Contents

Introduction 2 Part two –

Treating breast cancer
Part one – Introduction 8
Referral to a breast clinic
After diagnosis 9
Breast clinic appointment 3 Types of breast cancer 9

What to expect 3 Grade and stage of the cancer 11

Mammogram 4 Further tests 11

Ultrasound scan 5 Discussing treatment options 12

Fine needle aspiration cytology Questions you may want to ask 13

(FNAC) and core biopsy 5 The treatment team 14

Further tests 6 Standard treatment for

breast cancer 15
Getting your results 7
Surgery 16

Additional treatments 23
Chemotherapy 23
Radiotherapy 25
Hormone therapy 26
Monoclonal antibodies 28

Younger women 28

Clinical trials 29
Complementary therapies 29
Fatigue 30
After treatment 31
Finding out more 33
Useful addresses 33

Diagnosing and treating breast cancer 1

Introduction
In the UK, breast cancer affects a significant number of
Arab women and a small number of Arab men. This
booklet is about diagnosing and treating breast cancer. It
is divided into two main parts.
The information in the first part is for anyone who has
been referred to see a specialist at a breast clinic. It tells
you what to expect at the clinic and talks about the
different tests you may have. You may be feeling very
worried and anxious at this stage. We hope the booklet
and the CD that goes with it will give you enough
information to be able to talk to your GP (local doctor) or
breast specialist about any questions or concerns you
may have.
The second part of the booklet and CD describe the
range of treatments you may be offered if you have been
diagnosed with breast cancer. We hope the information
in this part will enable you to discuss your treatment fully
with your doctors, and be aware of some of the side
effects that may occur.
Although we refer to ‘women’ throughout the booklet,
most of the information applies also to men who have
been diagnosed with the disease.
2 Diagnosing and treating breast cancer
Part one
Referral to a breast clinic
Breast clinic appointment
Once your GP refers you to a breast clinic you can expect to
wait between two and ten weeks for an appointment.
(Waiting times will vary depending on where you live.) If your
GP feels the referral is urgent you will be seen within two
weeks of the referral letter being sent. Even if you are referred
urgently, it is important to remember that the problem may
still turn out not to be breast cancer.
You may also be referred to the breast clinic if a problem has
been picked up on a routine mammogram (breast x-ray) that
you have had as part of the NHS breast screening
programme. In this case you will be sent a letter asking you
to attend your local breast clinic for further tests.
What to expect
A doctor or specialist nurse experienced in diagnosing and
treating breast problems will see you first. The breast clinic
staff may not all be female but they are all experienced in
dealing with breast conditions and will do their best to ensure
your privacy and dignity. If you have difficulty understanding
English, the breast clinic staff may be able to book an
interpreter for you. It is best to ring before your appointment
3 Diagnosing and treating breast cancer
and ask them to book someone.
The doctor/nurse will ask you about your symptoms. You
may be asked to fill in a short form with questions about
any family history of breast problems and any medicines
you are taking.
This will be followed by a breast examination. The
doctor/nurse will check both your breasts while you are
sitting and when you are lying down. After checking your
breasts, they will usually examine the lymph nodes (glands)
in your armpits.
You may then need to have further tests. These will usually
include a mammogram and/or an ultrasound scan followed
by fine needle aspiration cytology (FNAC) and/or core biopsy.
(See below for more information about these tests.)
The breast examination, mammogram/ultrasound and
FNAC/core biopsy are known as triple assessment.
Sometimes all these tests can be done on your first visit
with the results available later that day. This is known as a
one-stop clinic. In some hospitals this isn’t possible and you
may have to make another appointment for further tests or to
get your results. You may have to wait for about a week for
your test results. This will vary with each breast clinic.
Mammogram
A mammogram is a breast x-ray. The radiographer (expert in
taking breast x-rays) will ask you to undress to the waist and
stand in front of the mammography machine. She or he will
then rest each breast in turn between two x-ray plates so that
it is compressed and flattened. Two images of each breast will
4 Diagnosing and treating breast cancer
be taken so that it can be seen from two different angles.
Some women may find this uncomfortable or even painful,
but it only lasts a few seconds.
Mammograms are usually only done on women over the age
of 35, as younger women’s breast tissue is generally too
dense to produce a good image.
Ultrasound scan
An ultrasound scan uses high-frequency sound waves to
produce an image of the breast. You will be asked to lie on a
couch with your arm above your head. Some gel will be
spread on your breast and a scanning probe will be moved
around it. This is the same technique used to look at babies
in the womb during pregnancy. An ultrasound scan is
painless and only takes a few minutes to do. This is more
suitable for women under the age of 35.
Regardless of age, sometimes an ultrasound scan may be
done as well as a mammogram when there is an area on the
x-ray that needs to be looked at more closely.
Fine needle aspiration cytology (FNAC)
and core biopsy
If a lump or an abnormal area is found a sample will be
taken. This can be a fine needle aspiration (FNAC) or a core
biopsy. Both these tests can be done with or without using
ultrasound for guidance.
5 Diagnosing and treating breast cancer
FNAC

