Breast cancer is the most common cancer in the UK, with around 55,000 new cases diagnosed each year. It accounts for 15% of all new cancers in the UK. While it predominantly affects women, around 400 men are diagnosed each year. Thanks to improvements in screening, early diagnosis, and treatment, survival rates have doubled over the past 40 years — today, around 3 in 4 women survive for at least 10 years.
What Is Breast Cancer?
Breast cancer develops when cells in the breast begin to grow abnormally and divide uncontrollably. Most breast cancers start in the ducts or lobules of the breast. It can spread to lymph nodes in the armpit and, if untreated, to other parts of the body including the bones, lungs, liver, and brain.
Symptoms of Breast Cancer
The most common symptoms to look out for include:
- A new lump or thickening in the breast or armpit
- A change in the size or shape of one or both breasts
- Skin changes — dimpling, puckering, redness, or an orange-peel texture
- A change in the position of the nipple, or nipple turning inward (inverted)
- Nipple discharge (other than breast milk), including blood
- Rash or crusting around the nipple area
- Pain in the breast or armpit that is new or unusual
Most lumps are not cancer — around 90% of breast lumps are benign — but any new lump or change should be assessed by your GP promptly. Do not wait to see if it resolves on its own.
NHS Breast Screening (Mammography)
The NHS Breast Screening Programme invites all women registered with a GP aged 50 to 70 (being extended to 47–73 in some areas) for a free mammogram every 3 years. A mammogram is an X-ray of the breast that can detect cancers too small to feel.
Women over 70 are no longer automatically invited but can self-refer for free screening through their local breast screening service. If you are at higher risk due to family history or genetic factors, you may be offered annual screening from a younger age.
What Happens at a Mammogram?
- You attend a specialist breast screening unit (often a mobile unit)
- A radiographer compresses each breast between two plates and takes two X-ray images
- The process takes around 20 minutes in total
- Results are sent by letter within 2 weeks
- Around 1 in 20 women are called back for further tests — most do not have cancer
Risk Factors for Breast Cancer
Factors You Cannot Change
- Age — Risk increases significantly after 50; most cases occur in women over 50
- Family history — First-degree relatives with breast cancer double your risk
- BRCA1 or BRCA2 gene mutations — Lifetime risk up to 72% (BRCA1) or 69% (BRCA2)
- Dense breast tissue — Makes mammograms harder to read and increases risk
- Previous breast cancer or DCIS — Higher risk in the other breast
- Previous benign breast disease — Especially atypical hyperplasia
- Early periods or late menopause — Longer exposure to oestrogen
- Never having children, or first child after 30
Lifestyle Factors (Modifiable)
- Alcohol — Each unit consumed daily increases risk by approximately 7–10%
- Being overweight after menopause — Increases oestrogen production via adipose tissue
- Sedentary lifestyle — Regular exercise reduces risk by up to 20%
- Combined HRT — Slightly increases risk; risk returns to normal within 5 years of stopping
- Oral contraceptive pill — Slightly increased risk, returns to normal after stopping
- Smoking
BRCA Gene Testing
Mutations in the BRCA1 and BRCA2 genes significantly increase the lifetime risk of breast and ovarian cancer. In the UK, genetic testing is offered on the NHS to those with a significant family history. The criteria for referral to clinical genetics include:
- Two or more first-degree relatives with breast cancer (at least one under 50)
- Three or more relatives on the same side of the family with breast cancer at any age
- A relative with ovarian cancer and a relative with breast cancer
- A relative with male breast cancer
- Ashkenazi Jewish heritage with breast cancer in the family
If a BRCA mutation is found, options include enhanced surveillance (annual MRI from age 30), chemoprevention (tamoxifen or raloxifene), or risk-reducing surgery (mastectomy and/or oophorectomy).
Types of Breast Cancer
| Type | Description | Frequency |
|---|---|---|
| Invasive ductal carcinoma (IDC) | Starts in the milk ducts, invades surrounding tissue | ~80% of all breast cancers |
| Invasive lobular carcinoma (ILC) | Starts in the lobules (milk-producing glands) | ~10–15% |
| Ductal carcinoma in situ (DCIS) | Non-invasive; cells in ducts, haven’t spread | ~20% of screen-detected cancers |
| Inflammatory breast cancer | Rare; causes redness, swelling, warmth — often mistaken for infection | <3% |
| Triple-negative breast cancer | Lacks oestrogen, progesterone receptors and HER2; harder to treat | ~15% |
| HER2-positive breast cancer | Overexpresses HER2 protein; responds to targeted therapy | ~15–20% |
Diagnosis
If breast cancer is suspected, your GP will refer you under the NHS 2-Week Wait pathway to a specialist breast clinic. At the clinic, diagnosis typically involves a “triple assessment”:
- Clinical examination — Physical breast examination by a specialist
- Imaging — Mammogram (40+), ultrasound (under 40 or additional assessment), or MRI
- Biopsy — Core needle biopsy or fine needle aspiration to confirm diagnosis and determine receptor status (ER, PR, HER2)
Receptor testing determines which treatments will be most effective. Around 75% of breast cancers are oestrogen receptor-positive (ER+), making them eligible for hormone therapies.
