A Must Read:Breast Cancer in Women

Overview

Breast cancer is the most common type of cancer in the USA. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer.

About 1 in 7 women are diagnosed with breast cancer during their lifetime. There’s a good chance of recovery if it’s detected at an early stage.

For this reason, it’s vital that women check their breasts regularly for any changes and always have any changes examined by a doctor.

In rare cases, men can also be diagnosed with breast cancer.

Symptoms of breast cancer

Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should also see a doctor if you notice any of these symptoms:

• a change in the size or shape of one or both breasts
• discharge from either of your nipples, which may be streaked with blood
• a lump or swelling in either of your armpits
• dimpling on the skin of your breasts
• a rash on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast

Breast pain is not usually a symptom of breast cancer.

Causes of breast cancer

The exact causes of breast cancer are not fully understood. However, there are certain factors known to increase the risk of breast cancer.

These include:

• age – the risk increases as you get older
• a family history of breast cancer
• a previous diagnosis of breast cancer
• a previous non-cancerous (benign) breast lump
• being tall, overweight or obese
• drinking alcohol

Diagnosing breast cancer

After examining your breasts, a doctor may refer you to a specialist breast cancer clinic for further tests. This might include breast screening (mammography) or taking a small sample of breast tissue to be examined under a microscope (a biopsy).

Find out more about how breast cancer is diagnosed.

Types of breast cancer

There are several different types of breast cancer, which develop in different parts of the breast.

Breast cancer is often divided into either:

• non-invasive breast cancer (carcinoma in situ) – found in the ducts of the breast (ductal carcinoma in situ, or DCIS) which has not spread into the breast tissue surrounding the ducts. Non-invasive breast cancer is usually found during a mammogram and rarely shows as a breast lump.
• invasive breast cancer – where the cancer cells have spread through the lining of the ducts into the surrounding breast tissue. This is the most common type of breast cancer.

Other, less common types of breast cancer include:

• invasive (and pre-invasive) lobular breast cancer
• inflammatory breast cancer
• Paget’s disease of the breast

It’s possible for breast cancer to spread to other parts of the body, usually through the blood or the axillary lymph nodes. These are small lymphatic glands that filter bacteria and cells from the mammary gland.

If this happens, it’s known as secondary, or metastatic, breast cancer.

Breast cancer screening

Mammographic screening, where X-ray images of the breast are taken, is the most commonly available way of finding a change in your breast tissue (lesion) at an early stage.

However, you should be aware that a mammogram might fail to detect some breast cancers.

It might also increase your chances of having extra tests and interventions, including surgery, even if you’re not affected by breast cancer.

Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition.

As the risk of breast cancer increases with age, all women who are 50 to 70 years old are invited for breast cancer screening every 3 years.

Women over the age of 70 are also entitled to screening and can arrange an appointment through their doctor or local screening unit.

Treating breast cancer

If cancer is detected at an early stage, it can be treated before it spreads to other parts of the body.

Breast cancer is treated using a combination of:

• surgery
• chemotherapy
• radiotherapy

Surgery is usually the first type of treatment you’ll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted treatments.

The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor should discuss the best treatment plan with you.

In a small proportion of women, breast cancer is discovered after it’s spread to other parts of the body (metastatic breast cancer).

Secondary cancer, also called advanced or metastatic cancer, is not curable, so the aim of treatment is to relieve symptoms.

Living with breast cancer

Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.

How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.

Forms of support may include:

• family and friends, who can be a powerful support system
• communicating with other people in the same situation
• finding out as much as possible about your condition
• not trying to do too much or overexerting yourself
• making time for yourself

Preventing breast cancer

As the causes of breast cancer are not fully understood, at the moment it’s not possible to know if it can be prevented.

If you have an increased risk of developing the condition, some treatments are available to reduce your risk.

Studies have looked at the link between breast cancer and diet. Although there are no definite conclusions, there are benefits for women who:

• maintain a healthy weight
• exercise regularly
• have a low intake of saturated fat
• do not drink alcohol

It’s been suggested that regular exercise can reduce your risk of breast cancer by almost as much as a third. Regular exercise and a healthy lifestyle can also improve the outlook for people affected by breast cancer. 

If you’ve been through the menopause, it’s particularly important that you try to get to, and maintain, a healthy weight.

This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast.

Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.