FNAC is where cells are drawn off using a fine needle and
syringe. The sample is then sent to the laboratory where it is
looked at under a microscope. The specialist will use the
result to help decide what further tests or treatments are
needed.
Core biopsy
A core biopsy uses a larger needle to obtain a sample of
tissue. The specialist may take several samples at the same
time. The tissue samples are sent to the laboratory where
they are looked at under the microscope to confirm a
diagnosis.
You will be given a local anaesthetic to numb the area. Once
this wears off you will probably find that your breast aches
and it may also be bruised. You may need to take painkillers if
the area is tender or painful.
Getting your results
It may be a good idea to have another adult with you when
you get your results. That way you can be sure of support if
you need it.
If your results show that you have cancer you may feel all
sorts of emotions such as fear, anger and helplessness, and
you may find it hard to take in what you are being told.
Having someone with you who can listen carefully or ask
questions can be very helpful. You will also be put in contact
with a breast care nurse who will talk to you about your
diagnosis and treatment. Information can help you
understand what is happening. As well as reading this
booklet or listening to the CD that goes with it, you might
find it helpful to call Breast Cancer Care’s helpline and talk in
your own language to a nurse or someone who has had
breast cancer.

Further tests
A triple assessment is usually all that is needed to make a
diagnosis but sometimes you may need further tests. You can
call Breast Cancer Care’s helpline (using an interpreter if you
like) to find out more about any tests you may be having.

6 Diagnosing and treating breast cancer Diagnosing and treating breast cancer 7
 or concerns. If you need an interpreter the hospital should
Part two provide one. Or you can take along a family member or
friend to translate for you. You can also ring our free helpline

Treating breast cancer to get up-to-date information and support from our specially
trained team, using an interpreter if you want to talk in your
own language. They won’t tell you what to do, but they will
help you consider your options and suggest questions you

Introduction may want to take back to your doctors. Similarly, during and
after treatment our helpline team is there to discuss any
concerns you may have.
Breast cancer is not one single disease. There are several types
of breast cancer. It can be found at different stages of
development and can grow at different rates. But having
breast cancer doesn’t automatically mean that you are going After diagnosis
to die.
Once you have been diagnosed with breast cancer, your
It is difficult to predict what course the disease will take and
doctors will discuss your treatment options with you and
what treatment you will have. Factors such as your age and
prepare a treatment plan. The plan will be based on the
your general health will all be considered by your specialists
results of the tests you had when you were being diagnosed
when they are working out the best treatment for you. This
(see page 4).
may involve surgery, chemotherapy, radiotherapy or hormone
therapy, either given alone or in any combination or order.
Types of breast cancer
You will see that we refer throughout the booklet to ‘your
doctors’. This is because it is recommended that breast There are two main types of breast cancer – non-invasive
cancer treatment is carried out by different specialists who cancer and invasive cancer.
work together as a team (see page 14). So it is important that
your GP refers you to a specialist breast unit from the start. Non-invasive cancer
If your local hospital doesn’t have such a complete team of
This means there are cancer cells in your breast tissue that are
specialists you can ask to be referred to a specialist breast unit
growing and dividing abnormally. They are only in the breast
elsewhere.
ducts (milk ducts) or lobules in the breast and have not
Most hospitals have a breast care nurse who is a very spread into the surrounding breast tissue or to other parts
important member of the team. There should be of the body. Some doctors may describe it to you as a
opportunities for you to discuss your treatment options with non-invasive (non-spreading) cancer while others may call it a
the breast care nurse or your doctors, and to raise any issues pre-cancerous condition. These conditions are called DCIS
(ductal carcinoma in situ) and LCIS (lobular carcinoma in situ).

