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Breast cancer (female)

Breast cancer is the most common cancer in the UK. About 48,000 women get breast cancer in the UK each year. Most of them are over 50.

Breast cancer is the most common cancer in the UK. About 48,000 women get breast cancer in Britain each year. Most (8 out of 10) are over 50, but younger women, and in rare cases, men, can also get breast cancer.

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.

Learn more about the causes of breast cancer.

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.

Learn more about symptoms of breast cancer.

If you notice any of these symptoms, see your GP as soon as possible. After an examination, they may feel it necessary to refer you to a specialist breast cancer clinic for further tests.

Read more information about how breast cancer is diagnosed.

Types of breast cancer

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

Non-invasive breast cancer

Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and 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 has necessarily 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 causes of breast cancer are 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 50–70 are invited for breast cancer screening every three years. Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit.

Read more information about breast cancer screening.

Treating breast cancer

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

Being diagnosed with breast cancer can affect daily life in many ways. However, there is support available for many aspects of living with breast cancer including emotional, financial and long-term health issues.

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.

Learn more about how breast cancer is treated.

Find your local cancer support services (including breast screening).

Online Personal Education and Risk Assessment (OPERA)

If you are concerned about your risk of developing inherited breast cancer, you can use Macmillan's online interactive assessment tool, OPERA.

The tool is based on the National Institute for Health and Care Excellence (NICE) guidelines for the classification and care of women at risk of familial breast cancer. It is used by patients and health professionals to assess a person's risk of developing the condition, based on their family history of both breast cancer and ovarian cancer. This is because the genes that are mainly responsible for breast cancer are also linked to ovarian cancer.


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Breast cancer (female)

The main symptom of breast cancer is usually a lump or thickened area of tissue in your breast. It is important to have it checked by a doctor.

The first symptom of breast cancer 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
  • a change in the size or shape of one or both breasts
  • discharge from either of your nipples (which may be streaked with blood)
  • a lump or swelling in either of your armpits
  • dimpling on the skin of your breasts
  • a rash on or around your nipple
  • a change in the appearance of your nipple, such as becoming sunken into your breast
  • pain in either of your breasts or armpits not related to your period

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Breast awareness

So 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 potential problems.

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Breast cancer (female)

Cancer is caused when the cells in a certain area of your body divide and multiply too rapidly. It is not fully understood why breast cancer occurs.

The causes of breast cancer are not fully understood. This means 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 you cannot do anything about, but there are some 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. 8 out of 10 breast cancer cases occur in women over 50.

All women between 50 and 70 years of age should be screened for breast cancer every three years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Currently, there are ongoing pilot studies looking at widening the screening age range to 47-73.

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 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 to regulate your periods.

Your risk of developing breast cancer may rise slightly with the amount of oestrogen your body is exposed to. For example, if you started your periods at a young age and 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 had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. See your GP if you were not contacted or you did not attend a consultation.

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

Hormone replacement therapy (HRT)

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

It is estimated there will be an extra 19 cases of breast cancer for every 1,000 women 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.

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Breast cancer (female)

If you notice a lump in your breast or any change in the appearance, feel or shape of your breasts, visit your GP.

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 your breasts. You may also need an ultrasound scan. If your cancer was detected through the NHS Screening Programme, you may need another mammogram or ultrasound scan.

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

Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. The image produced will show any lumps or abnormalities 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

biopsy involves taking a sample of tissue cells from your breast and testing them to see if they are cancerous. You may also need a scan and a needle test on 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. 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 you will be awake, but your breast will be numb. Your doctor may suggest 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, particularly ductal carcinoma in situ (DCIS).
  • Vacuum-assisted biopsy (mammotome biopsy). The needle may be attached to a gentle suction tube, which helps to obtain the sample and clear any bleeding from the area.

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Further tests for breast cancer

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

Scans and X-rays

Computerised tomography (CT) scans, or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to 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. These are the types of test you could be offered:

  • 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), 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" or "targeted" therapy.

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Breast Cancer Care: Diagnosis.

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: 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.

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Breast cancer (female)

Treatment for breast cancer usually involves a combination of surgery, chemotherapy, radiotherapy and, in some cases, hormone or biological therapies.

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 your 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.

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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.

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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 about a month after your surgery or chemotherapy to give your body a chance to recover. You will probably have radiotherapy sessions three to five days a week, for three to six weeks. Each 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. The types available are: 

  • breast radiotherapy. After breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
  • chest wall radiotherapy. After a mastectomy, radiotherapy is applied to the chest wall
  • breast boost. Some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed. However, the boost may affect the appearance of the breast, especially if you have larger breasts, and can sometimes have other side effects, including hardening of the breast tissue (fibrosis)
  • radiotherapy to the lymph nodes. Radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes

The side effects of radiotherapy include:

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

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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.

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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

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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

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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 the UK 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.

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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.

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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.

