Breast Cancer in Females

Breast cancer is the most common type of cancer.

Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men can also get breast cancer.

If it’s treated early enough, breast cancer can be prevented from spreading to other parts of the body.

The breasts

The breasts are made up of fat, connective tissue and thousands of tiny glands called lobules, which produce milk. When a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed.

The body is made up of billions of tiny cells, which usually grow and multiply in an orderly way. New cells are only produced when and where they’re needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably.

Symptoms of breast cancer

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

Most breast lumps aren’t cancerous, but it’s always best to have them checked by your doctor. You should also speak to your GP if you notice any of the following:

• 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 alone isn’t a symptom of breast cancer.

After examining your breasts, your GP or Gynecologist may refer you to a specialist breast cancer clinic for further tests. This might include a mammography (breast screening) or a biopsy.

Types of breast cancer

There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types.

Non-invasive breast cancer

Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasn’t developed the ability to spread outside the breast.

This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS).

Invasive breast cancer

Invasive cancer has the ability to spread outside the breast, although this doesn’t necessarily mean it has spread.

The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of all breast cancer cases and is sometimes called ‘no special type’.

Other types of breast cancer

Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Paget’s disease of the breast.

It’s possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, it’s known as ‘secondary’ or ‘metastatic’ breast cancer.

Breast cancer screening

There’s a good chance of recovery if breast cancer is detected in its early stages. For this reason, it’s vital that women check their breasts regularly for any changes and always get any changes examined by their GP or Gynecologist.

Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion. 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.

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

 

Treating breast cancer

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

Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy. Surgery is usually the first type of treatment you’ll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments.

The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will 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 (metastasis). Secondary cancer, also called advanced or metastatic cancer, isn’t curable, so the aim of treatment is to achieve remission (symptom relief).

Preventing breast cancer

As the causes of breast cancer aren’t fully understood, it’s not possible to know if it can be prevented altogether.

If you’re at increased risk of developing the condition, some treatments are available to reduce the risk.

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 and who have a low intake of saturated fat and alcohol.

It’s been suggested that regular exercise can reduce your risk of breast cancer by 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 or obese causes more oestrogen to be produced, which can increase the risk of breast cancer.

Living with breast cancer

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

How women cope with their diagnosis and treatment varies from person to person. You can be reassured that there are several forms of support available, if you need it. For example:

• your family and friends can be a powerful support system
• you can communicate with other people in the same situation
• find out as much as possible about your condition
• don’t try to do too much or overexert yourself
• make time for yourself

Symptoms of breast cancer

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

Most breast lumps (90%) aren’t cancerous, but it’s always best to have them checked by your doctor.

You should speak to your GP if you notice any of the following:

• a lump or area of thickened tissue in either breast
• 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 alone isn’t a symptom of breast cancer.

Breast awareness

It’s important to be breast aware, so you can pick up 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 much easier to spot potential problems.

Causes and risk factors of breast cancer

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

However, there are risk factors that are known to affect your likelihood of developing breast cancer. Some of these you can’t 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 among women over 50 who have been through the menopause. About 8 out of 10 cases of breast cancer occur in women over 50.

All women who are 50 to 70 years of age should be screened for breast cancer every 3 years. 

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 aren’t hereditary (they don’t run in families), but particular 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. A third gene (TP53) is also associated with an increased risk of breast cancer.

If you have, for example, 2 or more close relatives from the same side of your family, such as your mother, sister or daughter, who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If you’re worried about your family history of breast cancer, discuss it with your GP.

Previous diagnosis of breast cancer

If you’ve 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 again.

Previous benign breast lump

A benign breast lump doesn’t mean you have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely.

Breast density

Your breasts are made up of thousands of tiny glands (lobules), which 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 because there are more cells that can become cancerous.

Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes any lumps or areas of abnormal tissue harder to spot. 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.

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 your periods at a young age and experienced the menopause at a late age, you’ll 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 uninterrupted by pregnancy.

Being overweight or obese

If you’ve 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, because being overweight or obese after the menopause causes more oestrogen to be produced.

Being tall

If you’re taller than average, you’re more likely to develop breast cancer than someone who’s shorter than average. The reason for this isn’t fully understood, but it may be due to interactions between genes, nutrition and hormones.

Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink. 

Radiation

Certain medical procedures that use radiation, like X-rays and computerized tomography (CT) scans, may slightly increase your risk of developing breast cancer.

If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. Speak to your GP if you weren’t contacted, or if you didn’t attend a consultation.

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

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT.

Diagnosing breast cancer

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

What to expect at the breast clinic

The tests you’ll receive at the breast clinic depend on your current symptoms, your age, and the results of the initial examination you’ll have when you arrive. Many people don’t need any further tests after the initial examination.

Most of the time you can expect to spend up to 2 hours at the breast clinic.

Mammogram and breast ultrasound

If you have symptoms and have been referred by your GP, you’ll meet a specialist who’ll examine you to determine if you need further tests. 