8 Diagnosing and treating breast cancer Diagnosing and treating breast cancer 9
 Invasive cancer
This is what is generally meant by the term ‘breast cancer’.
With invasive cancer, the cancer cells are no longer confined
to the breast ducts or lobules. They have spread to the
surrounding breast tissue and have the potential to spread to
other parts of the body. If you have invasive breast cancer it
doesn’t automatically mean the cancer has or will spread, just
that it could spread.
Grade and stage of the cancer
The cancer cells’ potential to spread is measured by looking
at them under a microscope. This is known as grading. Breast
cancer is graded 1, 2 or 3. In general, a lower grade (1)
means a slower-growing cancer while a higher grade (3)
means a faster-growing cancer.
The extent of the spread of a cancer and the size of a tumour
is known as the stage of the disease. There are different ways
of describing staging so if you want to know more about the
stage of your cancer, ask your specialist to explain it to you.

Lobules Further tests

Further tests may be done to find out more about your
Ducts particular cancer and to help make sure you get the most
Lobular carcinoma
suitable treatment.
in situ (LCIS)

Hormone receptor test

This test is now routinely carried out on the cancer cells after
surgery. It is done to find out whether a cancer is sensitive to
Invasive lobular
carcinoma oestrogen and progesterone (female hormones) in the body.
Ductal carcinoma
If the test result is positive it means that hormone therapy
in situ (DCIS)
may be particularly helpful in preventing the cancer coming
back. (Hormone therapy is explained on page 26.)
Invasive ductal carcinoma
HER2 test

Some breast cancer cells divide and grow when a protein

called human epidermal growth factor attaches to another
protein called HER2 that is found on the surface of breast
cancer cells. Approximately 25 per cent of people with breast
cancer have an increased amount of HER2 protein (known as
HER2 positive breast cancer).

recnac tsaerb gnitaert dna gnisongaiD 11

10 Diagnosing and treating breast cancer
If your cancer is HER2 positive it may respond to drugs called
monoclonal antibodies (see page 28). There are various tests
to measure HER2 levels and national guidance states that all
women with primary breast cancer should have their HER2
levels tested.
Staging tests
If your cancer is a high grade, or if it has affected the lymph
nodes in your armpit, you may have other tests to check that
the cancer hasn’t spread to other parts of the body.
Your doctors or breast care nurse will explain what these tests
are for and what will happen.
Discussing treatment options
Once your doctors have all the information together they will
consider the best treatment for you. This is the point where
you can decide how much, or how little, involvement you
want. Everyone is different. Some women want to know
everything they can about their disease and expect to be fully
involved in making decisions about their treatment. Others
may want to be well informed about what is going on but
are happy to leave the treatment choices to their doctors.
Some may want to know as little as possible and leave all the
decisions to the specialists.
Whatever you decide, you don’t have to be rushed into
treatment. A few extra days to think about what you really
want, and a chance to discuss your options with your
husband, family, friends or GP will make no difference.
12 Diagnosing and treating breast cancer
Questions you may want to ask
You will probably have some questions and you should feel
free to ask for as much information as you feel you need.
Questions might include:
• Why is this the best treatment for me?
• Are there any other options?
• What are the possible side effects?
• Are there any long-term implications for me?
• How will these treatments impact on my everyday life?
• Where will I need to go for these treatments? Will I have to
travel far?
Your specialist team will be able to explain anything you
don’t understand. Breast Cancer Care’s helpline staff can also
talk to you about your proposed treatment, using an
interpreter who speaks your own language if you wish.
They may also be able to put you in touch with a Breast
Cancer Care volunteer who speaks your language and has
had breast cancer.
You don’t have to accept the advice you are offered, but
remember that the treatment recommended to you is the
best option in the opinion of the treatment team. Think
about it carefully and talk it over with other people if you feel
this would help. Take as much time as you need before
making a decision.
Diagnosing and treating breast cancer 13
Asking for a second opinion
You can ask for a second opinion at any stage and this
shouldn’t be a problem. You can either ask your GP or your
current specialist to refer you to another consultant. It is
important to remember that the second opinion may not be
different from the one you have already had. The time taken
to get a second opinion should make no difference to the
outcome of your treatment.
Declining treatment
Very occasionally someone may consider not having any
treatment. This may be because they think the treatment will
do them no good or that it will seriously affect their quality of
life, or they may simply be scared.
Even if you think you don’t want to accept one, or all, of the
treatments being offered, do consider the alternatives
carefully before making a final decision. Breast Cancer Care’s
helpline staff can discuss your options and refer you to other
organisations and sources of information and help.
The treatment team
The specialist team in a breast unit will usually include:
• consultant surgeon
• consultant medical oncologist (cancer drug specialist)
• consultant clinical oncologist (radiotherapy specialist)
• consultant radiologist (specialist in diagnosing disease
through x-rays and scans)
• breast care nurse (trained to give information and support
to anyone diagnosed with breast cancer)
• chemotherapy nurse (trained to give anti-cancer drugs)
14 Diagnosing and treating breast cancer
• consultant histopathologist/cytologist (specialist in analysing
tissue and cells under the microscope)
• diagnostic radiographer (trained to do x-rays and scans)
• therapy radiographer (trained to give radiotherapy
treatment).
You will see several members of the specialist team at
different times during your treatment. Other professionals
may also contribute to your care, such as psychologists,
plastic surgeons, physiotherapists and pharmacists.
Standard treatment for
breast cancer
If non-invasive cancer is not treated it may develop into
invasive cancer. So treatment for non-invasive cancer aims to
stop the cancer developing the ability to spread.
There is no single approach suitable for everyone with
non-invasive cancer. Your treatment will depend on factors
such as the extent of the non-invasive cancer, the grade and
where it is. It is possible for invasive cancer to be present too,
which will also affect the treatment you are offered.
For invasive cancer, treatment aims to:
• remove the cancerous area in the breast and any affected
lymph nodes in the armpit; and
• destroy any cancerous cells that may have already spread
from the breast into your body.
Diagnosing and treating breast cancer 15
 Surgery
Surgery is usually the first treatment for most women with
breast cancer. In some cases chemotherapy or hormone
therapy may be offered first to shrink the tumour so that
surgery can be less extensive. This is called neo-adjuvant
treatment.

