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Breast cancer (female)

 

Breast cancer is the most common female cancer in Ireland. About 2,700 women get breast cancer in Ireland each year. Most of them (8 out of 10) are over 50, but younger women, and in rare cases men, can also get breast cancer.

Anatomy of the breast

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

Our bodies are made up of billions of tiny cells. Normally, cells grow and multiply in an orderly way. New cells are only made when and where they are needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably.

Breast cancer can have a number of symptoms but usually shows as a lump or thickening in the breast tissue (although most breast lumps are not cancerous). If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body.

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, or pre-cancerous cells. This cancer is found in the ducts of the breast and has not developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast 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 does not mean it necessarily 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 cases of breast cancer 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 is 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 is known as secondary or metastatic breast cancer.

Breast screening

The exact cause of breast cancer is not fully understood, but many factors increase the likelihood of developing it, including age and family history of breast cancer.

Women who have a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women aged 50-64 are invited for breast cancer screening every two years.

Breast cancer can be treated using a combination of surgery, chemotherapy and radiotherapy. Some cases of breast cancer may also be treated using biological or hormone treatments.

One in nine women are affected by breast cancer during their lifetime. There is a good chance of recovery if it is detected in its early stages. For this reason, it is vital that women check their breasts regularly for any changes and always get any changes examined by their GP.


Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

So that you can pick up any changes as soon as possible, it is important to be breast aware. 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 any potential problems.

Symptoms of breast cancer

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast. Most lumps (90%) are not cancerous, but it is always best to have them checked by your doctor.

See your GP if you notice any of the following:

  • a lump or area of thickened tissue in either breast
  • discharge from either of your nipples (which may be streaked with blood)
  • a lump or swelling in either of your armpits
  • a change in the size or shape of one or both breasts
  • 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

Useful Links

The causes of breast cancer are not fully understood. This means that it is difficult to say why one woman may develop breast cancer and another may not.

Some things, known as risk factors, can change the likelihood that someone may develop breast cancer. There are some factors that you cannot do anything about, although there are others that you can change.

Age

The risk of developing breast cancer increases as you get older. Breast cancer is most common among women over 50 who have been through the menopause. Eight out of 10 cases of breast cancer occur in women over 50.

All women between 50 and 65 years of age should be screened for breast cancer every two years as part of the Irish Breast Screening Programme.

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, as breast cancer is the most common cancer in women, it is possible for it to occur more than once in the same family by chance.

Most breast cancer cases are not hereditary (they do not run in families). However, particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. It is possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with increased risk of breast cancer.

If you have, for example, two 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 are worried about your family history of breast cancer, discuss it with your GP.

Previous diagnosis of breast cancer

If you have previously had breast cancer or early non-invasive cancer cell changes contained within 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

benign breast lump does not mean that 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 more 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) harder 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

In some cases, breast cancer cells can be stimulated to grow by the female hormone oestrogen. Your ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty in order to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen that your body is exposed to. For example, if you started your periods at a young age and entered menopause at a late age, you will have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy.

Being overweight or obese

If you have been through the menopause and are overweight or obese, you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, as being overweight or obese after the menopause causes more oestrogen to be produced.

Being tall

If you are taller than average, you are more likely to develop breast cancer than someone who is shorter than average. This may be due to interactions between genes, nutrition and hormones, but the reason is not fully understood.

Alcohol

Your risk of developing breast cancer can increase with the amount of alcohol you drink. Research shows that, for every 200 women who regularly have two alcoholic drinks a day, there are three more women with breast cancer compared with women who do not drink at all.

Radiation

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

If you currently need radiotherapy for Hodgkin's 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.

It is estimated that there will be an extra 19 cases of breast cancer for every 1,000 women who are taking combined HRT for 10 years. The risk continues to increase slightly the longer you take HRT, but returns to normal once you stop taking it.

