Breast cancer

Breast cancer is a harmful growth which starts in the breast tissue. It is the most common cancer among New Zealand women, affecting one in nine women over their lifetime.

Breast Cancer Awareness Infographic

Some breast cancers grow very slowly, others develop more rapidly. Breast cancer can spread to the lymph glands and to other parts of the body, such as the bones and liver.

In New Zealand, about 2300 women are diagnosed each year with breast cancer. Men can develop breast cancer, though this is rarer, adding up to about 1% of all breast cancers.

Key points:

  1. Breast cancer can occur at any age, but is most common in women between the ages of 50 and 70 years.
  2. The risk of breast cancer increases with age. You are also more at risk if you have a family history of breast cancer.
  3. The best treatment for breast cancer is finding it at an early stage. By the time you can feel a breast cancer, it is already about the size of a cherry or walnut. Mammograms are can pick up breast cancers that are as small as a grain of rice.
  4. Women are advised to have a FREE screening mammogram every two years from age 45 to 69 years.
  5. If you find a breast lump, see your doctor to have it checked.
Seven New Zealand women, on average, will hear the news today that they have breast cancer. Most will survive five years or longer if the cancer is detected early enough but tragically, more than 600 women die of the disease every year. —NZ Breast Cancer Foundation

Causes

Cancer is caused when some of the cells in our body get out of control. These ‘cancerous' cells keep multiplying, forming a lump called a tumour that can spread to surrounding tissue, such as the breasts, and cause damage.

The causes of breast cancer are not clear, so there is no certain way to prevent it. There are some clues, or risk factors, about who is more likely to develop the disease.

Risk factors

The most important risk factors are:

  • sex – women are much more likely to get breast cancer than men
  • age – a woman's chances of developing breast cancer increase as she gets older
  • previous breast cancer
  • having an increased number of abnormal cells in the milk ducts (known as atypical hyperplasi')  this can be seen in a breast biopsy
  • a family history of breast cancer.

Women with a family history of breast cancer may have an increased risk of getting breast cancer. The risk can be mild, moderate or high and depends on the number of relatives affected, whether they are first or second degree relatives, (first degree are sisters or brothers and parents) and the age of the relative(s) when their breast cancer was found.

However, even among women with a high risk, most will not develop breast cancer. Those women with a very strong family history of breast cancer, who are shown to have inherited one of the abnormal genes associated with breast cancer, have an increased risk of developing breast cancer.

It is important to know that most women who develop breast cancer have no family history of the disease, so being aware of what to watch out for and having regular mammograms are your best protection.

Symptoms

Breasts undergo changes throughout a woman's life, particularly the normal changes experienced during the menstrual cycle. Some breast changes may be early signs of breast cancer, including:

  • a lump or lumpiness
  • thickening of the tissue
  • nipple changes, for example: skin dimpling
    • a blood-stained discharge from one nipple
    • an inverted nipple (unless the nipple has always been turned in)
    • a rash on a nipple
  • a change in shape
  • a painful area
  • a rash or red marks which appear only on the breast.

Although these changes do not necessarily mean you have breast cancer, any breast change should be checked by a doctor.

The majority of breast cancers begin in the milk ducts (ductal cancers), while a small number start in the milk sacs or lobules (lobular cancers). Within these two groups there are different subtypes of breast cancer.

Diagnosis

Breast cancer is diagnosed by physical examination, mammogram, scans, taking a sample of cells from the lump, biopsy or removal of the lump, and laboratory testing on any breast tissue samples. In some cases other scans or tests may be required. Your general practitioner may arrange these tests or you may be referred directly to a specialist.

Diagnostic imaging

Mammogram

mammogram is a breast x-ray. It will give your doctor more information about any lump or other change noticed. Occasionally, a lump that can be felt is not seen on a mammogram. Such a lump should not be ignored. Other tests will need to be done. 

Ultrasound

An ultrasound is a test using high frequency sound waves to help detect lumps or other changes.

Magnetic resonance imaging (MRI)

An MRI scan is a scan that uses magnetic resonance to detect abnormalities in the breast. This type of scan is sometimes used in lobular carcinomas to make sure there is not more than one cancer present, and it can check the other breast as well. It can also be used to check the breast if a mammogram is negative but the specialist is concerned about the lump or changes in the breast.