Types of operation

There are two main types:

• Breast-conserving surgery. This can range from

lumpectomy or wide local excision (where the tumour is
removed with a small amount of surrounding tissue) to
quadrantectomy (where approximately a quarter of the i¥d´ wF{u± lDÆ Ë√ ¸u∞« W∞«“≈ Íb∏∞« l°¸ W∞«“≈
breast is removed). It is sometimes also called a partial
mastectomy.
• Mastectomy. This is where all breast tissue is removed,
including the nipple. A simple mastectomy means the entire
breast is removed but the lymph nodes and muscles
underneath the breast are not affected. A modified radical
mastectomy means the whole breast is removed together
with some of the lymph nodes in the armpit. Occasionally,
one of the small muscles on the chest wall is also removed.
Some women also have a breast reconstruction at the same
time (see page 19).

For non-invasive cancer (and sometimes invasive cancer)

breast-conserving surgery followed by radiotherapy is often
sufficient treatment. Sometimes a mastectomy is necessary.
Your doctors will explain why they think a particular
treatment is best for you. WDOº° ‰UBµ∑ß« WOKL´ Íb∏K∞ ‰b
Ò F± w´UF® ‰UBµ∑ß«

For invasive cancer it is usually recommended that some or all

of the lymph nodes in the armpit are removed.