If you’re under 40 years of age, the specialist may suggest you only have a breast ultrasound scan. This is because younger women have denser breasts, which means a mammogram isn’t as effective as an ultrasound for diagnosing breast disease.

If you have a mammogram, it will produce an X-ray of your breasts. You may also need an ultrasound scan.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid.

Biopsy

A biopsy is where a sample of tissue 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. Different methods of carrying out a biopsy are discussed below.

Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue.

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’ll 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, but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS).

Vacuum-assisted biopsy, also known as a 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 to work out the best method of treatment.  

Scans and X-rays

Computerised tomography (CT) scans, or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to your lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of the condition within the breast.

If your doctor thinks that 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, which is carried out using a special camera.

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 best to treat it. The types of test you could be offered are discussed below.

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 cancer can be diagnosed using a HER2 test, and treated with medication to block the effects of HER2. This is known as ‘biological’ or ‘targeted’ therapy.

Stage and grade of breast cancer

Stage of breast cancer

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

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

• stage 1 – the tumour measures less than 2cm, the lymph nodes in the armpit aren’t affected, and there are no signs that the cancer has spread elsewhere in the body
• stage 2 – the tumour measures 2 to 5cm or the lymph nodes in the armpit are affected, or both, and 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, the lymph nodes in the armpit are affected but 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, ask 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 describes the size of the tumour, N describes whether cancer has spread to the lymph nodes, and M gives an indication of whether the cancer has spread to other parts of the body.

Grade 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

Treating breast cancer

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

Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment you’ll have will depend on your 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.

Secondary breast cancer

Most breast cancers are discovered in the condition’s early stages. However, a small proportion of women discover that they have breast cancer after it’s spread to other parts of the body (known as metastasis).

If this is the case, the type of treatment you have may be different. Secondary cancer, also called ‘advanced’ or ‘metastatic’ cancer, isn’t curable and treatment aims to achieve remission (where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full).

Surgery

There are 2 main types of breast cancer surgery. They are:

• surgery to remove the cancerous lump (tumour), known as breast-conserving surgery
• surgery to remove the whole breast, which is called a mastectomy

In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a bulge to replace the breast that was removed.

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 just 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 you have removed will depend on the:

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

Your surgeon will always remove an area of healthy breast tissue around the cancer, 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 reoccur. 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 will 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 will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).

Reconstruction

Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out 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 carried out.

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 the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they’re identified using a combination of a radioisotope and a blue dye.

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 the 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 6 weeks. Each session will only last a few minutes.

The type of radiotherapy you have will depend on your cancer and surgery type. Some women may not need to have radiotherapy at all. The types available are: 

• 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, the boost may affect the appearance of the breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of the 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 present in the lymph nodes

The side effects of radiotherapy include:

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

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medication to kill the cancer cells. It’s usually used after surgery to destroy any cancer cells that haven’t 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 medications are used for chemotherapy and three are often given at once. The choice of medication and the combination will depend on the type of breast cancer you have and how much it’s spread.

Chemotherapy is usually given as an outpatient treatment, which means you won’t have to stay in hospital overnight. The medications are usually given through a drip straight into the blood through 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 3 weeks, over a period of 4 to 8 months, to give your body a rest in between treatments.

The main side effects of chemotherapy are caused by their influence on normal, healthy cells, such as immune cells. Side effects include:

• infections
• loss of appetite
• nausea and vomiting
• tiredness
• hair loss
• sore mouth

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

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

If you haven’t experienced the menopause, your periods may stop while you’re undergoing chemotherapy treatment. After you’ve finished the course of chemotherapy, your ovaries should start producing oestrogen again.

However, this doesn’t always happen and you may enter an early menopause. This is more likely in women over 40 years old, because they’re closer to menopausal age. Your doctor will discuss with you the impact that any 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 won’t 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 types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects.

The type of hormone therapy you’ll have will depend on the stage and grade of your cancer, which hormone it’s sensitive to, your age, whether you’ve 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, making it easier to remove.

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

In most cases, you’ll need to take hormone therapy for up to five years after having surgery. If your breast cancer isn’t 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. It can cause several side effects, including:

• tiredness
• changes to your periods
• nausea and vomiting
• hot flushes
• aching joints
• headaches 
• weight gain

Aromatase inhibitors

If you’ve experienced the menopause, you may be offered an aromatase inhibitor. This type of medication works by blocking aromatase, a substance that helps produce oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries.

Three aromatase inhibitors may be offered. These are anastrozole, exemestane and letrozole. These are taken as a tablet once a day. Side effects include:

• hot flushes and sweats
• lack of interest in sex (loss of libido)
• nausea and vomiting
• tiredness
• aching joints and bone pain
• headaches
• skin rashes

Ovarian ablation or suppression

In women who haven’t experienced the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries working and producing oestrogen.

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

Ovarian suppression involves using a medication 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 is taken as an injection once a month and can cause menopausal side effects, including:

• hot flushes and sweats
• mood swings
• trouble sleeping

Biological therapy (targeted therapy)

Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells.

If you have high levels of the HER2 protein and are able to have biological therapy, you’ll probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin, is usually used after chemotherapy.

