Cancers are clumps of cells that have been damaged in some way so that their growth control mechanisms no longer work properly. In breast cancer, cells in a certain part of the breast (typically in the lining of the milk ducts) multiply uncontrollably and form a cancerous tumour. If undetected, these rogue cells may also spread to other parts of the breast, the lymph nodes under the arm, and to other parts of the body. It is important to realise that breast cancer isn’t just one simple disease. It takes many different forms and is characterised by differences in disease aggression and response.

Most breast lumps are not cancers; however, any new lump that does not go away after 3-4 weeks should be examined by a GP. Depending on the circumstances, a follow-up referral to a breast surgeon or a breast clinic for further tests may be appropriate. An ultrasound of the breast is simple and painless. Mammograms are breast X-rays and involve the breast being squashed between two plates so that the radiographer can clearly see the tissue in question. A biopsy, if needed, is done under a local anesthetic with a small needle similar to the type used in blood tests. If you are over 50, or have a family history of breast cancer, it is recommended that you have a mammogram every two years. These are provided as a free health service. If you are under 50 it is still important to conduct an examination of your own breasts every month, ideally just after a period. If you notice anything unusual, consult your GP.

While known risk factors may account for some breast cancers, more than 50% of breast cancer cases currently have no apparent explanation. The known risk factors include:

• Sex - Being female is the biggest risk factor for getting breast cancer, although it does affect a small percentage of men (about 1% of new cases are in males)
• Age - More than 70% of all breast cancer occurs in women aged 50 and over. The average age of diagnosis is 68 years, with less than 10% of all cases occurring in women under 40
• Family history - inherited cancers account for less than 10% of all breast cancer cases, however, they are often more aggressive and will occur at a much younger age. Two genes in particular have been implicated in familial breast cancer. Tests for these genes are available through a genetic counselling service
• Previous history of hormone-based breast disease; for example, benign cysts or fibroadenomas. This tends to only be a higher risk when aged over 50
• Early commencement of menstruation or late menopause

• Having a first child after the age of 30

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The four main treatments for breast cancer are radiotherapy, hormone therapy, chemotherapy and surgery (removal of the lump, removal of the breast, or removal of the breast plus surrounding lymph node tissue). These treatments can be used separately or in combination depending on patient preference, the size of the lump, the size of the breast and the type of cancer.

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We researching the factors involved in the development, growth and progression of breast cancer. Specifically, Garvan aims to investigate the genetic and environmental causes of breast cancer; to develop genetic markers for early disease detection, disease progression and response to treatment; and to study the genetics and biochemistry of tumour growth.

One of the breast cancer research groups has helped developed a large tissue bank and patient databases that can be used by scientists worldwide. This material is being used to identify new molecules that are markers of breast cancer subtype, disease progression and response to particular therapies. A major project, being conducted in collaboration with other research groups, aims to identify molecular markers of tamoxifen resistance, since loss of response to tamoxifen is a major reason for treatment failure.

There are further collaborative studies with other institutions to assess the role of new genes in breast cancer. One recent finding revealed that a protein called LMO4 can cause cancer in mice, promotes cancer cell invasion and predicts poor patient outcome.

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