 

Benign
Benign refers to a condition that should not become life threatening. In relation to tumours, benign means not cancerous.
Genetic
Genetic refers to genes, the characteristics inherited from a family member.
HRT
Hormone replacement therapy or HRT involves giving hormones to women when the menopause starts, to replace those that the body no longer produces.

Tests at the breast cancer clinic

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

Mammogram and breast ultrasound

If you have symptoms and have been referred by your GP, you will have a mammogram to produce an X-ray of the breasts. You may also need an ultrasound scan. If your cancer was detected through the Screening Programme, you may need to have another mammogram or ultrasound scan.

If you are under 35, your doctor may suggest that you have a breast ultrasound scan only. Younger women have denser breasts, which means a mammogram is not as effective as detecting cancer.

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. The image produced will show any lumps or abnormalities that are present in your breasts. 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 involves taking a sample of tissue cells from your breast and testing them to see if they are cancerous. You may also need to have a scan and a needle test on the lymph nodes in your armpit (axilla) to see if 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. The different methods of carrying out a biopsy are outlined 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 will have a local anaesthetic, which means that you will be awake but your breast will be numb. Your doctor may suggest that you have a guided needle biopsy (usually this is 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, in particular ductal carcinoma in situ (DCIS).

 

Further tests for breast cancer

If the 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

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

If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before you have 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 has 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 will also need to have 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.

  • Hormone receptor test. 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. 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) then they are known as hormone receptor positive.
  • HER2 test. 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 may be treated using drugs to block the effects of HER2. This is known as biological therapy 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. Sometimes, ductal carcinoma in situ (DCIS) is described as Stage 0. Other stages of breast cancer describe invasive breast cancer.

  • Stage 1. The tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body.
  • Stage 2. The tumour measures between 2cm and 5cm or the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body.
  • Stage 3. The tumour measures between 2cm and 5cm and may be attached to structures in the breast, such as skin or surrounding tissues. The lymph nodes in the armpit are affected. However, 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 called A, B and C. If you are not sure what stage you have, ask your doctor.

TNM staging system

The TNM staging system may also be used to describe breast cancer. 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 slow growing.
  • Medium grade (G2). Cells look more abnormal than low-grade cells.
  • High grade (G3). Cells look even more abnormal and are more likely to grow more quickly.

 

Treatment overview

The first type of treatment for breast cancer is usually surgery. The type of surgery depends 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 will have depends on the type of breast cancer. Your doctor will discuss the best treatment plan with you. Sometimes, chemotherapy or hormone therapy will be the first treatment.

Secondary breast cancer

Most breast cancers are discovered in the early stages of the disease. However, a small proportion of women discover that they have breast cancer after it has spread to other parts of the body (metastasis). If this is the case, the type of treatment you have may be different. Secondary cancer, also called advanced or metastatic cancer, is not curable and treatment aims to achieve a remission, where the cancer shrinks or disappears, making you feel normal and able to enjoy life to the full.

Surgery

There are two types of surgery for breast cancer. These are surgery to remove just the cancerous lump (tumour), known as breast-conserving surgery, and surgery to remove the whole breast, which is called a mastectomy. In many cases, a mastectomy can be followed by reconstructive surgery to recreate 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, in which just the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, in which 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 
  • the size of the tumour and where it is in your breast
  • the amount of surrounding tissue that needs to be removed
  • the size of your breasts

Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there is no cancer present in the healthy tissue, there is less chance that the cancer will recur. If cancer cells are found in the surrounding tissue, you may need to have more tissue removed from your breast.

After 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, in which your breast is removed, along with a sentinel lymph node biopsy (SLNB).

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 (SLNB) may be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They are part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they are 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 is generally given after surgery and chemotherapy to kill any remaining cancer cells.

If you need radiotherapy, your treatment will begin within 12 weeks of your surgery or within a month of your chemotherapy if you receive chemotherapy. Radiotherapy treatment is typically given five days a week and may last for three to five weeks. Each treatment session will only last a few minutes.

