Breast Cancer Awareness Month: A conversation with Mr Debashis Ghosh

No, not all breast lumps mean cancer. What we see in our clinic is that, if we see around 20 patients with breast lumps, only about three will have lumps that we need to biopsy, and of those, probably one will be breast cancer.

So, having a breast lump does not mean you have cancer. It could be a cyst, a benign fibroadenoma, changes that are unrelated to cancer, or simply normal breast tissue that we can feel.

People should look out for a persistent breast lump, whether it is small or larger, as well as changes such as retraction of the skin or nipple, asymmetry between the breasts, lumps under the arm, or an orange-peel-like appearance of the breast.

If a change persists for more than four weeks, people should not hesitate to contact their GP or seek medical advice.

There are three areas where we have direct evidence. Firstly, around 5% of all breast cancers are related to a genetic defect. If somebody has a family history and there is a genetic defect, that accounts for around 5% of breast cancers.

We also know that obesity and alcohol can increase the risk. It has been proven that increased alcohol intake and having a body weight above the normal range are associated with a higher chance of developing breast cancer.

Yes, absolutely. This service is provided both in the NHS and privately.

It is important to understand that genetic defects are not responsible for all breast cancers. We can also have people with a significant number of family members who have had breast cancer.

For example, somebody who has one family member diagnosed under the age of 40, two or more family members diagnosed under the age of 50, or three or more family members diagnosed above the age of 50 may be considered at increased risk of breast cancer.

These patients need to be monitored regularly, depending on whether they have a definite, proven genetic defect or not. These are the patients we want to keep under surveillance, and we regularly offer annual surveillance, from around the age of 35 through to 59.

Usually, when patients come to see us, they go through a one-stop clinic. They have a mammogram, an ultrasound scan and a biopsy, and then we discuss the biopsy results when they come back.

One of the biggest advantages we have at The London Clinic is that we can see a patient, carry out a scan on the same day and, within 48 hours, have their biopsy results, along with an MRI scan and PET-CT where appropriate. Within a week, we can have their full management plan.

We can then proceed to an operation by the end of the week. So, from the initial detection through to surgery, from Monday to Saturday, we can have a patient on the operating table. That’s what we can deliver.

Alternatively, within the same week, they may be able to start chemotherapy.

That helps to reduce the anxiety for patients.

Depending on the biology of the tumour, they may also have an MRI scan. If there is lymph node involvement, they may have a PET scan.

Currently, 3D tomosynthesis, contrast-enhanced mammograms and MRI scans are picking up breast cancers that we were not able to detect previously.

We also have the advantage of PET-CT scans, which can help pick up recurrent breast cancers.

One of the biggest advances is liquid biopsy and the detection of circulating tumour DNA. There are certain trials currently taking place in the NHS that are looking at whether breast cancer can be detected through a blood test, even before a lump is detected or before the cancer comes to clinical diagnosis.

These are some of the huge advances we are looking at in terms of early detection.

I think the most important point is that there are different types of breast cancer.

This is where people make a mistake. They hear that a friend or colleague has had breast cancer and assume that they have the worst possible type. But everybody’s journey is different, and everybody’s breast cancer is different.

This can also be a problem among doctors. Not all treating doctors understand the differences between the different types of breast cancer.

It is the biology of the tumour that makes the difference, not simply the stage of the tumour.

1. Early diagnosis saves lives. Every woman between the ages of 19 and 90 should remain breast aware. Men should also be breast aware and check their breasts, because men can develop breast cancer too.
2. Breast screening saves lives because it allows us to pick up breast cancer at its earliest stages, when the patient may not even have felt a lump. So, regular breast screening can save lives and help us detect breast cancer as early as possible. Breast screening through the NHS is available between the ages of 48 and 70. However, in Europe and the USA, as well as in the private sector in this country, breast screening can be offered from the age of 40 onwards and can be done annually.
3. And, finally, I think we are at a stage in modern medicine where I would say that 80–90% of breast cancers that are found early are treatable and curable.

Find out more about diagnostics at our One-Stop Breast Clinic.