Nipple
If there is a new change in the shape or look of your nipple, this could be a symptom of breast cancer.
A cancer may be present if there is nipple inversion – that is, the nipple is pulled in and cannot be pulled out to a normal shape, and rather than forming a slit shape the nipple is pulled in together, the nipple has any scaliness or crusting; an ulcer of sore; or unusual redness or a lump can be felt behind the nipple. However, nipple inversion may also occur naturally with increasing age.
Other physical signs or symptoms that could potentially indicate breast cancer can include pain in the armpit or breast, and nipple discharge. Find out more below.
Breast pain is not a common symptom of breast cancer. However, if the pain is new and persistent speak with you doctor.
Most women will experience some sort of breast pain over the course of their life. Breast pain may be accompanied by tenderness, lumpiness, fullness, heaviness or an increase in breast size. The pain can also extend to the armpit.
Breast pain can occur around the menstrual cycle, increasing around 3-7 days before the period begins. It is therefore important to be aware of how your menstrual cycle affects your breasts. Women can also experience breast pain when taking hormone replacement therapy after menopause.
Other common reasons for breast and armpit pain can include stress, wearing an unsupportive bra, weight gain, injury to the breast and breast cysts or fibroadenomas.
If you are concerned about breast pain, speak with your doctor.
Most nipple discharges will not be an indicator of breast cancer. However, a cancer may be present if the nipple discharge comes out without the nipple or breast being squeezed, comes from a single duct in one nipple, is blood-strained or tests positive for blood and is new, or in a woman 60 years or older.
Male Breast Cancer
For men, the most common symptom of breast cancer is a painless lump in the breast, often behind the nipple. The symptoms of male breast cancer closely resemble that of female breast cancer. If you notice a new change in your chest or nipples, talk to your doctor. If you are concerned about a change in your breasts, speak to your GP.
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