Breast conditions:
diagnosis & management

Non-modifiable risk factors

These factors are inherent to biology or personal and family history:

• Female sex — breast cancer mainly affects women
• Age — risk increases with age, especially after 50
• Personal history — personal history of breast cancer or of a high-risk lesion (atypical hyperplasia, lobular carcinoma in situ)
• Family history — breast cancer in your mother, a sister or a daughter, especially before age 50
• Genetic mutations — BRCA1, BRCA2, PALB2, ATM and other predisposition genes
• High breast density — dense breasts on mammography (density hides lesions and also increases the risk)
• Early puberty / late menopause — prolonged exposure to oestrogens
• Late first pregnancy or no full-term pregnancy — risk is slightly higher
• Absence of breastfeeding — breastfeeding has a protective effect
• Previous chest radiotherapy (e.g. Hodgkin lymphoma)

Modifiable risk factors

Some of these factors depend partly on lifestyle; acting on them lowers the risk, without ever removing it:

• Alcohol consumption — even moderate drinking increases the risk, and the more you drink, the higher it is
• Overweight and obesity — especially after menopause (body fat produces oestrogens)
• Sedentary lifestyle — regular physical activity is protective
• Menopausal hormone therapy — certain combined oestrogen-progestogen therapies slightly increase risk
• Smoking — increasingly documented link, especially early in life

What to do if you have risk factors?

Having one or more risk factors does not mean that a cancer will develop, but it does call for closer attention. A dedicated consultation helps assess your risk, adapt screening and discuss prevention.

Invasive carcinoma of no special type

The most common: 70 to 80% of breast cancers. Long called “invasive ductal carcinoma”, a name still found on many pathology reports. It starts in the ducts and spreads into the surrounding tissue.

Invasive lobular carcinoma

10 to 15% of breast cancers. It starts in the lobules and can be harder to see on a mammogram; an MRI (magnetic resonance imaging) is often useful to define its extent.

Ductal carcinoma in situ

The cancer cells stay inside the ducts without breaking through their wall. Most often found during screening, it has a very good prognosis.

Inflammatory breast cancer

A rare form, 1 to 5% of breast cancers, that progresses quickly. The breast becomes red, warm and swollen because the cells invade the lymphatic vessels of the skin. It calls for rapid, multidisciplinary care.

Paget’s disease of the nipple

It affects the skin of the nipple and areola, which itches, reddens and flakes. It is almost always associated with an underlying in situ or invasive carcinoma.

Breast cancer in men

Less than 1% of breast cancers. Often diagnosed later, because it is not suspected. Its management follows the same principles as in women.

Luminal A

The most common and most favourable. It expresses hormone receptors and grows slowly; hormone therapy is its main treatment.

Luminal B

It also expresses hormone receptors, but grows faster. Chemotherapy may be added to hormone therapy.

HER2-positive

The tumour produces too much of the HER2 protein. Targeted treatments directed against HER2 have profoundly improved its prognosis.

Triple-negative

It expresses neither hormone receptors nor HER2. Treatment relies on chemotherapy, often before surgery, combined with immunotherapy in some cases. It is more common in women carrying a BRCA1 mutation.

Surgery

Central to the treatment of localised breast cancer, and at the heart of Dr Monnier’s practice: breast-conserving surgery or mastectomy, lymph node assessment, oncoplastic surgery and reconstruction.

Radiotherapy

It most often follows breast-conserving surgery, sometimes a mastectomy. It reduces the risk of recurrence in the breast and the surrounding area.

Chemotherapy

It can be given before surgery, to shrink the tumour, or after, to lower the risk of recurrence. Whether it is indicated depends on the characteristics of the tumour.

Hormone therapy

For hormone-sensitive tumours. It blocks the action of oestrogen or reduces its production. It is taken for several years.

Targeted therapies and immunotherapy

Treatments directed at a specific target on the tumour, such as the HER2 protein, or that help the immune system recognise it. Their use depends on the subtype.

Genomic signatures

Tests that analyse the genes of the tumour to estimate the risk of recurrence. For some hormone-sensitive tumours, they help decide whether chemotherapy will bring a benefit — and sometimes make it possible to avoid it.