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Breast cancer
This fact sheet gives information about the diagnosis and treatment of breast cancer. Breast cancer can affect both women and men. This fact sheet is aimed mainly at women, as very few cases of breast cancer occur in men. However, the treatments used are the same. We also have fact sheets in your language about surgery, chemotherapy and radiotherapy. We hope this fact sheet answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment Throughout the fact sheet we may refer to other booklets and information that is available from Macmillan. Unfortunately, most of these are currently only available in English. However, if youd like to discuss this information with our cancer support specialists, interpreters are available for non-English speakers. Call the Macmillan Support Line free on 0808 808 00 00, MondayFriday, 9am8pm. If youre hard of hearing you can use textphone 0808 808 0121, or Text Relay. Alternatively, visit macmillan.org.uk Includes the following information

The breasts What is breast cancer? What causes breast cancer? What are the symptoms? How is breast cancer diagnosed? Staging and grading breast cancer Receptors Types of treatment Follow-up Research clinical trials Your feelings Related Macmillan information
The breasts
The breasts are made up of fat, supportive (connective) tissue and glandular tissue that contains lobes. The lobes (milk glands) are where breast milk is produced. These are connected to the nipple by a network of milk ducts. Its common for a womans breasts to be a different size or shape from each other. They also change throughout a womans life and often feel different at different times in the month because of hormonal changes. For example, just before a period they may feel lumpy. As a woman gets older, her breasts may become smaller and feel softer.

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Under the skin, an area of breast tissue extends into the armpit (axilla). The armpits also contain a collection of lymph nodes (glands), which are part of the lymphatic system. There are also lymph nodes just beside the breastbone and behind the collarbones. The lymph nodes throughout the body are connected by a network of tiny lymphatic tubes (ducts). Lymph fluid flows through the lymphatic system. It contains cells called lymphocytes, which are part of the bodys natural defence against infection and disease.

the body. They can spread through the bloodstream or lymphatic system. When these cells reach a new area they may go on dividing and form a new tumour. The new tumour is often called a secondary or metastasis. Breast cancer occurs when cells within the breast ducts and lobules become cancerous. If caught at an early stage, breast cancer can often be cured. If the cancer has spread to other areas of the body it cant usually be cured, but it can normally be effectively controlled for a long time.

What is breast cancer?


The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells. Although cells in each part of the body may look and work differently, most repair and reproduce themselves in the same way. Normally, cells divide in an orderly and controlled way. But if for some reason the process gets out of control, the cells carry on dividing and develop into a lump called a tumour. Breast tumours are usually caused by an overgrowth of the cells lining the breast ducts. They can be either benign or malignant. In a benign tumour, the cells grow abnormally and form a lump. But they dont spread to other parts of the body and so are not cancer. The most common type of benign breast tumour is called a fibroadenoma. This may need to be surgically removed to confirm the diagnosis. No other treatment is necessary. In a malignant tumour, the cancer cells have the ability to spread beyond the breast if they are left untreated. For example, if a malignant tumour in the breast isnt treated, it may grow into the muscles that lie under the breast. It can also grow into the skin covering the breast. Sometimes cells break away from the original (primary) cancer and spread to other organs in

What causes breast cancer?


The causes of breast cancer are unknown. But certain things called risk factors can increase a womans chances of getting breast cancer. Some women do seem to be at a higher risk of developing the disease. But having risk factors doesnt necessarily mean you will get breast cancer. Some women get it, while others (with the same risk factors) dont. Here we explain some of the known breast cancer risk factors:
Age The risk of developing breast cancer increases with age. Its rare in women under 35. 8 out of 10 breast cancers (80%) occur in women aged 50 or over. Previous cancer and other breast conditions Women whove had breast cancer or other breast conditions in the past may be at a higher risk of developing breast cancer. This includes women whove previously had: breast cancer, including ductal carcinoma in situ lobular carcinoma in situ an over-production of slightly abnormal cells called atypical ductal hyperplasia radiotherapy to the chest to treat Hodgkin lymphoma at a young age dense breast tissue (when the breast is made up of glandular and connective tissue with very little fatty tissue).