Trastuzumab

Trastuzumab is a type of biological therapy known as a monoclonal antibody. Antibodies occur naturally in your body and are made by your immune system to destroy harmful cells, such as viruses and bacteria. The trastuzumab antibody targets and destroys cancer cells that are HER2-positive.

Trastuzumab is usually given intravenously, through a drip. It’s also sometimes available as an injection under the skin (a subcutaneous injection).

You will have the treatment in hospital. Each treatment session takes up to one hour and the number of sessions you need will depend on whether you have early or more advanced breast cancer. On average, you’ll need a session once every three weeks for early breast cancer, and weekly sessions if your cancer is more advanced.

Trastuzumab can cause side effects, including heart problems. This means that it’s not suitable if you have a heart problem, such as angina, uncontrolled high blood pressure (hypertension) or heart valve disease. If you need to take trastuzumab, you’ll have regular tests on your heart to make sure it’s not causing any problems.

Other side effects of trastuzumab may include:

• an initial allergic reaction to the medication, which can cause nausea, wheezing, chills and fever
• diarrhea
• tiredness
• aches and pains

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 in the UK are carefully overseen to ensure they’re worthwhile and safely conducted. In fact, participants in clinical trials can do better overall than those in routine care.

If you’re asked to take part in a trial, you’ll be given an information sheet 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.

Psychological help

Dealing with cancer can be a huge challenge, for both patients and their families. It can cause emotional and practical difficulties. Many women 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.

There are various ways to find help and support. Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you’re feeling depressed, talk to your GP. A course of antidepressant drugs may help, or your GP can arrange for you to see a counsellor or psychotherapist.

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

Complementary therapies

Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. They’re given alongside conventional treatments and include relaxation techniques, massage, aromatherapy and acupuncture.

Complementary therapy can help some women cope with diagnosis and treatment, and provide a break from the 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 use, to make sure it doesn’t interfere with your conventional treatment.

 

Living with breast cancer

Recovery

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

During this time, 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. Don’t be afraid to ask for practical help from family and friends.

Follow-up

After your treatment has finished, you’ll be invited for regular check-ups, usually every 3 months for the first year.

If you’ve had early breast cancer, your healthcare team will agree a care plan with you after your treatment has finished. This plan contains the details of your follow-up. You will receive a copy of the plan, which will also be sent to your GP.

During the check-up, your doctor will examine you and may carry out blood tests or X-rays to see how your cancer is responding to treatment. You should also be offered a mammogram every year for the first 5 years after your treatment.

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 may occur after surgery, and the skin in these areas may be tight
• lymphoedema (a build-up of excess lymph fluid which causes swelling) – 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 bodily 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 early menopause brought on by cancer treatment.

Symptoms can include hot flushes, vaginal dryness and loss of sexual desire. Talk to your healthcare team about any symptoms you have and they’ll be able to help.

Prosthesis

A breast prosthesis is an artificial breast, which can be worn inside your bra to replace 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 didn’t have immediate breast reconstruction (carried out at the time of 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 and 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 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, don’t 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, your 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 aren’t getting better with time, you may want to speak to a counsellor or sex therapist.

Talk to other people

Your GP 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 to someone at a specialist helpline. Your GP surgery will have information on these.

Preventing breast cancer

As the causes of breast cancer aren’t 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 a healthy, balanced diet are recommended for all women because they can help prevent many conditions, including heart disease, diabetes and many forms of cancer.

Regular exercise can reduce your risk of developing breast cancer. If you have been through the menopause, it’s particularly important that you’re not overweight or obese. This is because these conditions cause more oestrogen to be produced, which can increase the risk of breast cancer.

Breastfeeding

Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who don’t. The reasons aren’t fully understood, but it could be because women don’t ovulate as regularly while they’re breastfeeding and oestrogen levels remain stable.

Treatments to reduce your risk

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

You will usually be referred to a specialist genetics service if it’s thought you have an increased risk of breast cancer. Healthcare professionals working at these services should discuss treatment options with you.

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

Mastectomy

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

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 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.

Medication

Either tamoxifen or raloxifene can be used in women who’ve been through the menopause, but only tamoxifen should be used in women who haven’t.

These medications may not be suitable if in the past you’ve had blood clots or womb cancer, or if you have an increased risk of developing these problems in the future.

Women who’ve already had a mastectomy to remove both breasts won’t be offered these medications, because their risk of developing breast cancer is very small.

A course of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for 5 years.

Raloxifene can cause side effects including flu-like symptoms, hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats, changes to your periods, and nausea and vomiting.

Your chances of giving birth to a child with birth defects increase while you’re taking tamoxifen, so you’ll be advised to stop taking it at least 2 months before trying for a baby. The medication can also increase your risk of blood clots, so you should stop taking it 6 weeks before having any planned surgery.

Tamoxifen and raloxifene aren’t currently licensed for the purpose of reducing the risk of breast cancer in women with an increased risk of developing the condition. However, they can still be used if you understand the benefits and risks, and your doctor believes the treatment will be helpful.