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Breast cancer (female)

As the causes of breast cancer are not fully understood it is not possible to know if anything can prevent it altogether.

As the causes of breast cancer are not fully understood, it is not possible to know if it can be prevented altogether.

For women at a higher risk of developing the condition than the general population, some treatments are available to reduce this risk.

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. Use the healthy weight calculator to check if you are a healthy weight.

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 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.

Read more information about getting regular exercise and maintaining a healthy weight.

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.

Treatments to reduce your risk

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

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

You will usually be referred to a specialist genetics service if it is suspected that you are at an increased risk of breast cancer. Healthcare professionals working at these services should discuss the treatment options with you.

The two main treatments are surgery to remove the breasts (mastectomy) or medication. These are described in more detail below.

Mastectomy

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

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

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

If you want to, you can usually choose to have a breast reconstruction either during the mastectomy operation, or at a later date. During breast reconstruction surgery, your original breast shape is recreated using either implants or tissue from elsewhere in your body.

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

See mastectomybreast reconstruction and living with breast cancer for more information.

Medication

In June 2013, the National Institute for Health and Care Excellence (NICE) announced that two medications, called tamoxifen and raloxifene, would be available on the NHS for women who have an increased risk of developing breast cancer.

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

These medications may not be suitable if in the past you have had blood clots or womb cancer, or if you have an increased risk of developing these problems in the future. Women who have already had a mastectomy to remove both breasts won't be offered these medications because their risk of developing breast cancer is very small.

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

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

Your chances of giving birth to a child with birth defects increases while you are taking tamoxifen, so you will be advised to stop taking it at least two months before trying for a baby. The medication can also increase your risk of blood clots so you should stop taking it six weeks before any planned surgery.

Currently, these two medications are not licensed for the purpose of reducing the risk of breast cancer in women with an increased risk of developing the condition. However, they can still be used if you understand the benefits and risks and your doctor believes the treatment will be helpful.

For more information, read ‘Drugs to be offered to women at high risk of breast cancer’.

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Breast cancer (female)

The NHS Breast Screening Programme screens around 1.6 million women every year and around a third of breast cancers are diagnosed through screening.

The NHS Breast Screening Programme screens around 1.6 million women a year. Women aged 50 to 70, who are registered with a GP, are automatically invited for screening every three years. You will first be invited for screening between your 50th and 53rd birthday.

Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. The NHS has extended the breast screening age range in England so that all women aged 47 to 73 will be invited.

Screening takes place at a special clinic or mobile breast screening unit. A mammogram (X-ray of the breast) is taken by a female health professional. The mammogram is then studied to look for any abnormalities. The aim is to detect breast cancer at an early stage, when any changes in the breast would be too small to feel and when there is a good chance of successful treatment and full recovery.

Not all cancers are found during breast screening. Breast cancer can develop between screening appointments. Even if you go to breast screening, it is important to get to know your breasts so you can spot any unusual changes early on and report them to your GP.

What happens at the screening unit?

Screening is carried out by female staff, who take mammograms to detect abnormalities. The breasts are X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.

Most women find the compression uncomfortable and occasionally it may be painful. However, the compression is necessary to ensure the mammogram is clear. Any discomfort will be over quickly.

The results of the mammogram will be sent to you and your GP.

The pros and cons of breast screening

Regular screening prevents deaths from breast cancer – it is estimated to save around 1,300 lives a year. Around a third of breast cancers are diagnosed through screening.

Screening can find breast cancer early and the earlier it is found, the better your chance of surviving it. You are less likely to need a mastectomy (breast removal) or chemotherapy if breast cancer is found early.

However, if you already have an advanced stage of breast cancer, screening may not help. Also, cancers may sometimes be found that are treated even though they may not have caused any symptoms or become life-threatening.

Misdiagnosis

There is also a chance that the results of the mammogram may not be accurate. There are two types of misdiagnosis, known as:

  • a false negative result – you receive a normal result, but cancer is present
  • a false positive result – you receive a positive result and go on to have further tests, but there is no cancer

About 1 in 20 women will be called back for further assessment. Being called back does not mean you definitely have cancer. The first mammogram may have been unclear. About one in six women who are called back for further assessment are diagnosed with breast cancer.

Radiation

Having a mammogram means your breasts are exposed to a small amount of radiation (2 to 5 millisieverts, or mSv).

For comparison, a person in the UK receives a dose of 2.2 mSv every year from natural background radiation. However, the benefits of screening and early detection are thought to outweigh the risk.

Read more information about the risks and benefits of breast screening.

Screening for women at high risk of breast cancer

You may be eligible for breast cancer screening before the age of 50 if you have a higher than average risk of developing breast cancer. You may be considered to be at an increased risk if you have a family history of breast cancer (female or male) or ovarian cancer.

If you are at an increased risk of developing breast cancer, you may have yearly MRI scans or mammograms, depending on your age and your specific level of risk. MRI scans are sometimes used instead of mammograms because they are better at detecting cancer if you have dense breasts.