16 Diagnosing and treating breast cancer Diagnosing and treating breast cancer 17
Checking the lymph nodes
With invasive cancer it is important for your doctors to find
out whether the cancer has spread to the lymph nodes in
your armpit because this will influence your further treatment.
The number of lymph nodes removed will vary depending on
the practice of your surgeon. There are approximately 20
lymph nodes in the armpit. Either some of them can be
removed (between four and ten) and checked or all of them
can be removed.
There is a new way of checking the lymph nodes called
sentinel node biopsy. It uses radioactive material and
coloured dye to see whether any lymph nodes have been
affected. As surgeons have to be specially trained to use this
technique it is not yet available in all breast units. You can ask
whether it is available in your hospital and whether it is
suitable for you.
Which operation?
One of the first big decisions you may have to make may be
the type of operation you have. You may find it helpful to talk
through your choices with your breast care nurse and discuss
how each might affect you.
Some women will be offered a choice between
breast-conserving surgery and a mastectomy. More than
half of early stage breast cancers can now be treated by
breast-conserving surgery, usually followed by radiotherapy.
Studies show that long-term survival is the same for
breast-conserving surgery followed by radiotherapy as
for mastectomy.
18 Diagnosing and treating breast cancer
The type of breast-conserving surgery you have will be based
on the type of cancer, the size of the tumour, where it is in
the breast and how much surrounding tissue needs to be
removed. It will also depend on how large your breasts are.
The surgeon will want to give you the most effective surgery
as well as the best cosmetic result possible. That means
conserving as much as possible of your breast while
minimising the risk of the cancer coming back.
There are times when the surgeon will have good reasons for
recommending a mastectomy. It can be the better option
when:
• the breast is small and the remaining tissue would look
misshapen after breast-conserving surgery
• the cancer occupies a large area of the breast
• there is more than one area of cancer in the breast
• the tumour is in the centre of the breast or directly behind
the nipple.
Reconstruction
The aim of breast reconstruction is to make a breast that
looks and feels as much like the natural breast as possible. If
you are going to have a mastectomy you will usually be
offered a breast reconstruction, either at the same time or
later on. This will depend partly on the type of breast cancer
you have and any future treatment you may need. If you
prefer to wait a while and see how you feel after surgery,
then tell your specialist. Some women decide later that they
would like to have a reconstruction. Others find that they
become used to living without a breast and wearing a
prosthesis (a false breast shape that fits inside the bra) and
eventually decide against a reconstruction.
Diagnosing and treating breast cancer 19
Reconstruction is major surgery and should be considered
carefully. There are different types of reconstructive surgery
and many issues to consider. You can discuss the details with
the surgeon who is going to do the operation and ask to see
photographs of the operations she or he has done. You might
like to talk it over with your breast care nurse or ask to meet a
woman who has had the same type of reconstruction.
Breast prostheses
If you have a mastectomy and don’t have a reconstruction
you may want to wear a prosthesis. On the NHS you are
entitled to both a temporary and a permanent prosthesis
without having to pay for them. Your breast care nurse, ward
nurse or the hospital’s appliance officer can fit you with a
temporary prosthesis before you go home after surgery. Later
you can choose and be fitted with a permanent prosthesis.
(You should have a choice of different prostheses, including
ones that match your skin colour.)
After your surgery
Everyone reacts differently but the symptoms described here
are very common. For instance, some women feel sick after
their operation. This is due to the anaesthetic and should
pass within a day or two. (If you know anaesthetics make you
sick tell the anaesthetist first as extra anti-sickness drugs can
be given.)
You will probably have wound drains put in during the
operation. These plastic tubes drain blood and fluid away
from the wound into a bottle. The drains will stay in for a few
days then be removed by a nurse. You can walk around and
move quite normally with the drains in.
20 Diagnosing and treating breast cancer
Some people may have pins and needles, burning, numbness
or darting sensations in the chest area and down the arm on
the operated side. This is quite common and can go on for
weeks or even months. The scar may feel tight and tender.
While this lasts you may not be able to wear a bra or
anything that puts pressure on the area. As it becomes less
sensitive you may choose to wear a lightweight prosthesis to
help restore your shape until your scar heals completely. If
you have had breast-conserving surgery you may find it more
comfortable to wear a supportive bra, even in bed at night.
Your arm and shoulder on the operated side are likely to feel