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Hormonal factors Exposure to the hormones oestrogen and progesterone for long, uninterrupted periods can affect your breast cancer risk. Factors that increase this risk include: taking combined hormone replacement therapy (HRT) containing oestrogen and progesterone over several years (if youre over 50) not having children or having them later in life not having breastfed or breastfeeding for less than a year starting your periods early (under 12) or having a late menopause (after 50) taking the contraceptive pill (but the risk reduces if you stop taking it). Certain lifestyle factors may also increase your risk of breast cancer. These include drinking more than two units of alcohol a day over many years, being overweight and smoking heavily. Genetic factors (family history) Only 510% (1 in 201 in 10) of breast cancers are thought to be linked to an inherited breast cancer gene. The genes most commonly linked to an increased risk of breast cancer in families are BRCA1 and BRCA2. If you have one relative who was diagnosed with breast cancer at an older age, its not likely that the cancer is due to an inherited breast cancer gene.

there is a close relative with breast

cancer and another relative on the same side of the family with ovarian cancer.

Close relatives, sometimes called your first degree relatives, are parents, children, sisters and brothers. If you have any of the above in your family, talk to your GP. Depending on your family history and degree of risk, your GP may refer you to a family cancer clinic. Our booklet Cancer genetics how cancer sometimes runs in families, has more information. There is no evidence that damage to the breast (such as a knock) causes cancer. Breast cancer is not infectious and cant be passed on to other people.
What are the symptoms?

Symptoms of breast cancer can include: a lump in the breast a change in the size or shape of the breast dimpling of the skin or thickening in the breast tissue a nipple thats turned in (inverted) a rash (like eczema) on the nipple discharge from the nipple swelling or a lump in the armpit.
If you have any of these symptoms, get them checked by your GP.

An inherited genetic change (known as a mutation) that increases the risk of breast cancer is only likely to be present if: there are three close relatives on the same side of the family who developed breast cancer at any age there are two close relatives on the same side of the family who developed breast cancer at the age of 60 there is one close relative who developed breast cancer under the age of 40 there is a close male relative with breast cancer there is a close relative with cancer in both breasts

How is breast cancer diagnosed?


Most people begin by seeing their family doctor (GP). They will refer you to a breast clinic to see a breast specialist. You should receive an appointment for the breast clinic within two weeks. Some women are referred through the breast screening programme because there are changes on their mammogram (see next page).

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At the breast clinic Many hospitals have a special one stop breast clinic, which usually means you can have tests and get the results on the same day. However, sometimes you may need to come back for further tests and wait up to a week for the results.

At the clinic youll be seen by a breast specialist (a surgeon). Youll usually be asked if youve had previous breast problems or if theres a history of breast cancer in your family. The specialist will examine your breasts and the lymph nodes in your armpits. They will then explain which tests you need. Women usually have a mammogram and an ultrasound scan, followed by a fine needle aspiration and/or a needle (core) biopsy.
A mammogram is a low-dose x-ray of the breast.

Youll be asked to take off your top and bra, and to lie down on a couch with your arm above your head. The person doing the ultrasound scan puts gel onto your breast and moves a small hand-held device around it. A picture of the inside of the breast shows up on screen. An ultrasound only takes a few minutes and is painless.
Fine needle aspiration (FNA) This is a quick and simple procedure carried out in the x-ray department. The doctor uses x-ray or ultrasound guidance to make sure the cells are taken from the right area. Using a fine needle, your doctor withdraws some cells from the lump into a syringe. The sample is then sent to the laboratory to check for cancer cells.

Before the mammogram, youll be asked to take off your top and bra and be given a gown to wear. The radiographer (who takes the x-ray) will position you so your breast is against the x-ray machine. Your breast is then flattened and compressed with a flat, clear, plastic plate, which keeps the breast still to get a clear picture. This can be uncomfortable and a little painful, but doesnt last long. Youll have two mammograms of each breast taken from different angles. Mammograms are usually only done in women over 40. Breast tissue is denser in younger women, which makes it harder to get a good picture and see any changes. Some breast units now use digital mammography. The image is taken electronically and then stored on a computer in digital form. A breast ultrasound uses sound waves to build up a picture of the breast. It can tell whether a lump is a solid (made of cells) or fluid-filled cyst. An ultrasound is more useful than a mammogram in women under 40.