Fine needle aspiration

A fine needle aspiration can be done in your specialist's rooms, a hospital outpatient department, or at a laboratory by a pathologist. A very narrow needle is used to take some cells from the lump. These cells are then sent to a laboratory for examination.

A fine needle aspiration may cause a little discomfort but is not usually any more painful than a blood test. Results from this test may be available immediately or take some time, depending on where it is done.

Biopsy

Sometimes a biopsy will be necessary. A biopsy is the removal of a sample of a lump or the entire lump for examination under a microscope. This can be done as a core biopsy, surgical open biopsy or hook wire biopsy.

Core biopsy

A larger needle than that used for fine needle aspiration is used to obtain a sliver of tissue from the lump. This is done with a local anaesthetic. Core biopsy can be done by a radiologist under ultrasound guidance or in a mammogram machine (stereotactic core biopsy). Sometimes it is done by palpation (feeling) of the lump by the specialist.

Open biopsy

Sometimes, a surgical or open biopsy is necessary to remove the whole lump. This small operation is usually done under general anaesthetic, although occasionally a local anaesthetic is all that is needed. To have an open biopsy, you may need to stay in hospital overnight.

Hook wire biopsy

If the abnormality in the breast can only be detected by the mammogram (your doctor cannot feel the lump), a guide wire may be inserted in the breast to mark the area of the breast to be removed in the biopsy. This procedure takes place in the radiology department. The placement of the wire is done under local anaesthetic, and the abnormality is then removed as in an open biopsy under general anaesthetic, and sent to the laboratory for testing.

Hormone-receptor tests

If the lump is a cancer, hormone tests will be done using immuno-histochemistry (IHC), on the sample that was removed. These tests show whether the cancer cells have special 'markers' on them called 'hormone receptors' (oestrogen/progesterone). If these markers are present, the cancer is described as 'hormone receptor positive' and the cancer is more likely to respond to hormone treatment if this is needed later.

HER2 tests

HER2 is a growth factor protein which tells breast cancer cells to grow. Approximately one in five women with breast cancer test 'HER2 positive', which means their cancer is more aggressive.

Two tests (IHC and FISH) are available to check HER2. The IHC test is used first and if this is only weakly positive, then the FISH test is used. If tests show that you have HER2 positive cancer, this will influence future choices of chemotherapy, hormones, or monoclonal antibodies. A monoclonal antibody drug called trastuzumab (Herceptin) targets the growth factor so that breast cancer cells stop growing.

Staging breast cancer

'Staging' is a process of assessing the extent of a tumour. Other tests may also be necessary if cancer is diagnosed. These include blood tests and a chest x-ray. In some situations a bone scan and a liver scan may be done.

The complete results from the biopsy and any further tests will help to determine the best treatment for you. With this information your doctors will know if you have an early breast cancer, locally advanced breast cancer, or metastatic (secondary) breast cancer.

Grading breast cancer

The pathologist (doctor who looks at cancers in the laboratory) ‘grades’ the cancer from 1 to 3, according to the way the cancer cells look and behave.

The cells of a Grade 1 breast cancer look more like normal breast cells, whereas the cells of a Grade 3 breast cancer look very abnormal, indicating a faster-growing cancer.

The treatment choices you are offered will be based on all the information the doctor has about your cancer.

Treatment

Breast cancer is treated by several different methods: surgery, radiation treatment, chemotherapy and hormone treatment. The treatment choice, using just one treatment or a combination, depends on the actual breast cancer: its type, size, and whether or not it has spread; and the individual woman: her age, general health and personal choice.

Understand the options

Before any treatment begins, make sure you have discussed the choices with your doctor. Your doctor may advise that one method of treatment is better than another. Make sure you understand the reasons for this advice. Ask for a second opinion if you want one.

You may find it useful to have your husband or partner or another friend with you when you talk to the doctor. You may also find it helpful to make a list of questions before your visit. 