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

  • 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 dose radiotherapy. This means an additional dose of radiotherapy to the area of the breast where they cancer was removed. Having a boost may mean that you are more likely to get radiotherapy side effects.
  • Radiotherapy to the lymph nodes. Lymph nodes behind the collar bone (supraclavicular fossa) or under the arm (axilla) may be treated to kill any cancer cells that may be present.

The side effects of radiotherapy include:

  • The skin inside the area treated with radiotherapy may become red and irritated and occasionally may peel. These effects heal after radiotherapy but the skin colour may be permanently darker or lighter in the treated area.
  • fatigue (extreme tiredness)
  • lymphoedema (excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm)
  • The breast may become tender and sensitive. In the long-term the breast may appear smaller in size and the breast tissue may harden (fibrosis)

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill the cancer cells. Chemotherapy is usually used after surgery to destroy any cancer cells that have not been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is generally used to shrink a large tumour. This is called neo-adjuvant chemotherapy.

Several different drugs are used for chemotherapy and often three are given at once. The choice of drugs and the combination depends on the type of breast cancer and how much it has spread.

Chemotherapy is usually given as an outpatient treatment, which means you will not have to stay in hospital overnight. The drugs 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 receive chemotherapy sessions once every two to three weeks, over a period of four to eight 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 drugs can also stop the production of oestrogen in your body. Oestrogen is known to encourage the growth of some breast cancers. If you have not been through the menopause, your periods may stop while you are undergoing chemotherapy treatment. After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again. However, in some cases this does not happen and you will enter an early menopause. This is more likely in women over the age of 40, as they are 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 the body, chemotherapy will not cure the cancer but it may shrink the tumour, relieve your symptoms and help lengthen your life.

Hormone treatment

Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These 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 have will depend on the stage and grade of your cancer, which hormone it is sensitive to, your age, whether you have been through the menopause and what other type of treatment you are having. You will probably have hormone therapy after surgery and chemotherapy, but it is 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 will need to take hormone therapy for up to five years after your surgery.

If your breast cancer is not sensitive to hormones, hormone therapy will have no effect.

Tamoxifen

Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Tamoxifen is 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 have been through the menopause, you may be offered an aromatase inhibitor. This drug works by blocking aromatase, a substance that helps to make 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
  • loss of interest in sex
  • nausea and vomiting
  • tiredness
  • aching joints and bone pain
  • headaches
  • skin rashes

Ovarian ablation or suppression

In women who have not been through the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries from working and from producing oestrogen.

Ablation can be carried out using surgery or radiotherapy. This stops the ovaries working permanently and means that you will go through the menopause early.

Ovarian suppression involves using a drug called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa). Your periods will stop while you are taking it, although they should start again once your treatment is complete. If you are approaching the menopause (around the age of 50), your periods may not start again once 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 will 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 given intravenously, through a drip, and 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 will 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 is 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 will need regular tests on your heart to make sure it is not causing any problems. Other side effects of trastuzumab may include:

  • an initial allergic reaction to the drug, which can cause nausea, wheezing, chills and fever
  • diarrhoea
  • 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 of treatment. These advances were discovered in clinical trials, where new treatments and treatment combinations are compared with standard ones.

All cancer trials in Ireland are carefully overseen to ensure the trial is worthwhile and safely conducted. In fact, participants in clinical trials can do better overall than those in routine care.

If you are asked to take part in a trial, you will be given an information sheet and, if you want to take part, you will 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 bring 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 are 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 has 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 have had cancer treatment.

Complementary therapies

Complementary therapies are holistic therapies that can promote physical and emotional wellbeing. They are 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 is important to speak to your breast cancer specialist nurse about any complementary therapy you wish to use to make sure it does not interfere with your conventional treatment.