You should see a doctor if you notice any of the following:

• a new lump or area of thickened tissue in either breast that was not there before
• a change in the size or shape of one or both breasts
• a discharge of fluid from either of your nipples
• a lump or swelling in either of your armpits
• a change in the look or feel of your skin, such as puckering or dimpling, a rash or redness
• a rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple
• a change in the appearance of your nipple, such as becoming sunken into your breast

Breast pain is not usually a symptom of breast cancer.

Breast awareness

It’s important to be breast aware so you notice any changes as soon as possible.

Get to know what is normal for you – for instance, your breasts may look or feel different at different times of your life. This will make it easier to notice potential problems.

Causes

The causes of breast cancer are not fully understood, making it difficult to say why one woman may develop breast cancer and another may not.

However, there are risk factors known to affect your likelihood of developing breast cancer. Some of these you cannot do anything about, but there are some you can change.

Age

The risk of developing breast cancer increases with age. The condition is most common in women over age 50 who have been through the menopause. About 8 out of 10 cases of breast cancer happen in women over 50.

All women who are 50 to 70 years of age should be screened for breast cancer every 3 years as part of the the medical services Breast Screening Programme.

Women over the age of 70 are still eligible to be screened and can arrange this through their doctor or local screening unit.

Family history

If you have close relatives who have had breast cancer or ovarian cancer, you may have a higher risk of developing breast cancer.

However, because breast cancer is the most common cancer in women, it’s possible for it to occur in more than one family member by chance.

Most cases of breast cancer do not run in families, but genes known as BRCA1 and BRCA2 can increase your risk of developing both breast and ovarian cancer. It’s possible for these genes to be passed on from a parent to their child. 

The genes TP53 and CHEK2, are also associated with an increased risk of breast cancer.

Speak to a doctor if breast or ovarian cancer runs in your family and you’re worried you may get it too. 

They may refer you for an the medical services genetic test, which will tell you if you have inherited one of the cancer-risk genes.

Previous breast cancer or lump

If you have previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast.

A benign breast lump does not mean you have breast cancer, but certain types of breast lumps may slightly increase your risk of developing cancer.

Some benign changes in your breast tissue, such as cells growing abnormally in ducts (atypical ductal hyperplasia), or abnormal cells inside your breast lobes (lobular carcinoma in situ), can make getting breast cancer more likely.

Dense breast tissue

Your breasts are made up of thousands of tiny glands (lobules) that produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser.

Women with dense breast tissue may have a higher risk of developing breast cancer as there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) difficult to read, as any lumps or areas of abnormal tissue are harder to see.

Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense.

Hormones and hormone medicine

Exposure to oestrogen

The female hormone oestrogen can sometimes stimulate breast cancer cells and cause them to grow.

The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty, to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to.

For example, if you started having periods at a young age and experienced the menopause later than average, you will have been exposed to oestrogen over a longer period of time.

In the same way, not having children or having children later in life may slightly increase your risk of developing breast cancer because your exposure to oestrogen is not interrupted by pregnancy.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with an increased risk of developing breast cancer.

All types of HRT can increase the risk of breast cancer, except for vaginal oestrogen.

There is no increased risk of breast cancer if you take HRT for less than 1 year.

But if you take HRT for longer than 1 year, you have a higher risk of breast cancer than women who never use HRT.

The increased risk of breast cancer falls after you stop taking HRT, but some increased risk remains for more than 10 years compared to women who have never used HRT.

Contraceptive pill

Research shows that women who take the contraceptive pill have a slightly increased risk of developing breast cancer.

However, the risk starts to decrease once you stop taking the pill, and your risk of breast cancer is back to normal 10 years after stopping.

Lifestyle factors

Being overweight or obese

If you have experienced the menopause and are overweight or obese, you may be more at risk of developing breast cancer.

This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Alcohol

Drinking alcohol increases the risk of getting breast cancer.

People who drink even small amounts of alcohol on a regular basis have a greater risk of getting breast cancer than people who do not drink alcohol at all. The more alcohol you drink, the more your risk of getting breast cancer increases.

Radiation

Certain medical procedures that use radiation, such as X-rays and CT scans, may slightly increase your risk of developing breast cancer.

If you had radiotherapy to your chest area for Hodgkin lymphoma you should have already received a letter from the Department of Health and Social Care inviting you for a consultation with a specialist to discuss your increased risk of developing breast cancer.