The treatment team

From the time you are first diagnosed with breast cancer you will be cared for by one or more of a team of health professionals including:

  • your family doctor, who will often be the first person you see
  • a breast surgeon who specialises in breast diseases, and sometimes a plastic (reconstructive) surgeon
  • a pathologist, a doctor who diagnoses disease by studying cells and tissues under a microscope
  • a radiation oncologist, a doctor who specialises in the use of radiation in the treatment of cancer
  • a medical oncologist, a doctor who specialises in the use of drug treatments for cancer
  • a radiation therapist, who prepares you and gives you your radiation treatment
  • oncology nurses and breast care nurses, who will help you through all stages of your cancer experience
  • dietitians, who will recommend the most suitable foods to eat
  • social workers, physiotherapists, and occupational therapists, who will advise you on the support services available, and help you get back to normal activities.

Ideally, your hospital should have all available means of diagnosis and treatment, although this will not be the case in some areas.

Surgery for breast cancer

The first treatment for breast cancer is usually surgery. This includes surgery on the breast and, for most women, on the glands in the armpit (the axillary lymph nodes). Examination of these lymph glands by the pathologist will indicate whether further treatment should be considered after the surgery.

The aim of surgery is to remove all of the cancer. The type of surgery depends on a number of factors, including the size of the cancer, the size of the breast, the position of the cancer in the breast, and the patient’s choice. Surgery may involve removing the cancer and a rim of breast tissue around it (wide local excision) or removing the whole breast (mastectomy). At the same time some of the lymph glands in the armpit are also removed.

Mastectomy

Mastectomy is the removal of the whole breast including some of the skin and the nipple. The chest muscles are not removed. Some lymph glands in the armpit are also removed during the operation. Usually the lymph nodes are removed through the same cut (incision) during this operation (called axillary node clearance – or dissection).

Today, mastectomy is less disfiguring than the radical mastectomy of the past. The type of mastectomy performed today allows for easier breast reconstruction. After mastectomy, most women will have a horizontal scar across their chest.

Breast reconstruction can be performed at the same time as mastectomy (immediate reconstruction) or after all the treatments for cancer are completed, as a separate operation (delayed reconstruction).

Breast-conserving treatment

For many women it is now possible to have smaller operations, such as partial mastectomy (or wide local excision). A breast-conserving operation involves removing the breast lump with some surrounding normal breast tissue to ensure a good clearance.

Surgery is then followed by radiation treatment to the remaining part of the breast – this is usually six to eight weeks after surgery. This makes sure any cancer cells that are still present in the breast are treated, and significantly reduces the risk of cancer recurring in the remaining breast tissue. Lymph glands are also removed for examination in these smaller operations, and this is often through a separate incision in the armpit.

Breast-conserving operations have been routinely performed now for many years. Studies show that both mastectomy and breast-conserving operations with radiation treatment are equally effective in the treatment of early breast cancer. However, breast-conserving surgery is not suitable for every woman with breast cancer.

Advantages and disadvantages of surgical methods

While many women may want a breast-conserving operation, the choice between a mastectomy and a breast-conserving operation depends on the size of the breast cancer and the size of the breast.

It is also helpful to weigh up the advantages and disadvantages of each method for yourself:

 

Advantages

Disadvantages

Mastectomy

Radiation treatment may not be needed

In some cases if the tumour is large, close to the underlying muscle or if there are many involved lymph nodes, radiation treatment is still recommended to reduce the risk of cancer recurring

 

In some small-breasted women, mastectomy and reconstruction will give a better cosmetic result than breast-conserving surgery

The breast is lost (though reconstruction is possible)

Breast-conserving operation

The breast is saved

Small-breasted women may find that the breast-conserving operation still leaves them with a big change in their breast shape and a potentially poor cosmetic result

 

 

Further treatment with radiation treatment is almost always needed. This can take up to six weeks