Chemotherapy
Chemotherapy is a treatment of an illness or disease with a chemical substance, for example in the treatment of cancer.
Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Mastectomy
A mastectomy is an operation to remove a breast and most of the skin covering it. It is usually done to treat or prevent breast cancer.
Radiotherapy
Radiotherapy uses X-rays to treat disease, especially cancer.

Diet and lifestyle

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

Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions at the moment, there are benefits for women who maintain a healthy weight, do regular exercise and who have a low intake of saturated fat and alcohol.

It has also been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If you have been through the menopause, it is particularly important that you are 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 do not. The reasons are not fully understood, but it could be because women do not ovulate as regularly while they are breastfeeding and oestrogen levels remain stable.

Breast screening means taking a mammogram (x-ra) of the breasts to look for signs of early breast cancer. In Ireland BreastCheck invites women aged 50-64 on a two yearly cycle for their free breast mammogram. If breast cancer is found early, it is easier to treat at this and a woman has a high chance of a good recovery. No screening tool is 100 per cent effective and breast screening does not find all breast cancer, but screening in other countries has been shown to lower the number of women dying from breast cancer.

Why should women come for breast screening?
Regular breast screening means that if there are changes they will be found as early as possible. Finding a breast cancer when it is small normally means:

  • There is a greater chance of treating the cancer successfully
  • It is less likely to have spread to other parts of the body
  • There may be more treatment options available

Finding cancer early is important. Breast screening and better treatments are helping to lower deaths from breast cancer. Screening programmes in other counties have greatly reduced the number of women dying from breast cancer. Northern Ireland has shown a reduction in deaths from breast cancer by 20 per cent in the last 10 years.

What is a Mammogram and does it hurt?
A mammogram is an x-ray of the breast. When you have a mammogram, a special x-ray machine is used to take a picture of your breasts. One at a time, your breasts are pressed between two special plates to take the x-ray. There has to be pressure to make sure that the mammogram is a high quality. A mammogram takes a few minutes and pressure is applied for a few seconds to each breast. There is no evidence that this pressure harms your breasts. Some women might find this uncomfortable or painful but normally just for the short time their breasts are being pressed.

Why screen women aged 50 to 64?
In Ireland over 70 per cent of breast cancer occurs in women over 50 years of age. Breast cancer occurs infrequently in women under 40 years. In women who have not reached the menopause, the breast tissue is usually dense and it is more difficult to see a small cancer with a mammogram. Once a woman has reached the menopause the breast tissue changes and turns into fatty tissue. This makes it much easier to see a small cancer on the breast x-ray. There is a higher chance of developing breast cancer as women get older.

The Department of Health and Children chose the 50-64 year age group for screening as there is a greater proportion of women at risk of dying from the disease in this age group compared to women above or below this age range.

Screening Process

Consent and Invitation
Each woman is initially sent an information leaflet explaining the BreastCheck service and a letter seeking her consent to invite her for an appointment.

If the woman does not wish to avail of this service, she should convey this decision in writing within three weeks of receiving the consent letter.

The woman does not need to do anything if she does wish to participate in the programme. BreastCheck will send her an appointment letter in due course.

These consent letters and invitations are only issued when a particular area is being screened (based on electoral areas).

Women will receive a routine recall to screening on a two yearly cycle.

All screening units are fully accessible to people with disabilities. BreastCheck ask that a woman advises in advance if special needs are to be accommodated.

The Screening Appointment
Depending on where she lives, each woman will either be invited to a screening unit or mobile unit.

On arrival for a mammogram, a radiographer asks the woman about any clinical details or history of breast disease. The radiographer answers any questions, explains what will happen and carries out the mammogram.

The doses of radiation used in the mammogram is very small and within recommended limits, so the risk to your health is very low.

The Mammogram
A mammogram is an x-ray of the breast. When you have a mammogram, a special x-ray machine is used to take a picture of your breast. One at a time, your breasts are pressed between two special plates to take the x-ray. There has to be pressure to make sure that the mammogram is a high quality

The Results
The mammograms are examined by two Consultant Radiologists and the results sent to the woman’s home and her GP within three weeks.