Genetic screening for breast cancer

If, following an assessment at a specialist clinic, you are felt to be at an increased risk of breast cancer due to your family history, it may be because one of the genes that make breast cancer more likely runs in your family. In these cases, you should be offered genetic counselling before genetic testing.

Genetic counselling is a service that provides information and advice about genetic conditions. It is provided by healthcare professionals specially trained in the science of human genetics (a genetic counsellor or a clinical geneticist).

The counsellor will discuss the risks, benefits and limitations of genetic testing with you. They will also explain how the information found as a result of genetic testing could have implications for both you and your family.

After you have had genetic counselling, a genetic blood test to look for mutated (altered) versions of genes called BRCA1, BRCA2 and TP53 will be offered because having one of these altered genes increases your chances of developing breast cancer.

If possible, a relative who has already had breast cancer will be tested first because this will make it easier to find any genetic faults. If a faulty gene is found, other family members can then be tested to see if they have the same gene.

If a close relative is not available for testing, you should be offered testing yourself if your family history suggests you have at least a 1 in 10 chance of having a faulty gene.

If genetic tests show you have one of these faulty genes, you may be offered regular screening to check for signs of breast cancer and possible treatments to reduce your risk should also be discussed.

See preventing breast cancer for more information about treatments to reduce your risk.

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Breast cancer (female)

Breast cancer can affect your daily life in different ways, depending on what stage it is at and what treatment you are having.

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.

Read more information about recovering from an operation.

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 the first five years after your treatment.

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate, giving them free prescriptions for all medication, including medicine for unrelated conditions.

The certificate is valid for five years and you can apply for it through your GP or cancer specialist.

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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.

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Breast cancer (female)

 Emma Duncan, 33, has been diagnosed with breast cancer twice in the past four years, once in each breast. Her first treatment was a lumpectomy with

Emma Duncan, 33, has been diagnosed with breast cancer twice in the past four years, once in each breast.

Her first treatment was a lumpectomy with chemotherapy and radiotherapy. Her second treatment included a full mastectomy, removing both breasts, followed by reconstructive plastic surgery.

"I asked my GP if there was any screening programme they could put me into when I was 25 because my mother had died from breast cancer when she was 32. They referred me to the Royal Victoria Infirmary and I used to come once a year just for a check-up.

"A few years later I was in the bath and I noticed a lump under my left armpit. I didn’t quite know what to make of it. I was quite worried at first. I went to see my GP the next day and he suspected that it might just be a cyst as I was only 28 at the time. But because of my family history, he referred me to a specialist.

"At the hospital, I had an ultrasound, a mammogram and a needle biopsy. When I returned a week later for the results, they confirmed that I did have breast cancer and that I would need to come in for lumpectomy surgery 10 days later.

"I had chemotherapy for six months after my first diagnosis, followed by five weeks of radiotherapy. It was really hard. All my hair fell out and it made me feel so ill.

"My husband Graham was great and tried to support me as best he could throughout it. My sister-in-law was never off the phone and my best friend Claire was lovely.

"My sister handled it in a very different way. She had watched my mum become very poorly, and then her older sister was diagnosed. She found it hard to deal with and she just couldn’t handle coming to see me. She later admitted being terrified that it might be her next.

"The second time I was diagnosed, I had a bigger operation: a double mastectomy. The decision to have a mastectomy was quite easy to make. For me, it was the only decision having had cancer twice.

"The reality after the event was very different. With the reconstructive surgery as well, I knew it would be a long recovery, but I don’t think anything prepared me for just how long. I cried every single day because I was so uncomfortable.

"I was referred to a psychologist who told me I wasn’t going mad. Anybody who had been through what I had would be expected to have a few tearful days. Things settled down, then it was just a case of trying to get back to normal.

"Looking back at everything, I wouldn’t have changed my decision at all. It was definitely for the best.

"I now have check-ups every six months with my oncologist, breast surgeons and at the family clinic. I see my plastic surgeon, my geneticist and have an ultrasound once a year, plus a blood test every four months as part of the ovarian screening programme. The Macmillan breast care nurses ring me up every once in a while to keep me up to date and to check that I’m all right. I’m very well looked after.

"Now I just want to stay cancer-free. I’ve done as much as I possibly can to prevent it from coming back or getting a new cancer. I didn’t quite make it after my first diagnosis, but I’d like to get through the next five years without the cancer returning.

"My advice to other women would be to speak to your breast care nurse or go on the Cancer Research UK or Breast Cancer Care websites. There are so many recognised sources of information. The internet is full of horror stories, so make sure you get as much information as you can from reputable sources."

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Breast cancer (female)

In this video, people who have been through cancer treatment talk about what kept them going and the practicalities of

In this video, people who have been through cancer treatment talk about what kept them going and the practicalities of treatment.

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