See your doctor if you were not contacted or if you did not attend a consultation. You’re usually entitled to have your breast checked with an MRI scan.

If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins.

Diagnosed

You may be diagnosed with breast cancer after routine breast screening, or you may have symptoms that you’ve seen your doctor about.

Seeing a doctor

See a doctor as soon as possible if you notice any symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts.

The doctor will examine you. If they think your symptoms need further assessment, they’ll refer you to a specialist breast cancer clinic.

Tests at a breast cancer clinic

If you have suspected breast cancer, either because of your symptoms or because a mammogram has shown an abnormality, you’ll be referred to a specialist breast cancer clinic for further tests.

Mammogram and breast ultrasound

If you have symptoms and have been referred to a specialist breast unit by a doctor, you’ll probably be invited to have a mammogram, which is an X-ray of your breasts. You may also need an ultrasound scan.

If cancer was detected through the the medical services Breast Screening Programme, you may need another mammogram or ultrasound scan.

Your doctor may suggest that you only have a breast ultrasound scan if you’re under the age of 35. This is because younger women have denser breasts, which means a mammogram is not as effective as ultrasound in detecting cancer.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities.

Your breast specialist may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Find out more about breast screening.

Biopsy

A biopsy is where a sample of cells is taken from your breast and tested to see if it’s cancerous.

You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected.

Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition. 

Needle aspiration

Needle aspiration may be used to test a sample of your breast cells for cancer or drain a small fluid-filled lump (benign cyst).

Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

Needle biopsy

Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle.

You may have a local anaesthetic, which means you’ll be awake during the procedure, but your breast will be numb.

Your doctor may suggest that you have a guided needle biopsy, usually guided by ultrasound or X-ray, or sometimes MRI, to obtain a more precise and reliable diagnosis of cancer.

This can also distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS).

Vacuum-assisted biopsy

Vacuum-assisted biopsy, also known as mammotome biopsy, is another type of biopsy.

During the procedure, a needle is attached to a gentle suction tube, which helps to obtain the sample and clear any bleeding from the area.

Further tests for breast cancer

If a diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and the best method of treatment.

Scans and X-rays

A CT scan, chest X-ray and liver ultrasound scan may be needed to check whether the cancer has spread.

An MRI scan of the breast may be needed to clarify the results or assess the extent of the condition within the breast.

If your doctor thinks the cancer could have spread to your bones, you may need a bone scan.

Before having a bone scan, a substance containing a small amount of radiation known as an isotope will be injected into a vein in your arm.

This will be absorbed into your bone if it’s been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan.

Tests to determine specific types of treatment

You’ll also need tests that show whether the cancer will respond to specific types of treatment.

The results of these tests can give your doctors a more complete picture of the type of cancer you have and how to treat it.

In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone.

If this is the case, the cancer may be treated by stopping the effects of the hormones or by lowering the level of these hormones in your body. This is known as hormone therapy.

During a hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone.

If the hormone is able to attach to the cancer cells using a hormone receptor, they’re known as hormone-receptor positive.

While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 (HER2).

These types of cancers can be diagnosed using a HER2 test and are treated with medicine that blocks the effects of HER2. This is known as targeted therapy.

Stage and grade of breast cancer

Stage of breast cancer

When breast cancer is diagnosed, your doctors will give it a stage. The stage describes the size of the cancer and how far it has spread, and is used to predict the outlook.

Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:

• stage 1 – the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
• stage 2 – the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
• stage 3 – the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
• stage 4 – the tumour is of any size and the cancer has spread to other parts of the body (metastasis)

This is a simplified guide. Each stage is divided into further categories: A, B and C. If you’re not sure what stage you have, talk to your doctor.

TNM staging system

The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis:

• T – the size of the tumour
• N – whether the cancer has spread to the lymph nodes
• M – whether the cancer has spread to other parts of the body

Grades of breast cancer

The grade describes the appearance of the cancer cells.

• low grade (G1) – the cells, although abnormal, appear to be growing slowly
• medium grade (G2) – the cells look more abnormal than low-grade cells
• high grade (G3) – the cells look even more abnormal and are more likely to grow quickly

Treatment

If you have breast cancer, you should be assigned a multidisciplinary team (MDT), which is a group of specialists who work together to provide the best treatment and care.