stiff and sore for some weeks. Your breast care nurse, surgeon
or physiotherapist will give you exercises to help you regain
full movement. This is part of the healing process which you
should continue after you go home. If doing the exercises is
painful, painkillers may help. If you have radiotherapy it is
important to continue these exercises in a modified form,
probably for at least two years. You can also get a
poster/booklet from Breast Cancer Care called Exercises
after breast surgery.
Lymphoedema
Surgery to remove some or all of the lymph nodes under
your arm may affect your lymphatic system. It can cause a
blockage that results in a build-up of fluid in the tissue of
your arm. This is called lymphoedema. The risk of
lymphoedema is greater the more lymph nodes you have
removed. Having radiotherapy to the armpit can have a
similar effect.
Diagnosing and treating breast cancer 21
If you notice any swelling of the hand or arm on the affected
side, tell your specialist or breast care nurse as soon as
possible, however trivial it may seem at the time. This can
happen months, or even years, after treatment. You may
reduce your risk of developing lymphoedema by taking
some precautions, such as avoiding scratching or cutting your
hand and arm on the affected side. If possible, avoid having
your blood pressure or blood samples taken from your
affected arm.
22 Diagnosing and treating breast cancer
Additional treatments
Depending on the grade and stage of your cancer (see
page 11), you may need further treatment after your surgery.
This may include chemotherapy, radiotherapy and hormone
therapy or a monoclonal antibody. Your specialist may advise
you to have one or all of these treatments.
Chemotherapy
Chemotherapy treats the whole body with a combination of
anti-cancer drugs. The aim is to destroy cancer cells that may
have spread from the breast into the bloodstream. The drugs
may be given by injection into a vein, a drip or as tablets.
Why
Chemotherapy may be offered to you depending on different
factors, for example your age, your general health and the
grade and stage of your cancer.
When
You are most likely to be given chemotherapy after your
surgery but before radiotherapy, although sometimes it may
be the other way round. In some cases, women may be given
chemotherapy before surgery to try to shrink large tumours,
or if the tumour seems to be growing very fast.
Diagnosing and treating breast cancer 23
What happens
You will usually be given chemotherapy by a specialist
chemotherapy nurse as an outpatient. You receive a course of
drugs every three or four weeks for a specified period.
Side effects
Some women have few side effects from chemotherapy while
others may not be so fortunate. Drugs have different effects
and the same dosage and combination can affect women
quite differently. Mouth ulcers, feeling sick, tiredness,
vomiting and hair loss are some of the more common
side effects.
Some of these side effects can be minimised. For instance,
you can be given drugs to control the sickness and vomiting.
You may be offered a ‘cold cap’ to wear before and during
your treatment to help reduce hair loss. (A cold cap reduces
the blood flow to the hair follicles, which means that the
amount of drugs that reaches the hair follicles is also
reduced.)
Chemotherapy can affect the healthy blood cells, making you
more prone to infections and anaemia (low red blood cells).
This is why you will be given a blood test before each
treatment.
Tell your specialist or chemotherapy nurse about any side
effects you have as they may be able to change the dose or
combination of drugs, or give you drugs to control the side
effects.
24 Diagnosing and treating breast cancer
Radiotherapy
This uses radiation in small doses to destroy cancer cells that
may remain in and around the breast area after surgery.
Why
Radiotherapy is usually recommended after any type of
breast-conserving surgery to reduce the risk of the cancer
coming back in the same breast. It is also sometimes given
after a mastectomy. It may be given to the armpit if some
lymph nodes have been removed and are affected. It will not
usually be given to the armpit if all the lymph nodes have
been removed.
When
Your treatment will usually start a few weeks after your
operation, giving you time to recover from your surgery.
Treatment plans vary but generally you will have to go to the
hospital for radiotherapy each day, usually five days a week
for three to six weeks. It is important not to miss your
appointments but you can ask for a time that suits you, for
example if you have family commitments or are working.
What happens
Before your radiotherapy begins your specialist or
radiographer will explain the treatment, why you are having
it, how it will be done and what your treatment plan will be.
You will then spend some time in a simulator unit where the
radiographer will measure the area to be treated and draw
lines around it so that exactly the same area is treated each
time. These lines are not permanent, so try to keep the skin in
Diagnosing and treating breast cancer 25
that area dry during your treatment. Alternatively, if you Why
agree, the area might be marked with a permanent pinprick
If you have a hormone-sensitive cancer, hormone therapy can
tattoo.
help stop the cancer from coming back.