It can be a bit uncomfortable when the needle goes in, but its usually over quickly. Your results may be ready on the same day. You may feel a bit bruised and sore for a few days afterwards taking some mild painkillers should ease this.
Ultrasound and FNA of the lymph nodes Youll also have an ultrasound of the lymph nodes in the armpit. If any of the nodes feel swollen or look abnormal on the ultrasound, the doctor will do an FNA on the node or nodes. Biopsy This is when a small piece of tissue is removed from the lump or abnormal area and examined under a microscope. There are different types of biopsy (see next page) your surgeon or breast care nurse will explain which type youll have. After a biopsy your breast can be bruised and feel sore for a few days. You can take painkillers until it eases and any bruising should go away within a couple of weeks. Needle (core) biopsy The doctor uses a needle to take a small piece of tissue from the lump or abnormal area. First, they will inject some local anaesthetic into the area to numb it. You may feel a little pain or a sensation of pressure for a short time

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during the biopsy. Several biopsies can be taken at the same time.
Excision biopsy Occasionally, the whole lump is removed under a general or local anaesthetic, depending on its size. If the lump is too small to be felt but has shown up on a mammogram or ultrasound, the radiologist may need to identify the area for the surgeon before the biopsy. This is done using wire localisation (see below). Vacuum-assisted biopsy (VAB) A special vacuum-assisted technique is sometimes used to take a biopsy. If you need this type of biopsy, your doctors will explain the procedure to you. Wire localisation Sometimes a very small wire is guided into the area using x-ray or ultrasound. It marks the exact area that needs to be biopsied by the surgeon. Afterwards, its removed and the cut is covered with a small dressing (no stitches are needed). Further tests If breast cancer is confirmed then you may have some of the following tests to prepare for an operation or check the stage of the cancer. Blood tests Youll have blood taken to check your general health, the number of cells in your blood (blood count) and how well your kidneys and liver are working. Occasionally, a blood test may be used to check whether the breast cancer cells are producing certain chemicals (tumour markers). But this isnt usually done. Chest x-ray This is to make sure your lungs are healthy before your operation. MRI (magnetic resonance imaging) scan This test uses magnetism to build up a detailed picture of areas of your body.

including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. Its painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. Its also noisy, but youll be given earplugs or headphones.
CT (computerised tomography) scan A CT scan takes a series of x-rays, which builds up a three-dimensional picture of the inside of the body. The scan takes 1030 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

Waiting for test results can be an anxious time for you. It may help to talk about your worries with a partner, relative, close friend or counsellor. You could also speak to one of our cancer support specialists on 0808 808 00 00.

Staging and grading breast cancer


Your breast specialist needs certain information about your cancer to help decide on the most appropriate treatment for you. This includes the stage and grade of your cancer.
Staging Breast cancer can be divided into four number stages, which measure the size of the cancer (lump) and whether its spread to the lymph nodes or another part of the body. Ductal carcinoma in situ (DCIS) This is the earliest form of breast cancer. In DCIS, cancer cells are in the ducts of the breast, but they havent started to spread into the surrounding breast tissue. DCIS shows up on a mammogram and is usually

Before the scan you may be asked to complete and sign a checklist. This is to make sure that its safe for you to have an MRI scan. Before having the scan, youll be asked to remove any metal belongings,

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diagnosed when women go for breast screening. We have separate information about DCIS.
Stage 1 The cancer (lump) is smaller than, or equal to, 2cm and has not spread to the lymph nodes in the armpit. Stage 2 is divided into two stages: Stage 2A Either the lump is smaller than 2cm and has spread to lymph nodes in the armpit OR its bigger than 2cm (but under 5cm) and hasnt spread to the lymph nodes OR the cancer cant be found in the breast but is in the lymph nodes in the armpit. Stage 2B Either the lump is smaller than 5cm and has spread to the lymph nodes in the armpit OR its bigger than 5cm but hasnt spread to the lymph nodes in the armpit. Stage 3 is divided into three stages: Stage 3A Either the cancer cant be found in the breast or the lump is under 5cm and the cancer is in the lymph nodes in the armpit, which are stuck together OR the lump is bigger than 5cm and has spread to the lymph nodes. Stage 3B The cancer has spread to tissue near the breast and may be attached to surrounding skin or muscle. There are usually cancer cells in the lymph nodes in the armpit as well. Stage 3C The cancer has spread to lymph nodes in the armpit, below the breastbone, near the neck or under the collarbone. Stage 4 The cancer has spread to other parts of the body such as the bones, liver or lungs. This is called secondary or metastatic breast cancer.