The main treatments for breast cancer are:

• surgery
• radiotherapy
• chemotherapy
• hormone therapy
• targeted therapy

You may have one of these treatments, or a combination. The type or combination of treatments you have will depend on how the cancer was diagnosed and the stage it’s at.

Breast cancer diagnosed at routine screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment.

Your MDT should discuss with you which treatments are most suitable.

Choosing the right treatment for you

When deciding what treatment is best for you, your doctors will consider:

• the stage and grade of the cancer (how big it is and how far it has spread)
• your general health
• whether you have experienced the menopause

You should be able to discuss your treatment with your care team at any time and ask questions.

Want to know more?

The online tool Predict helps you see how different treatments for early invasive breast cancer might affect you.

Treatment overview

Surgery is usually the first type of treatment for breast cancer. The type of surgery you have will depend on the type of breast cancer you have.

Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or targeted therapies.

Again, the treatment you’ll have will depend on the type of breast cancer.

Your doctor will discuss the most suitable treatment plan with you. Chemotherapy or hormone therapy will sometimes be the first treatment.

Treatment aims to achieve remission, where cancer shrinks or disappears, and you feel able to enjoy a good quality of life.

Secondary breast cancer

Most breast cancers are discovered at an early stage.

A small proportion of women discover they have breast cancer after it has already spread to other parts of the body (metastasis), and for some women breast cancer may come back after initial treatment.

In these cases, the type of treatment you have may be different. Secondary cancer, also called “advanced” or “metastatic” cancer, is not curable.

Surgery

There are 2 main types of breast cancer surgery:

• breast-conserving surgery, where the cancerous lump (tumour) is removed
• mastectomy, where the whole breast is removed

In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a breast.

Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.

Breast-conserving surgery

Breast-conserving surgery ranges from a lumpectomy or wide local excision, where the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed.

If you have breast-conserving surgery, the amount of breast tissue that is removed will depend on:

• the type of cancer you have
• the size of the tumour and where it is in your breast
• the amount of surrounding tissue that needs to be removed
• the size of your breasts

Your surgeon will always remove an area of healthy breast tissue around the tumour, which will be tested for traces of cancer.

If there’s no cancer present in the healthy tissue, there’s less chance that the cancer will return.

If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.

After having breast-conserving surgery, you’ll usually be offered radiotherapy to destroy any remaining cancer cells.

Mastectomy

A mastectomy is the removal of all the breast tissue, including the nipple.

If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy.

If the cancer has spread to your lymph nodes, you’ll probably need more extensive removal (clearance) of lymph nodes from the area under your arm (axilla).

Reconstruction

Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast.

Reconstruction can be done at the same time as a mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction).

It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.

Lymph node surgery

To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy may be done.

The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They’re part of the lymph nodes under your arms (axillary lymph nodes).

The position of the sentinel lymph nodes varies. They’re identified using either a combination of a radioisotope and a blue dye, or a magnetic liquid (Magtrace).

The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.

If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under your arm.

Radiotherapy

Radiotherapy uses controlled doses of radiation to kill cancer cells. It’s usually given after surgery and chemotherapy to kill any remaining cancer cells.

If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy to give your body a chance to recover.

You’ll probably have radiotherapy sessions 3 to 5 days a week, for 3 to 5 weeks. Each session will last a few minutes.

The types of radiotherapy

The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

Types of radiotherapy include:

• breast radiotherapy – after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
• chest-wall radiotherapy – after a mastectomy, radiotherapy is applied to the chest wall
• breast boost – some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed; however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue (fibrosis)
• radiotherapy to the lymph nodes – where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be in the lymph nodes

The side effects of radiotherapy

Side effects of radiotherapy include:

• irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin
• extreme tiredness (fatigue)
• excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm (lymphoedema)

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medicine to kill cancer cells.

It’s usually used after surgery to destroy any cancer cells that have not been removed. This is called adjuvant chemotherapy.

In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy.

Several different medicines are used in chemotherapy, and 2 to 3 are often given at once.

The choice of medicine and the combination will depend on the type of breast cancer you have and how far it has spread.

Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight.

The medicines are usually given through a drip straight into a vein.

In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 4 weeks and then have a break. Each treatment session is known as a cycle. You may have up to 8 cycles of chemotherapy.