Short-term side effects

When
Everyone is different, but a common side effect of
Hormone therapy usually starts after surgery. If you are also
radiotherapy is a skin reaction: a change in skin colour,
having chemotherapy it will probably start once this is
itching, soreness or tenderness. The radiotherapy staff will
finished. Sometimes people are given hormone therapy
advise you on how to take care of your skin according to the
before surgery to try to shrink larger tumours.
type of reaction you have.

You may feel extremely tired towards the end of the course of What happens
treatment. This feeling of fatigue is common and can last for
There are several different types of hormone therapy drugs
months, so be kind to yourself and try to ease up on your
and your specialist will consider which is the most suitable.
commitments. Regular exercise such as a daily walk can help
You will usually take the drugs for several years.
with fatigue. See page 30 for more information about fatigue.

Side effects
Long-term side effects
Many women have side effects from hormone treatment.
In the long term, some women may develop lymphoedema
These can include menopausal symptoms such as hot flushes,
(see page 21). Other problems can appear years later because
night sweats and mood swings. Some people gain weight or
of radiation damage to the tissues, nerves or bones, although
have painful joints.
with modern treatment this is rare.
If you are tempted to stop hormone treatment because of
side effects, discuss the situation first with your doctors and
Hormone therapy
your breast care nurse, as there may be another drug that
Some breast cancer cells are stimulated to grow by the suits you better.
hormones oestrogen and progesterone. So a hormone
receptor test is now done routinely after surgery to find out
whether your breast cancer is sensitive to these hormones
(see page 11). If it is positive it means that you may be
offered hormone therapy, which stops the hormones from
stimulating the growth of breast cancer cells.

26 Diagnosing and treating breast cancer Diagnosing and treating breast cancer 27
Monoclonal antibodies
Monoclonal antibodies are a type of breast cancer drug. The
best known of these drugs is Herceptin (trastuzumab). It is
used to treat people with primary or secondary breast cancer
that is HER2 positive. These types of breast cancer tend to
grow faster than ones that are HER2 negative.
Herceptin stops one of the ways that breast cancer cells
divide and grow by sticking to a protein called HER2 on the
surface of the cancer cells. It also helps the body’s immune
system to destroy breast cancer cells. If your breast cancer is
HER2 positive you should, in most cases, be offered Herceptin
to reduce the chances of the breast cancer returning or
spreading.
Younger women
Women who have not reached the menopause when they are
diagnosed with breast cancer often have extra concerns when
making treatment decisions. Uncertainty over fertility, new
relationships, family life and career opportunities may all have
an impact.
Take time to think about what you want, now and in the
future. Only you can decide on the treatment that is right for
you. Your breast care team are there to support you, and
Breast Cancer Care’s helpline staff can also help you discuss
your options, in your own language if you prefer, and refer
you to other sources of information and support.
28 Diagnosing and treating breast cancer
Clinical trials
Researchers are constantly trying to improve breast cancer
treatments. This is why you may be asked to take part in a
clinical trial. Clinical trials are studies to find out the best
treatment for a particular condition. They may be to test new
drugs or other treatments such as types of surgery, varying
doses of radiotherapy and differences between treatments.
You will not be put on a trial without your knowledge and
without giving your informed consent. This means fully
understanding the purpose of the trial, why you are
considered suitable for it and what it will mean for you. You
should be given detailed written information and plenty of
time to discuss your options. If you have been asked to take
part in a trial and you decide not to, don’t feel guilty or
worried that your doctors will treat you differently. You will
continue to have treatment and care as before. The decision
is entirely up to you.
Complementary therapies
Complementary therapies include a wide range of
approaches that can be used as well as standard medical
treatment. The therapies are mainly gentle and natural and
they can have psychological as well as physical benefits. They
can often help people with cancer feel more in control of
their lives.
For example, aromatherapy, shiatsu and other types of gentle
massage can be very relaxing. Prayer or meditation may help
you cope with emotional stress. Acupuncture can be used to
Diagnosing and treating breast cancer 29
ease sickness, pain and tension. Some of these therapies can
also help with menopausal symptoms caused by hormone
therapy.
Always tell your breast care nurse or specialist about any
complementary therapy you want to use to make sure it
doesn’t affect any other treatment you are having.
Fatigue
Fatigue is a common – and perfectly normal – side effect of
treatment. People may feel tired or exhausted some or all of
the time, often without the energy to complete even simple
everyday tasks. Most people get their energy back in six
months to a year after treatment, but for some it can be a
continuing problem.
Fatigue can be very distressing. It can affect your
concentration and make you feel angry, anxious and
frustrated. If fatigue is affecting your life, do talk to your
doctors or breast care nurse as they may be able to help you
manage it. And let family and friends know how you are
feeling and what they can do to help.
You may also find that at least 30 minutes of gentle exercise
three times a week reduces fatigue and improves your sleep
and your general quality of life.
30 Diagnosing and treating breast cancer
After treatment
The end of treatment can be a difficult time. After coping
with the physical and emotional demands of cancer and its
treatment, it may seem a bit of an anticlimax, especially if
you expected to feel relieved and happy it’s all over.
You and the people close to you will be expecting things to
get back to normal. But it may not be easy just to go back to
work or to looking after the family as if nothing had
happened. Some things may have changed, so don’t feel
guilty about taking time to fit back into your old life or adapt
to a different role.
After treatment you will have time to think about what has
happened to you. If there have been permanent changes in
the way you look or feel you’ll probably need to grieve for
what has been lost. It can take a long time to get used to the
changes that have taken place and to adjust to life after
breast cancer treatment. Many people worry about whether
their cancer will come back. It may take time for you to
regain trust in your body, and not to assume that every ache
and pain is the cancer returning.
Some events may be particularly stressful – the days leading
up to your checkups, or finding out that someone you know
has cancer. We all deal with such anxieties in our own way,
and there are no easy answers.
The effects of your breast cancer may continue for many
years, but time may also bring a greater understanding of
what has happened to you. This perspective may mean that
you want to give more time to doing things that are
important to you, like spending time with friends and family
or treating yourself every now and then.
Diagnosing and treating breast cancer 31
As time goes by, breast cancer will no longer be so important
in your everyday life but an experience that has shaped you Finding out more
and your outlook. People do manage to look forward, make
new plans and resume ones that had to be put on hold.
Having breast cancer does change your life. It can have
Useful addresses
positive and negative effects but many people find that they
come through it with a different outlook and a renewed
feeling for life. Cancerbackup
3 Bath Place
If you would like to discuss any concerns during and
Rivington Street
after treatment, or would like more information on any of
London EC2A 3JR
Breast Cancer Care’s services, call our free helpline on
0808 800 6000 (using an interpreter if you want to talk in Office: 020 7696 9003
your own language). Freephone helpline for cancer information in Arabic:
0808 800 0130
Freephone helpline (for cancer information in any language):
0808 800 1234
Email: info@cancerbackup.org
Website: www.cancerbackup.org.uk