Staging
| Stage | Description | 5-Year Survival (approx.) |
|---|---|---|
| Stage 0 (DCIS) | Non-invasive; cells in ducts only | Near 100% |
| Stage 1 | Tumour up to 2cm; no lymph node spread | ~99% |
| Stage 2 | Tumour 2–5cm and/or minor lymph node involvement | ~90% |
| Stage 3 | Larger tumour or significant lymph node involvement | ~70% |
| Stage 4 | Spread to distant organs (metastatic) | ~28% |
Treatment Options on the NHS
Surgery
- Lumpectomy (wide local excision) — Removes the tumour and a margin of surrounding tissue; breast is preserved. Usually followed by radiotherapy.
- Mastectomy — Removal of the whole breast. Options include skin-sparing and nipple-sparing approaches.
- Breast reconstruction — Can be immediate or delayed; uses implants or your own tissue (TRAM flap, DIEP flap, latissimus dorsi flap)
- Sentinel lymph node biopsy — Checks whether cancer has spread to lymph nodes without removing them all
- Axillary node clearance — Removal of lymph nodes under the arm if cancer has spread there
Radiotherapy
Usually given after lumpectomy and sometimes after mastectomy to destroy any remaining cancer cells. Modern NHS radiotherapy is typically 5 treatments over 1 week (hypofractionated), replacing older 15-session regimes.
Chemotherapy
May be given before surgery (neoadjuvant — to shrink the tumour) or after (adjuvant — to reduce recurrence risk). Common NHS regimens include FEC-T (fluorouracil, epirubicin, cyclophosphamide followed by docetaxel) and EC-T combinations.
Hormone Therapy (Endocrine Therapy)
For ER-positive tumours, hormone therapy is taken for 5–10 years after treatment to reduce recurrence risk:
- Tamoxifen — Used pre-menopause and post-menopause; blocks oestrogen receptors
- Aromatase inhibitors (anastrozole, letrozole, exemestane) — Used post-menopause; reduce oestrogen production. Anastrozole (Arimidex) and letrozole (Femara) are available on the NHS.
- Ovarian suppression (goserelin/Zoladex) — Used in pre-menopausal women with high-risk disease alongside tamoxifen or AIs
Targeted (Biological) Therapy
- Trastuzumab (Herceptin) — For HER2-positive breast cancer; given with chemotherapy and for 12 months after. Available on NHS.
- Pertuzumab (Perjeta) — Combined with trastuzumab for HER2+ cancer; NICE-approved for high-risk early breast cancer.
- CDK4/6 inhibitors (palbociclib/Ibrance, ribociclib/Kisqali, abemaciclib/Verzenios) — For advanced ER+/HER2- breast cancer; NICE-approved combinations available on NHS
- PARP inhibitors (olaparib/Lynparza) — For BRCA-mutated advanced breast cancer; NHS-approved
- Pembrolizumab (Keytruda) — Immunotherapy for triple-negative breast cancer; NICE-approved for certain presentations
Living With and After Breast Cancer
After treatment, you will be monitored through a combination of annual mammograms and hospital or community-based follow-up appointments. Common side effects to manage include:
- Lymphoedema — Swelling of the arm if lymph nodes were removed; managed with compression sleeves and specialist physiotherapy
- Menopausal symptoms — Hot flushes, joint pain from aromatase inhibitors; options include lifestyle measures and non-hormonal treatments
- Fatigue — Very common; addressed with graded exercise, sleep hygiene, and psychological support
- Peripheral neuropathy — Tingling/numbness from chemotherapy (particularly taxanes)
- Bone thinning — From aromatase inhibitors; monitored with DEXA scans; bisphosphonates (zoledronic acid) may be prescribed
Support and Resources in the UK
- Breast Cancer Now — breastcancernow.org — UK’s largest breast cancer charity; helpline: 0808 800 6000
- Macmillan Cancer Support — macmillan.org.uk — Support line: 0808 808 00 00
- Cancer Research UK — cancerresearchuk.org — Information and clinical trial finder
- NHS Cancer Information — nhs.uk/conditions/breast-cancer
- Younger Women Together — Breast Cancer Now programme for women under 45
When to See a GP
See your GP as soon as possible if you notice any new lump, skin change, nipple change, or unexplained breast pain. GPs are required to refer anyone with suspected breast cancer under the 2-Week Wait rule to be seen at a specialist breast clinic within 14 days.
This information is intended as general educational guidance. Always consult your GP or specialist for personalised medical advice.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Cervical Screening Guide — Breast and cervical screening are both NHS cancer prevention programmes; understand how to stay up to date with both.
- Bowel Cancer Guide — Understand the full range of NHS cancer screening programmes and the importance of attending all your invitations.
- Menopause Guide — Menopause affects breast cancer risk and treatment outcomes; learn what to discuss with your oncology and gynaecology teams.
- HRT Guide — Hormone replacement therapy has a complex relationship with breast cancer risk; understand the NICE evidence and what to ask your GP.
- Endometriosis Guide — Both endometriosis and breast cancer involve hormonal factors; learn about oestrogen-driven conditions and NHS support.
- Osteoporosis Guide — Breast cancer treatment (especially aromatase inhibitors) significantly increases osteoporosis risk; learn about NHS bone protection strategies.