The main side effects of chemotherapy are caused by its influence on normal, healthy cells, such as immune cells.

Side effects of chemotherapy include:

• infections
• loss of appetite
• feeling sick
• being sick
• tiredness
• hair loss
• sore mouth

Many side effects can be prevented or controlled with medicines that your doctor can prescribe.

Chemotherapy medicine can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers.

If you have not experienced the menopause, your periods may stop while you’re having chemotherapy treatment.

After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again.

But this does not always happen and you may enter an early menopause. This is more likely in women over 40, as they’re closer to menopausal age.

Your doctor will discuss with you the impact that treatment will have on your fertility.

Chemotherapy for secondary breast cancer

If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy will not cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life.

Hormone treatment

Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These are known as hormone receptor-positive cancers.

Hormone therapy lowers the levels of oestrogen or progesterone hormones in your body or stops their effects.

The type of hormone therapy you have will depend on the stage and grade of the cancer, which hormone it’s sensitive to, your age, whether you have experienced the menopause, and what other type of treatment you’re having.

You’ll probably have hormone therapy after surgery and chemotherapy, but it’s sometimes given before surgery to shrink a tumour and make it easier to remove.

Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you having surgery, chemotherapy or radiotherapy.

In most cases, you’ll need to take hormone therapy for 5 years or more after having surgery.

If the type of breast cancer you have is not sensitive to hormones, hormone therapy will have no effect.

Tamoxifen

Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. It’s taken every day as a tablet or liquid.

Aromatase inhibitors

If you have experienced the menopause, you may be offered an aromatase inhibitor.

This type of medicine blocks aromatase, a substance that helps the body to produce oestrogen after the menopause. Before the menopause, oestrogen is made by the ovaries.

3 aromatase inhibitors may be offered. These are anastrozole, exemestane and letrozole. These are taken as a tablet once a day.

Ovarian ablation or suppression

In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.

Ovarian ablation or suppression stops the ovaries working and producing oestrogen.

Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.

Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa).

Your periods will stop while you’re taking it, although they should start again once your treatment is complete.

If you’re approaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin.

Goserelin comes as an injection you have once a month.

Targeted therapies

Targeted therapies are medicines that change the way cells work and help to stop cancer from growing and spreading. Not all types of breast cancer can be treated with targeted therapies

The targeted therapy most commonly used to treat breast cancer is trastuzumab (also known by the brand name herceptin).

Other targeted therapies include abemaciclib (brand name Verzenios), and palbociclib (brand name, Ibrance). These are used alongside hormone therapy treatments such as fulvestrant to treat certain types of breast cancer. You may be offered them if the cancer has spread to other parts of your body.

Abemaciclib is also used for primary breast cancer if it’s likely to come back after treatment such as surgery.

Targeted therapies come as tablets or injections or are given through a drip into a vein.

Side effects of targeted therapies include:

• shivering and feeling unwell
• diarrhoea
• feeling and being sick
• headache
• cough
• skin rash

Risk of infection

Some of the medicines used to treat breast cancer can make you more vulnerable to infections. You should contact your care team immediately if you develop possible symptoms of infection, such as:

• a high temperature
• feeling shivery
• you suddenly feel very unwell even though your temperature may be normal

Bisphosphonates

If you have been through the menopause, you may be offered bisphosphonates (zoledronic acid or sodium clodronate).

Recent research has shown they may help to reduce the risk of breast cancer spreading to your bones and elsewhere in your body.

Bisphosphonates will probably be given to you at the same time as chemotherapy, either directly into a vein or as tablets.

Rarely, they can cause kidney problems and osteonecrosis of the jaw (when bone in the jaw dies).

Your doctor will explain the benefits and possible side effects before starting this treatment.

Psychological support

Dealing with cancer can be a huge challenge for you and your family and friends. It can cause emotional and practical difficulties.

Many women with breast cancer will have to cope with the removal of part or all of a breast, which can be very upsetting.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness.

Your hospital doctor, specialist nurse or doctor can refer you to a counselor.

If you’re feeling depressed, talk to a doctor. A course of antidepressants may help, or a doctor can refer you to see a counsellor or psychotherapist.

It can also help to talk to someone who’s been through the same thing as you. Many breast cancer charities have helplines and online forums and staff can also put you in touch with other women who have had cancer treatment.