Grading Grading refers to how the cancer cells look under the microscope compared with normal breast cells. Grade 1 (low-grade) The cancer cells look similar to normal cells and grow very slowly. Grade 2 (moderate- or intermediategrade) The cancer cells look more abnormal and are slightly faster growing. Grade 3 (high-grade) The cancer cells look very different from normal cells and tend to grow quickly.

Receptors
Some breast cancer cells have receptors, which allow particular types of hormones or proteins to attach to the cancer cell. The pathologist examines the tissue thats been removed during surgery and carries out tests for hormone or protein receptors on it.
Hormone receptors Some breast cancers have receptors for the hormones oestrogen and progesterone. If there are a significant number of oestrogen receptors, its known as oestrogenreceptor positive or ER positive breast cancer. If not, its known as oestrogenreceptor negative or ER negative breast cancer. The term ER is used because the American spelling of oestrogen is estrogen.

ER positive breast cancers respond well to hormonal treatments (see page 10). About 70% (7 in 10) of breast cancers are ER positive.
Protein receptors Some breast cancers have receptors for the protein HER2 (human epidermal growth factor 2). Cancers that have high levels of these receptors are called HER2 positive breast cancers. They respond well to treatment with trastuzumab, which is commonly called Herceptin (see page 11).

This fact sheet is about stage 13 breast cancer. If you have stage 4 breast cancer, you may find our booklet about secondary breast cancer helpful.

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Types of treatment
The treatment of breast cancer depends on many factors. These include the stage and grade of the cancer, your age, whether or not you have had the menopause (change of life) and whether the cancer cells have hormone or protein receptors. Surgery, radiotherapy, hormonal therapy and chemotherapy may be used to treat breast cancer. Usually, more than one type of treatment is used. Its important to discuss any treatment fully with your doctor, so that you understand what it involves. Its a good idea to take someone with you who can speak both your language and English. Interpreters may be available if you need one, but try to let the hospital know in advance if you would like one present. You might also be introduced to a breast care nurse (sometimes known as a clinical nurse specialist) who can talk to you in detail about treatment as well as help with any problems you may have in between appointments. You will be asked to sign a consent form to show that you understand and agree to the treatment. Consent forms should be available written in your language. Remember, no treatment will be given without your consent. Surgery Surgery is often used to remove the cancer and an area of healthy cells all around the cancer. Sometimes the whole breast may need to be removed (mastectomy) and sometimes just the cancer may be removed (lumpectomy). If you have a lumpectomy, you will usually be advised to have radiotherapy to the remaining breast tissue afterwards. You may also need to have radiotherapy after a mastectomy. Research has shown that in early breast cancer a lumpectomy followed by

radiotherapy is as effective at curing the cancer as a mastectomy. You may be asked to choose the treatment which suits you best. The different treatments have different benefits and side effects, so this can be a difficult decision to make. To help you make the decision you may want to discuss both options fully with your doctor, breast care nurse or our cancer support specialists. This can help you feel confident that youve made the right decision for you. Its often possible for women who have had a mastectomy to have their breast reconstructed. This involves making a new breast shape using either an implant or fat and muscle from another part of your body. Sometimes this is done at the same time as the mastectomy. It can also be done some months, or even years, after the original operation. There are several different methods of breast reconstruction and your surgeon can discuss the different options that may be suitable for you. If youd like to consider breast reconstruction, discuss it with your doctor at the beginning of your treatment so they can tell you about the different methods available. After a mastectomy, youll be given an artificial breast made of lightweight foam, which you can put inside your bra. This is sometimes called a cumfie. Its designed to be worn immediately after the operation when the area feels tender. When your wound has fully healed, youll be fitted with a permanent prosthesis (false breast). Theyre made of soft plastic (silicone). Several types of prosthesis are available on the NHS. Prostheses are also available to match different types of skin colour.
Checking the lymph nodes As part of any operation for breast cancer, the surgeon will usually remove lymph nodes to check if there is cancer in them. Theyre taken from under your arm on the side of the cancer. There are approximately 20 lymph nodes in the armpit (axilla), although the exact number varies from person to person. The lymph nodes are examined under a