Side effects of breast surgery

  • Wound infection – the wound may feel tender, swollen, warm to touch. There may be redness in the area and/or discharge from the wound. You may feel unwell with fever and need antibiotics.
  • Bruising and haematoma (a collection of blood within the tissues surrounding the wound causing swelling, discomfort and hardness). The body will reabsorb the blood within a few weeks.
  • Pain – if you have lymph glands removed you are more likely to have pain in the armpit or down the arm. You will be advised about exercises to reduce pain and improve arm movement after surgery.
  • Cording – a pain like a tight cord running from your armpit, down your upper arm and through to the back of your hand. Cording is thought to be due to hardening of the lymph vessels. Cording may restrict movement and may continue for many months (physiotherapy and exercise may help)
  • Reduced sensitivity of the inner side of your upper arm due to nerve damage, may sometimes occur. This is usually temporary and improves or disappears about 3 months after surgery.
  • Some women have a swelling caused by fluid build up (seroma) that may need to be drained for days, and in some cases several weeks.
  • Swelling of the arm (lymphoedema) may occur in some women after lymph glands have been removedrom the armpit. On rare occasions this swelling can extend into the chest wall.
  • Reduced range of movement in the shoulder. You will be given an exercise programme to improve this after surgery. Sometimes a physiotherapist will help you with this.

Discuss possible side effects with your doctor before your operation. Report any problems that occur after surgery to your breast care nurse or doctor.

After your cancer has been removed, your surgeon will discuss your tumour with other specialists to decide what further treatment, if any, will be recommended.

Radiation treatment

Radiation treatment is the use of radiation (rays of energy called 'photons' or little particles called 'electrons') to destroy cancer cells, usually using a machine called a 'linear accelerator'. You will see a radiation oncologist who will discuss this treatment with you.

Treatment is carefully planned to reduce any effect on normal cells. Treatment is given four to five days a week, over about four to five weeks. It is painless and only takes a few minutes for each treatment. An extra radiation ‘boost dose’ may be given to the area where the breast cancer was located, taking the overall treatment time up to five to six weeks. Partial breast irradiation is currently being investigated as an alternative to whole breast irradiation in certain patients.

Sometimes radiation is given after mastectomy and axillary surgery to reduce the likelihood of developing recurrence in/over the chest wall or in the axillary or supraclavicular (above the collar bone) lymph nodes. This decision is usually made once the results of the surgery are available and the risks for recurrence in these sites have been assessed.

Radiation may also be used for the treatment of recurrence or cancers that cannot be removed, either in the area of the breast or in other parts of the breast. The aim is to try to control the disease or reduce symptoms. This usually requires fewer visits.

If you live a long way from the nearest oncology (cancer) centre, you will need to stay nearby during your radiation treatment. Oncology centres have special accommodation close by.

See also: radiation treatment

Side effects of radiation treatment

Side effects of radiation treatment may include:

  • general tiredness
  • some reddening or 'sunburning' of the skin – follow the advice of your radiation therapists regarding skin care and underarm hygiene
  • your breast may feel firmer.

Late side effects, which develop many months or years later, may include skin changes, changes in size, shape, colour, or feel of the breast. Radiation to the lymph nodes can increase the risk of developing lymphoedema.

If you are having radiation treatment you should get both extra rest and regular exercise to help cope with tiredness. Try to wear loose cotton clothing whenever possible to reduce any irritation to the area having the radiation. Talk with your doctor or the radiation therapy staff about any possible side effects and how to manage them.

See also: radiation treatment side effects

Chemotherapy

Chemotherapy is the treatment of cancer by drugs. The aim is to destroy cancer cells while having the least possible effect on normal cells. The drugs are usually injected into a vein via a drip so they can be circulated around the body.

Chemotherapy treats the whole body (systemic therapy) compared with surgery and radiation treatment, which are local treatments to a specific area in the body (breast, chest wall, axilla, etc).

Treatment is often in cycles at three-weekly intervals, and may last for 6 cycles (nearly 6 months). A doctor who specialises in cancer (an oncologist) will discuss all aspects of the treatment with you.

Chemotherapy is offered to some women with early breast cancer as an additional treatment to surgery, radiation treatment or both. This is called 'adjuvant chemotherapy'.

Adjuvant chemotherapy aims to destroy cancer cells that remain in the body but which cannot be detected. The purpose of this treatment is to reduce the chance of the breast cancer coming back (known as a recurrence).

Radiation treatment, if it is necessary, comes after chemotherapy, starting about 4 weeks after the last cycle of chemotherapy. Hormone therapy, if recommended, comes after the radiation treatment.