Cancerbackup is the leading national information and

support charity for people affected by cancer. Services include
a helpline staffed by specialist cancer information nurses, a
website, cancer information booklets and local information
centres. All Cancerbackup services are free to people affected
by cancer.

Diagnosing and treating breast cancer 33

32 Diagnosing and treating breast cancer
Macmillan Cancer Support Central Office Breast Cancer Care is committed
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also available in Braille on request. Call 020 7384 4629
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2004 uO≤u¥ Íb∏∞« ÊU©dß v{d± W¥U´¸ © Breast Cancer Care Scotland ÊU©dº∞« l± «u®UF∑¥ Ê√ vK´ ”UM∞« b´Uº¢ Macmillan Cancer Support
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34 Íb∏∞« ÊU©dß Ãö´Ë hOªA¢

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?WOKL´ W¥√
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. w∞Ë_« b´UºL∞« ÃöF∞U°
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9 Íb∏∞« ÊU©dß Ÿ«u≤√ 3 Íb∏∞« …œUOF° b´u±
11 ÊU©dº∞« WK•d±Ë W§¸œ 3 :lÆu∑L∞« u≥ U±
11 ‹«¸U∂∑îô« s± b¥e±
4 Mammogram )«d§u±U±( Íb∏∞« WLßd±
12 ÃöF∞« ‹«¸UOî WAÆUM±
WO¢uÅ ‚uH∞« ëu±_U° wFDIL∞« h∫H∞«
13 UNO∞Qº¢ Ê√ s¥b¥d¢ UL°¸ WKµß√ 5 Ultrasound scan )ÊUJß b≤ËUß«d∑∞«(
14 ÃöF∞« o¥d≠ WFO≠¸ …d°S° jHA∞U° U¥öª∞« h∫≠
15 Íb∏∞« ÊU©dº∞ œU∑FL∞« ÃöF∞« Fine needle aspiration cytology

16 W•«dπ∞« tB∫≠Ë wKî«œ ZOº≤ ‰UBµ∑ß«Ë (FNAC)

5 core biopsy U¥dNπ±
23 WO≠U{≈ Ãö´ ‚d©
6 ‹«¸U∂∑îô« s± b¥e±
23 ‹U¥ËULOJ∞U° ÃöF∞«
25 WF®_U° ÃöF∞« 7 pπzU∑≤ vK´ ‰uB∫∞«
26 ‹U≤u±dN∞U° ÃöF∞«
28 oOKª∑∞« W¥œU•√ W¥uO∫∞« ‹«œUCL∞«
28 UÎMß dGÅ_« ‹«bOº∞«
29 WOJOMOKØ »¸Uπ¢
29 WOKOLJ¢ Ãö´ ‚d©
30 VF∑∞«Ë ‚U≥¸ùU° ¸uFA∞«
31 ÃöF∞« bF° U±
33 b¥eL∞« W≠dF±
33 …bOH± s¥ËUM´

1 Íb∏∞« ÊU©dß Ãö´Ë hOªA¢