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microscope to check if any cancer cells have spread into them from the breast. This provides more information about the stage of the cancer and helps your cancer specialist decide if you need further treatment to reduce the risk of the cancer coming back. There are different ways of checking and removing the lymph nodes:
Sampling A few lymph nodes may be removed, which is known as axillary node sampling. If any of the lymph nodes contain cancer cells, the rest of the nodes may need to be removed in a further operation. Some women may be offered radiotherapy to the area that contains the lymph nodes instead of another operation. Sentinel lymph node biopsy (SLNB) The sentinel node or nodes (there may be more than one) is the first node that lymph fluid from the breast drains to. So, if any cancer cells have spread, theyll most likely to go to the sentinel node.

nodes that contain cancer cells. You wont need radiotherapy to the nodes afterwards. Its usually done when: the ultrasound of the lymph nodes is abnormal fine needle aspiration (FNA) of the lymph nodes is positive the sentinel node biopsy or sampling shows there are cancer cells in the nodes. Theres an increased risk of developing swelling of the arm called lymphoedema after ALND. We have a separate booklet about lymphoedema. Radiotherapy Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is often used after surgery for breast cancer. It may occasionally be used before, or instead of, surgery. If part of the breast has been removed (lumpectomy) radiotherapy is usually given to the remaining breast tissue to reduce the risk of the cancer coming back in that area. After a mastectomy, radiotherapy to the chest wall may be given if your doctor thinks there is a risk that any cancer cells have been left behind. If a few lymph glands have been removed and these contained cancer cells, or if no lymph nodes have been removed, radiotherapy may be given to the armpit to treat the remaining lymph nodes. If all the lymph nodes have been removed from under the arm, radiotherapy to the armpit is not usually needed. Radiotherapy treatment for breast cancer is usually given externally from outside the body using high-energy rays. Its usually given as a series of short daily treatments in the hospital radiotherapy department. It has to be planned very carefully to make sure its as effective as possible. You will usually visit the hospital before treatment

A SLNB involves your surgeon carrying out a special procedure while you are having your breast surgery. During the procedure the surgeon injects a radioactive liquid and dye into the breast. These help to show up the sentinel node, which is removed and then tested for cancer cells. SLNB isnt suitable for everyone your surgeon will explain more about it if its an option for you. If the sentinel node or nodes dont contain cancer cells, you wont need surgery to remove more lymph nodes. If any of the nodes contain cancer cells, youll need an operation to remove all the lymph nodes (axillary lymph node dissection). Some women may have radiotherapy to the lymph nodes instead of surgery.
Axillary lymph node dissection (ALND) This procedure involves removing all the lymph nodes in the armpit. It provides information about the stage of the cancer and treats the area by removing lymph

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for a planning session where scans are carried out. These help doctors to plan the radiotherapy treatment very precisely. The treatments are normally given from MondayFriday with a rest at the weekend. The number of treatments will depend on the size and position of the cancer, but the whole course of treatment will usually be given for three weeks. Each treatment takes from 1015 minutes. Your doctor will discuss the possible side effects with you. These include soreness of the skin in the radiotherapy area, tiredness and feeling slightly sick. If the cancer has spread to the bones, radiotherapy may also be very effective in relieving symptoms, such as pain. Its important to get plenty of rest during your treatment. The side effects can usually be well-controlled with medicines and should gradually get better once the treatment finishes. External radiotherapy does not make you radioactive and it is safe for you to be with other people, including children, after your treatment. Chemotherapy This is the use of anti-cancer drugs to destroy cancer cells. The drugs are carried in the blood and can reach anywhere in the body. They work by disrupting the growth of cancer cells. Chemotherapy may be used to shrink a large cancer before surgery, or after surgery to reduce the chance of the cancer coming back. It may also be used if the cancer has spread to another part of the body, or if it comes back in the future. The drugs are usually given by injection into a vein but sometimes they may be given as tablets. Two or three chemotherapy drugs are often given together. When chemotherapy drugs are given by injection, they are usually given over a few hours. This is known as a session of treatment and is followed by a rest period of a few weeks, which allows your body to