The women who are most likely to benefit from chemotherapy are those in whom the lymph glands in the armpit do have cancer cells. There is also a benefit from chemotherapy in women who do not have spread into armpit glands, but have more aggressive cancers (Grade 3 and oestrogen receptor negative). Women who are HER2 positive will benefit greatly from chemotherapy.

Women with large tumours or a type of cancer called inflammatory breast cancer may be offered chemotherapy pre-surgery. This is called neo-adjuvant chemotherapy.

See also: chemotherapy

Side effects of chemotherapy

Chemotherapy side effects vary according to the particular drugs used. When adjuvant chemotherapy is given to women with breast cancer, side effects may include:

  • infections – the drugs can lower your ability to fight infections (see below re fever)
  • sore mouth
  • nausea and vomiting
  • loss of appetite or taste changes
  • feeling off-colour and tired
  • thinning or loss of hair
  • if you are still having periods, you may find that your periods become irregular or stop while you are having treatment. If you are approaching the menopause, your periods may not return once the treatment has stopped
  • your ability to become pregnant may be affected by chemotherapy; however, this is not always certain. If you are sexually active with a male partner, you and your partner should use a reliable contraceptive, such as a diaphragm or condom during treatment because the drugs can cause birth defects or miscarriage
  • infertility – some women may be permanently infertile after chemotherapy
  • hot flushes, vaginal dryness, mood swings or other symptoms of menopause
  • individual chemotherapy drugs may have particular side effects, and these will be discussed with you.

When to see your doctor

If you are feverish (your temperature is 38 degrees C or more), or if you feel unwell in any way – do not wait to see what happens – take action quickly. Contact your cancer doctor or nurse, and follow the advice given.

Discuss any side effects with your doctor. Side effects are usually temporary and there are ways of reducing the impact of any unpleasant symptoms. If you have temporary hair loss you are entitled to a benefit to buy a wig.

See also: chemotherapy side effects

Monoclonal antibodies

Monoclonal antibodies are drugs that recognise and bind to specific proteins (receptors) that are found in particular cancer cells or in the bloodstream.

Trastuzumab (Herceptin) is given intravenously once every week or three weeks, and is usually well tolerated. It may cause some impairment of heart pumping function, especially when used with a chemotherapy drug which affects the heart. A heart echo test will be done every 12 weeks to check this.

Hormone treatments

Many breast cancers appear to be influenced by the female hormones, oestrogen and progesterone.

Pre-menopausal women may be offered tamoxifen, a hormone treatment taken as a tablet. They may also have menopause induced to stop their own production of hormones. This can be done by four-weekly injections with goserelin (Zoladex) or by surgical removal (laparoscopic oophorectomy) of the ovaries. Once you stop taking goserelin your periods will usually return.

Post-menopausal women may be offered oral hormone treatments – either tamoxifen or aromatase inhibitors anastrozole (Arimidex) or letrozole (Femara), which reduce the production of hormones in the body (other than from the ovaries).

General side effects of hormone treatments

Side effects of hormone treatments may include:

  • menopausal symptoms such as hot flushes, vaginal dryness, mood swings
  • effects on fertility – if you have not reached menopause it may still be possible to become pregnant while you are taking hormone therapies. If you are sexually active with a male partner, it is recommended you use reliable contraception, such as a diaphragm or condom. Sometimes you may have permanent menopause as a result of your hormone therapy.

Hormone drugs may cause additional side effects. Discuss these with your doctor.

Aromatase inhibitors can cause loss of minerals from bones (osteoporosis). It may be recommended you have a bone density study before starting or some time during treatment. Treatment may be given for several years. Osteoporosis can be treated with oral bisphosphonates (bone hardening drugs).

Taking part in a clinical trial

Research into the causes of breast cancer and into ways to prevent, detect and treat it, is continuing. Your doctor may suggest you consider taking part in a clinical trial. It is always your decision to take part in a clinical trial. If you do not wish to take part, your doctor will discuss the best current treatment option for you.
See also: cancer & clinical trials

After treatment

During your illness you will be monitored frequently. After the completion of your treatment you will have regular check-ups, and your doctor will decide how often these are required. Check-ups will gradually become less frequent if you have no further problems.

Many people worry that any pain or illness is a sign the cancer is coming back. This is usually not the case, but if you are worried, ask your doctor what to expect.