Clinical trials

A great deal of progress has been made in breast cancer treatment, and more women now live longer and have fewer side effects from treatment.

These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.

All cancer trials  are carefully overseen to ensure they’re worthwhile and conducted safely.

If you’re invited to take part in a trial, you’ll be given information about it and, if you want to take part, you’ll be asked to sign a consent form.

You can refuse or withdraw from a clinical trial without it affecting your care.

Complementary therapies

Complementary therapies are therapies that may help improve physical and emotional wellbeing.

They’re given alongside conventional treatments and include:

• breathing exercises for stress
• massage
• aromatherapy
• acupuncture

Complementary therapies can help some women cope with their diagnosis and treatment, and provide a break from their regular treatment plan.

Your hospital or breast unit may be able to provide access to complementary therapies or suggest where you can get them.

It’s important to speak to your breast cancer specialist nurse about any complementary therapy you wish to try to make sure it does not interfere with your conventional treatment.

Living with brest cancer

Breast cancer can affect your daily life in different ways, depending on what stage it’s at and the treatment you’re receiving.

How women cope with their diagnosis and treatment varies from person to person, but there are several forms of support if you need it. Not all of them work for everybody, but one or more of them should help.

You could:

• talk to your friends and family – they may be a powerful support system
• communicate with other people in the same situation
• find out as much as possible about your condition
• avoid doing too much or overexerting yourself
• make time for yourself

Recovery and follow-up

Recovery

Most women with breast cancer have an operation as part of their treatment. Getting back to normal after surgery can take time. It’s important to give yourself time to recover.

During recovery, avoid lifting things – for example, children or heavy shopping bags – and avoid heavy housework. You may also be advised not to drive.

Some other treatments, particularly radiotherapy and chemotherapy, can make you very tired.

You may need to take a break from some of your normal activities for a while. Do not be afraid to ask for practical help from family and friends.

Follow-up

If you’ve had breast cancer, your healthcare team will agree on a care plan with you after your treatment has finished.

This plan contains the details of your follow-up. You’ll receive a copy of the plan, which will also be sent to your doctor.

Sometimes, breast cancer may come back (recur) after your initial treatment.

It’s important to know and look out for the signs and symptoms that breast cancer has come back. The symptoms can vary depending on where the cancer has spread, but general symptoms may include:

• feeling tired all the time
• feeling sick (nausea) all the time
• unexplained weight loss
• loss of appetite

Speak to your cancer care team or doctor immediately if you have any concerns about:

• any new symptoms, even if you’ve already been diagnosed with secondary breast cancer
• symptoms that do not have an obvious cause
• symptoms that do not go away

You should be offered regular mammograms after your treatment finishes.

Long-term complications

Although it’s rare, your treatment for breast cancer may cause new problems, such as:

• pain and stiffness in your arms and shoulders after surgery, and the skin in these areas may be tight
• a build-up of excess lymph fluid that causes swelling (lymphoedema) – this may occur if surgery or radiotherapy damages the lymphatic drainage system in the armpit

Talk to your healthcare team if you experience these or any other long-term effects of treatment.

Your body and breasts after treatment

Dealing with changes to your body

A diagnosis of breast cancer may change how you think about your body. All women react differently to the physical changes that happen as a result of breast cancer treatment.

Some women react positively, but others find it more difficult to cope. It’s important to give yourself time to come to terms with any changes to your body.

Early menopause

Although most cases of breast cancer occur in women over 50 who have experienced the menopause, some younger women have to cope with an early menopause caused by cancer treatment.

Symptoms can include:

• hot flushes
• vaginal dryness
• loss of sexual desire

Talk to your healthcare team about any symptoms you have.

Prosthesis

An external breast prosthesis is an artificial breast, which can be worn inside your bra to replace the volume of the breast that’s been removed.

Soon after a mastectomy, you’ll be given a lightweight foam breast to wear until the area affected by surgery or radiotherapy has healed.

After it’s healed, you’ll be offered a silicone prosthesis. Prostheses come in many different shapes and sizes, and you should be able to find one that suits you.

Reconstruction

If you did not have immediate breast reconstruction at the time you had a mastectomy, you can have reconstruction later. This is called a delayed reconstruction.