recover from any side effects of treatment. The session of treatment together with the rest period is called a cycle. The number of cycles can vary but most women have between four and eight. As well as the chemotherapy, youll be given injections to stop you feeling sick. Most people are able to go home on the same day. Some people will have their chemotherapy given through a central line or a PICC line. These are long plastic tubes that are placed into a vein either in your chest or the crook of your arm. The lines can stay in place for the whole of your treatment. Its important that the line is kept clean and dry to prevent infection. Youll be taught how to look after the line before you go home. Some chemotherapy drugs may contain very small amounts of alcohol. The alcohol is used to stablise the drug to make it safe to give. If youre concerned about having these drugs because of your religious and cultural beliefs, it may help to discuss this with your religious leader, doctor or nurse. Chemotherapy is usually given to you as an outpatient, but occasionally you may need to spend a few days in hospital. Chemotherapy can cause unpleasant side effects. Many people have just a few side effects and those that occur can often be well-controlled with medicines. Chemotherapy lowers the blood count, which can sometimes lead to lowered resistance to infection, bruising or occasionally bleeding. The other main side effects are tiredness and feeling weak, feeling sick, a sore mouth and loss of appetite. Its important to let your doctor or chemotherapy nurse know about any side effects. You should contact your doctor straight away if you develop a temperature that goes above 38C (100.4F) or you suddenly feel ill, even with a normal temperature.

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Some chemotherapy drugs can cause hair loss, which is usually temporary. Your doctors will let you know if the chemotherapy drugs youre having are likely to cause hair loss. Hair loss can be a distressing side effect for many women, but there are many ways of covering it up by using wigs, hats or scarves. You may be entitled to a free wig from the NHS. If you do lose your hair, it should start to grow back within 36 months of finishing treatment. You may find our booklet Coping with hair loss useful. Hormonal therapies Hormones exist naturally in the body. They help to control how cells grow and what they do in the body. Hormones, particularly oestrogen, can encourage some breast cancer cells to grow. Hormonal therapies work by lowering the level of oestrogen in the body, or by preventing oestrogen from attaching to the cancer cells. They only work for women who have oestrogen-receptor positive cancers (see page 6). Hormonal therapies are given to reduce the chance of breast cancer coming back and to protect the other breast. They can work in different ways and are usually given for a number of years. Youll start hormonal therapy after you have finished chemotherapy (if youre having it). Hormonal therapies can also be used before surgery to shrink a large cancer to avoid the need for a mastectomy. The type of hormonal therapy you have usually depends on: whether or not youve been through the menopause the risk of the cancer coming back how the side effects of the drugs are likely to affect you. Postmenopausal women may be offered hormone treatment with either an anti-oestrogen drug (such as tamoxifen), an aromatase inhibitor (such as

anastrozole, letrozole or exemestane) or a combination of the two different types, where one type is given after the other. Premenopausal women are usually offered hormonal treatment with either an antioestrogen drug (such as tamoxifen) and sometimes Zoladex, which is a type of drug known as a pituitary down-regulator. Zoladex stops the production of a hormone from the pituitary gland. In premenopausal women this lowers the level of oestrogen and stops periods. These effects are usually reversible once treatment is stopped. Zoladex is given as a monthly injection under the skin of the abdomen. Hormonal therapies can cause side effects. These include hot flushes and sweats, feeling sick, putting on weight, joint pains, dryness of the vagina and an increased discharge from the vagina. These side effects are usually mild. Taking aromatase inhibitors for a long time may lead to your bones becoming more fragile, so your doctor may advise you to take medicines called bisphosphonates to prevent this.
Stopping the ovaries from working (ovarian ablation) Other ways of lowering oestrogen levels include stopping the ovaries from working, which is sometimes called ovarian ablation.

It can be done by having an operation to remove the ovaries or rarely with a short course of radiotherapy to the ovaries. Unfortunately ovarian ablation brings on an early menopause, which can be distressing, especially for a woman who was hoping to have children or complete her family. It also causes menopausal side effects, such as hot flushes, dry skin, emotional changes and sometimes depression. However, these symptoms can be effectively treated. Trastuzumab (Herceptin ) Trastuzumab (commonly known as Herceptin) is a treatment that may be given to some women with breast cancer.