You may find it helpful to join, or continue in, a cancer support group.

Arm care

Following your surgery, it may take some time to regain the full use of your arm. Your physiotherapist or breast care nurse will give you instructions for exercises.

You may be concerned that your arm will swell after your lymph glands have been removed. This is much less common today because of the better methods of surgery and radiation treatment.

However, a few women will still develop problems with arm swelling (called lymphoedema). To reduce the risk of this happening, you should try to avoid injury or infection to your arm or hand.

Some simple measures will help:

  • Wear gardening gloves when gardening, use an oven glove when handling hot dishes, and use a thimble for sewing. If you're out in the sun, protect your arm from sunburn by wearing a long-sleeved shirt. Use a good sunscreen (SPF 30+) on uncovered areas.
  • Get help with heavy jobs like moving furniture or carrying heavy luggage, handbags, and avoid using heavy backpacks for any length of time.
  • It is suggested that it may be beneficial to wear a support sleeve when flying.
  • If it can be avoided, do not have your blood pressure or blood taken from that arm. Avoid having an intravenous drip in that arm and ask that any injections, including acupuncture or anaesthetics, be given elsewhere.
  • If you have a cut, clean it well and use an antiseptic dressing. See your doctor quickly if you think it is infected.
  • Be aware of swelling in the arms at any point in the future. Contact your doctor if this occurs.

Lymphoedema therapists and physiotherapists can also advise about the need to wear a support sleeve if swelling occurs.

Breast forms (prosthesis)

If you have had a mastectomy it is important to know about a breast form (prosthesis). A breast form can give a good cosmetic appearance as well as helping your balance and posture. Many women choose to use a breast form although some women prefer not to.

Breast forms are also available for women who have had lesser surgery (partial mastectomy). Immediately after surgery, temporary prostheses are available from your local Cancer Society or breast care nurse. About six weeks post-operatively, you may choose to wear a permanent prosthesis.

You are entitled to a benefit for a permanent breast form. Ask your surgeon or breast care nurse for a medical certificate of entitlement.

Reconstruction of the breast

After a mastectomy your breast can be reconstructed either immediately or at a later date. A surgeon's decision about which method of reconstruction to recommend is based on many different factors. Reconstruction should be discussed fully with your specialist, and you may be referred to a plastic (or reconstructive) surgeon.

Many women do not wish to have a reconstruction. Speaking with a breast care nurse or with women who have had breast cancer may be helpful. 

Possibility of cancer recurrence

Sometimes, breast cancer can come back (a recurrence). Most recurrences appear within five years after the initial treatment. Regular check-ups are necessary during this period.

You should also regularly examine your remaining breast and mastectomy area and report any unusual breast symptoms or general symptoms to your doctor. You will need a yearly mammogram.

Treatment of recurrent breast cancer may be by surgery, radiation treatment, chemotherapy or hormone treatment, or combinations of these. It aims to control the disease.

Successful treatment of recurrent breast cancer will allow many women to continue leading normal lives.

Common concerns following breast cancer treatment

Following breast cancer treatment, it is natural to have many questions and concerns that reach beyond whether the initial cancer has been cured. Your recent experiences mean you may need access to good advice on how to best cope with the physical, emotional and psychological upheaval breast cancer has had on your life. Common concerns include: 

Pain and numbness

Surgery for breast cancer is usually less extensive today than it used to be. However, pain after surgery, radiation treatment or chemotherapy is still a reality for some women. Pain is not something you should ignore (even if that is possible). Pain does not help your recovery and it can mean the things that do help (eg, sleep and ability to exercise) are hindered.

There are ways to minimise pain, not all of which involve medications. Your doctor, nurse or pain clinic can suggest suitable options (eg, a programme of exercise, yoga, meditation or acupuncture). Low doses of certain antidepressant medications can ease some sorts of pain.

Numbness or tingling in your arm is more common if lymph nodes have been removed from the armpit. This is normal and is caused by the slow regrowth of nerves, which needed to be cut during surgery. If it does not clear up in a few weeks or months you should tell your doctor or nurse.

Fluid build-up

If the cancer, surgery or radiation treatment involved the lymph nodes in the armpit, the normal drainage of fluid (lymph) from the hand and arm back to the body may be affected. In some women, this can cause arm swelling (lymphoedema), but it is less common with today's treatments.