Normal Result: The majority of women receive a ‘normal’ result and will be reinvited for routine screening in two years time.

Abnormal Result: A small number of women will be asked to return for another mammogram. Please don't worry. About one in 20 women who receive a BreastCheck mamogram is called called back for more tests. In some cases this recall may be for technical reasons, i.e. if the image is not clear enough. Most women are given normal results following the tests. A small number of women will require further investigation.

Routine re-call
Most women are given the all-clear after further investigation and are reinvited for further routine screening on a two yearly cycle.

What happens if cancer is found?
If a woman is found to have cancer, she is seen by a consultant surgeon who is part of the multidisciplinary team in the assessment unit for a discussion of treatment options available. This is essential before making any decisions on surgery.

Is there anyone to talk to?
The assessment unit has a Breast Care Nurse who is available to give advice and help women during investigations through to diagnosis and up to primary treatment.

Treatment
This usually involves some form of surgery, followed by radiotherapy, chemotherapy, or hormone therapy – or a mixture of these. The exact course of treatment depends on the type of cancer found and the woman.

Recovery and follow-up

Recovery

Most women with breast cancer have an operation as part of their treatment. Getting back to normal after surgery can take time. It is 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 heavy housework. You may also be advised not to drive.

Some other treatments, particularly radiotherapy and chemotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Do not be afraid to ask for practical help from family and friends.

Follow-up

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

If you have 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 do blood tests or X-rays to see how your cancer is responding to treatment. You should also be offered a mammogram every year for life.

Long-term complications

Although it is rare, your treatment for breast cancer may cause new problems:

  • Pain and stiffness in your arms and shoulder may occur after surgery and the skin in these areas may be tight.
  • Lymphoedema is a build-up of excess lymph fluid which causes swelling. This may happen if surgery or radiotherapy causes damage to 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 your 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 changes to their body due to breast cancer treatment. Some women react positively but others find it more difficult to cope. It is important to give yourself time to come to terms with any changes to your body.

Early menopause

Although most breast cancer occurs in women over 50 who have been through the menopause, some younger women have to cope with early menopause brought on by treatment for cancer. Symptoms can include hot flushes, vaginal dryness and loss of sexual desire. Talk to your healthcare team about any symptoms you have and they will be able to help.

Prosthesis

A breast prosthesis is an artificial breast which can be worn inside your bra to replace the breast that has been removed. Soon after a mastectomy, you will be given a lightweight foam breast to wear until the area affected by surgery or radiotherapy has healed. After it has healed, you will be offered a silicone prosthesis. Prostheses come in many different sizes and shapes and you should be able to find one that suits you.

Reconstruction

If you did not have immediate breast reconstruction (carried out at the time of mastectomy), you can have reconstruction later, called a delayed reconstruction. There are two main methods of breast reconstruction. These are reconstruction using your own tissue and reconstruction using an implant. Which type is more suitable for you depends on many factors, including the treatment you have had, any ongoing treatment and the size of your breasts. Talk to your healthcare team about which reconstruction is suitable for you.

Relationships and sex

Relationships with friends and family

It is 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. But do not feel shy about telling them that you need some time to yourself, if that is what you need.

Your sex life

Breast cancer and its treatment can affect your sex life. It is common for women to lose interest in sex after treatment for breast cancer. 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 grieving the loss of your breasts or, in some cases, your fertility.

It is 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.

Money and financial support

If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support:

  • If you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer.
  • If you don't have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance.
  • If you are caring for someone with cancer, you may be entitled to Carer's Allowance.
  • You may be eligible for other benefits if you have children living at home or if you have a low household income.

Find out early what help is available to you. Speak to the social worker at your hospital, who can give you the information you need.

Talk to other people

If you have questions, your GP or nurse may be able to reassure you. 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. Some people find it helpful to talk to other people who have breast cancer, either at a local support group or in an internet chatroom.


Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.