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Its a type of drug known as a monoclonal antibody. It works by attaching to HER2 receptors (proteins) on the surface of breast cancer cells. This stops the cancer cells dividing and growing. It also works by encouraging the bodys own immune system to destroy the cancer cells. Herceptin can reduce the chance of breast cancer coming back after initial treatment for early breast cancer. However, its only effective for women whose breast cancer cells have a large number of the HER2 receptors on their surface. This is known as being HER2 positive. The side effects of Herceptin are usually mild. Some occur during the infusion or within about four hours of the drug being given, particularly with the first dose. These include flu-like symptoms such as headaches, high temperature (fever) and chills, or feeling sick. They generally get better within a few hours of the infusion finishing. Another possible side effect is an allergic reaction, but this is rare. Signs may include a skin rash, itching, wheezing or feeling breathless. Youll be checked closely during the infusion and if you do have a reaction, it can be treated quickly with drugs. Side effects can also occur a few days or weeks after treatment. These include diarrhoea, headaches and feeling sick.
Effects on the heart Herceptin may lead to heart problems in some women. Usually, any effect is mild and reversible. Because of this risk, Herceptin isnt normally given to women who already have heart problems or uncontrolled high blood pressure.

or breast care nurse can give you advice about contraception. Women who have had breast cancer are usually advised not to use contraception that contains hormones, such as the pill or coils (intra-uterine devices), that release hormones. Non-hormonal coils or barrier methods of contraception, such as condoms or the cap, are usually the most suitable. Unfortunately, the withdrawal and rhythm methods of contraception are not safe enough to be effective as protection against pregnancy. Some women may choose to be sterilised to prevent pregnancy. Choosing an effective contraception is your personal decision. Your preferences, and those of your partner, are obviously important. Some women also have religious and moral implications to consider. You may find it helpful to talk through your situation with a religious leader, the Family Planning Association or a trained family planning counsellor. They can help you find an acceptable method of contraception.
Hormone replacement therapy (HRT) HRT isnt usually recommended after breast cancer because it contains oestrogen, which could encourage the cancer to grow. Some doctors may prescribe HRT in situations where a womans menopausal symptoms are severe and nothing else has helped.

Follow-up
After your treatment has finished youll have regular check-ups and mammograms. These will be every few months at first but eventually you may only be seen once a year. Sometimes, instead of routine appointments women are asked to contact their specialist if there's anything they are worried about.

Youll have tests on your heart before treatment to check that its healthy, and tests during treatment to make sure Herceptin isnt causing any damage. Contraception Its generally advised to avoid getting pregnant for two years after treatment for breast cancer. Your GP, hospital doctor

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Research clinical trials


Research into new ways of treating breast cancer is ongoing. No current cancer treatment results in the cure of all patients treated, so cancer doctors are continually looking for new ways to treat the disease. They do this by using clinical trials. Many hospitals now take part in these trials.

This fact sheet has been written, revised and edited by Macmillan Cancer Supports Cancer Information Development team. It has been approved by our medical editor, Dr Terry Priestman, Consultant Clinical Oncologist. With thanks to Professor RE Coleman, Professor of Medical Oncology, and the people affected by cancer who reviewed this edition. This fact sheet has been compiled using information from a number of reliable sources, including: Bland, et al. The Breast: Comprehensive management of benign and malignant diseases. 4th Edition. 2009. Saunders Elsevier. Advanced breast cancer: Diagnosis and treatment. Guidance 81. 2009. National Institute for Health and Clinical Excellence (NICE). Early and locally advanced breast cancer: Diagnosis and treatment. Guidance 80. 2009. National Institute for Health and Clinical Excellence (NICE). Management of breast cancer in women: A national clinical guideline. SIGN 84. 2005. Scottish Intercollegiate Guidelines Network (SIGN). This fact sheet was revised in 2012. The next edition will be available in 2013.

Your feelings
You may have different emotions about cancer, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their illness.

Related Macmillan information

Cancer genetics how cancer


sometimes runs in families

Cancer treatment and fertility


information for women

Coping with hair loss Eating well after cancer treatment Life after cancer treatment Managing the late effects of breast
cancer treatment

Sexuality and cancer The emotional effects of cancer Understanding breast cancer
(available in English and Welsh)

Understanding breast cancer in men Understanding ductal carcinoma in


situ (DCIS)

We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third-party information such as information on websites to which we link. Macmillan Cancer Support 2012. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ. MAC12467_12

Understanding secondary breast cancer


For copies of this related information call free on 0808 808 00 00, or see it online at macmillan.org.uk

Page 12 of 12 Macmillan fact sheet 2012: Breast cancer