Where this is a risk, it can often be prevented by regaining movement in the shoulder and by carrying out regular arm exercises recommended by your breast care nurse. It is important that you continue to protect this arm from injury, infection and sunburn and do not use it for heavy lifting. The problem can develop months or years after treatment.

Weight loss and fatigue

Weight loss and fatigue (ongoing tiredness) are known problems when recovering from breast cancer. In the past, women were advised to rest. Now, research shows women may feel better if they keep up a certain level of regular physical activity. Exercise can boost the immune system, help relieve pain, stress and depression, stimulate the appetite and help you sleep better. You should ask your doctor about suitable forms of exercise, and find one you can enjoy.

Menopause

The growth of some types of breast cancer is stimulated by the female hormone oestrogen and sometimes progesterone. For hormone-sensitive cancers, ongoing antihormonal drug treatment may be recommended. If you have not already been through menopause, the removal of the ovaries (surgically or medically) may be necessary with some treatments.

Stopping the body's oestrogen production or blocking its action on the cancer reduces the chances of the cancer coming back. However, this can create unwanted menopausal symptoms. Your doctor, nurse and wider team may be able to help provide advice on ways to reduce the impact of these symptoms.

Fertility

Some types of treatment (eg, chemotherapy) often cause infertility. For many women, being unable to have children is a difficult reality to have to face. You should take time to adjust to this loss and seek support from your partner, family, close friends and through your doctor and breast cancer team.

It is usually advised to use a reliable method of contraception for a couple of years after the end of treatment. This is the time cancers are more likely to recur and some treatments may harm an unborn baby. Even if a treatment is likely to make you infertile, it may not do so immediately, so contraception must be used during this time.

For women who become pregnant after finishing successful treatment, there is no evidence pregnancy increases the risk of breast cancer recurring.

Self-image and self-confidence

It is natural to experience a sense of shock and sadness immediately after breast cancer treatment. With time and support, any loss of confidence or self-esteem can be overcome. If you have had a mastectomy, you may find it helps to talk to other women who have been through a similar experience. Your breast nurse is trained to help with any problems you may have, including scarring, skin rash and finding a suitable prosthetic breast to wear inside your bra. Your surgeon will be able to discuss with you what options are available for breast reconstruction or implants.

Relationships and sexuality

The anxiety and/or depression felt by some women after diagnosis or treatment can affect their sexual desire. Tiredness following an anaesthetic, major surgery, radiation treatment or chemotherapy will also reduce sexual desire. If you have had a mastectomy, looking at yourself in the mirror can be difficult.

Sometimes women feel nervous about showing their mastectomy scar to their partners. It helps if you are able to discuss your feelings openly so that your partner understands your fears and concerns. However, sometimes partners may be unsure of their own reactions to the breast surgery.

If you and your partner need to make changes, it is important to remember that sexual intercourse is only one of the ways you can express affection for each other. Gestures of affection, gentle touches, cuddling and fondling also reassure you of your need for each other.

Talk to someone you trust if you are experiencing ongoing problems with sexual relationships. Friends, family members, nurses or your doctor may be able to help. Your Cancer Society can also provide information about counsellors who specialise in this area.

Depression and sleep problems

One in four women have some depression after breast cancer treatment. It is a normal response, but your doctor can discuss and provide treatment options for depression and assist you to find the support you need.

Exercise is beneficial for alleviating depression and for aiding sleep. Good sleep is important as it can improve your mood and energy level. If sleep is a problem, talk to your doctor.

Heredity and your family

About one in 20 breast cancers is caused by a faulty breast cancer (BRAC) gene. If yours was caused by such a gene, your doctor can help you decide whether genetic testing would be helpful for your wider family.

Learn more 

NZ Breast Cancer  NZ Breast Cancer Foundation, 2013
NZ Breast Cancer facts & statistics  NZ Breast Cancer Foundation
Breast Cancer  NHS Choices (UK), 2014
Living with Breast Cancer  NHS Choices (UK), 2014

Credits: Adapted from the Cancer Society NZ in 2007. Reviewed By: Health Navigator Team Last reviewed: 24 Mar 2015