There are 2 main methods of breast reconstruction:

• reconstruction using your own tissue
• reconstruction using an implant

The type that’s most suitable for you will depend on many factors, including the treatment you’ve had, any ongoing treatment, and the size of your breasts. Talk to your healthcare team about which reconstruction is suitable for you.

Relationships and sex

Relationships with friends and family

It’s not always easy to talk about cancer, either for you or your family and friends. You may sense that some people feel awkward around you or avoid you.

Being open about how you feel and what your family and friends can do to help may put them at ease. However, do not be afraid to tell them that you need some time to yourself if that’s what you need.

Your sex life

Breast cancer and its treatment can affect your sex life. It’s common for women to lose interest in sex after breast cancer treatment.

Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer.

You may be upset by the changes to your body, or grieve the loss of your breasts or, in some cases, fertility.

It’s understandable that you may not feel like having sex while coping with all this. Try to share your feelings with your partner.

If you have problems with sex that are not getting better with time, you may want to speak to a counsellor or sex therapist.

Talk to other people

Your doctor or nurse may be able to answer any questions you have about your cancer or treatment.

You may find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your doctor surgery will have information on these.

Some people find it helpful to talk to other people who have breast cancer, either at a local support group or on an internet chatroom.

Prevention

As the causes of breast cancer are not fully understood, it’s not known if it can be prevented altogether.

Some treatments are available to reduce the risk in women who have a higher risk of developing the condition than the general population.

Diet and lifestyle

Regular exercise and eating a healthy, balanced diet are recommended for all women, as they can help prevent many health conditions, including heart disease, diabetes and many forms of cancer.

Studies have looked at the link between breast cancer and diet, and although there are no definite conclusions, there are benefits for women who:

• maintain a healthy weight
• exercise regularly
• have a low intake of saturated fat
• do not drink alcohol

Use our body mass index (BMI) calculator to check if you’re a healthy weight.

It’s also been suggested that regular exercise can reduce your risk of developing breast cancer by almost as much as a third.

If you’ve been through the menopause, it’s particularly important that you’re not overweight or obese. This is because being overweight causes more oestrogen to be produced by your body, which can increase your risk of some types of breast cancer.

Breastfeeding

Studies have shown women who breastfeed are statistically less likely to develop breast cancer than those who do not.

The reasons are not fully understood, but it could be because women do not ovulate as regularly while they’re breastfeeding and oestrogen levels remain stable.

Treatments to reduce your risk

Your level of risk is determined by factors such as your age, your family’s medical history, and the results of genetic tests.

If you have an increased risk of developing breast cancer, treatment is available to reduce your risk.

You’ll usually be referred for specialist genetic testing if it’s thought you have an increased risk of breast cancer. Healthcare professionals at these services should discuss treatment options with you.

The 2 main treatments are surgery to remove the breasts (mastectomy) or medicine.

Mastectomy

A mastectomy is surgery to remove the breasts. It can be used to treat breast cancer and can also reduce the chances of developing the condition in the small number of women who have a high risk.

By removing as much breast tissue as possible, a mastectomy can reduce your risk of breast cancer by up to 90%.

However, like all operations, there’s a risk of complications, and having your breasts removed can have a significant effect on your body image and sexual relationships.

If you want to, you can usually choose to have a breast reconstruction either during the mastectomy operation, or at a later date.

During breast reconstruction surgery, your original breast shape is recreated using either breast implants or tissue from elsewhere in your body.

An alternative is to use breast prostheses. These are artificial breasts that can be worn inside your bra.

An alternative to mastectomy is a nipple-sparing mastectomy, where the whole mammary gland is removed, but the skin of the breast is preserved. This is not widely available at the moment, but it’s being used more often and can achieve excellent results.

Medicine

There are 3 medicines available on the the medical services for women who have an increased risk of breast cancer:

• tamoxifen – for women who either have or have not been through the menopause
• anastrozole – for women who have been through the menopause
• raloxifene – for women who have been through the menopause

These medicines are usually taken once a day for 5 years. They can reduce your risk of breast cancer while you’re taking them and possibly for several years afterwards.

Side effects of these medicines can include:

• hot flushes
• sweating
• feeling sick
• tiredness
• leg cramps

There’s also a small risk of more serious problems, such as weakened bones (osteoporosis), blood clots or womb cancer.

If your doctor suggests taking medicine to reduce your risk of breast cancer, ask them about the benefits and risks of each medicine.