Breast cancer is a harmful growth that starts in your breast tissue. It is the most common cancer among New Zealand women, affecting 1 in 9 women over their lifetime.
On average, 8 New Zealand women will hear the news today that they have breast cancer. Most will live for 5 years or longer if the cancer is detected early enough, but more than 600 women die of the disease every year. 1
Men can develop breast cancer, though this is rarer, adding up to about 1% of all breast cancers.
Breast cancer can occur at any age but is most common in women between 50 and 70 years old. You are more at risk if you have a family history of breast cancer.
Treatment is usually more successful if breast cancer is found at an early stage.
For this reason, women are advised to have a free mammogram every two years from 45 to 69 years old.
By the time you can feel a breast cancer, it is about the size of a cherry or walnut, while mammograms can pick up breast cancers that are as small as a grain of rice.
If you find a breast lump, see your doctor to have it checked.
What are the causes of breast cancer?
Cancer is caused when some of the cells in our body start to grow out of control. These cells keep multiplying and form a lump called a tumour.
Some breast cancers grow very slowly, while others grow much faster. Breast cancer can spread to the lymph glands and to other parts of the body, such as the bones and liver.
Risk factors for breast cancer
The causes of breast cancer are not clear, but many risk factors are known. The following increase your chance of getting breast cancer:
getting older (for women)
having previously had breast cancer
having an increased number of abnormal cells in the milk ducts (atypical hyperplasia). This can be seen in a breast biopsy.
a family history of breast cancer. This 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, brothers and parents), and the age of the relative(s) when their breast cancer was found.
women who have inherited one of the abnormal BRCA genes associated with breast cancer.
even among women with a high risk, most will not develop breast cancer.
Heredity and breast cancer
About 1 in 20 breast cancers is caused by a faulty breast cancer 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. Find out more about the BRCA gene.
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.
What are the symptoms of breast cancer?
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, such as 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 breast shape
a painful area
a rash or red marks that appear only on your breast.
If you have any of these changes. You don’t necessarily have breast cancer, but you should see your doctor to get your breasts checked.
Most 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.
How is breast cancer diagnosed?
Your doctor will talk to you about your medical history and symptoms and will do a physical examination.
You may them be referred to a specialist for a mammogram and/or ultrasound scans. Further testing, such as taking a sample of cells from the lump, biopsy or removal of the lump, and laboratory testing on any breast tissue samples may be required.
Breast cancer is treated by four different methods: surgery, radiation treatment (radiotherapy), chemotherapy and hormone treatment. Find out more about each of these types of treatment for breast cancer.
Which treatment or combination of treatments is used depends on the type and size of the breast cancer and whether or not it has spread, and the age, general health and personal choice of the woman with breast cancer.
Understand your options
Before any treatment begins, make sure you have discussed the options 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.
Your treatment team
If you are diagnosed with breast cancer, you will be cared for by one or more of a team of health professionals, including:
your family doctor
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 help you through all stages of your cancer treatment
dietitians, who recommend the best foods to eat
social workers, physiotherapists and occupational therapists, who advise you on the support services available and help you get back to normal activities.
In some areas, not all means of diagnosis and treatment are available.
What happens after breast cancer treatment?
After your treatment is finished, you will have regular check-ups. Your doctor will decide how often these are needed. They will gradually become less often if you have no further problems.
You should also regularly examine your breasts, or remaining breast and mastectomy area. Tell your doctor about any unusual breast symptoms or general health symptoms.
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, talk to your doctor about what you are experiencing.
Sometimes, breast cancer can come back. This is called a recurrence. Most recurrences appear within five years after the initial treatment.
Treatment of recurrent breast cancer may be by surgery, radiation treatment, chemotherapy or hormone treatment or a combination of these. Treatment aims to control the disease.
Successful treatment of recurrent breast cancer allows 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.
Your general practitioner may arrange these tests or you may be referred directly to a specialist.
Your doctor will talk to your about your medical history and symptoms and will do a physical examination of your breasts. You may feel awkward about having this done so it may help to remember that your doctor does these kinds of examinations every day and will know how to ensure it is as comfortable and stress-free as possible.
If your regular doctor is a male you may feel more comfortable requesting to see a female doctor.
A 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.
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.
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.
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.
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.
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 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.
Which treatment or combination of treatments is used depends on the type and size of the breast cancer and whether it has spread, and the age, general health and personal choice of the woman with breast cancer.
The first treatment for breast cancer is usually surgery. The aim of surgery is to remove all the cancer. The type of surgery depends on factors such as the size of your cancer, the size of your breast, the position of the cancer in your breast and what you want.
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 your armpit (the axillary lymph nodes) are removed. A pathologist will examine these lymph glands to see whether you need further treatment after your surgery.
Mastectomy is the removal of your whole breast, including some of the skin and the nipple. Your chest muscles are not removed.
Usually, the lymph nodes in your armpit are removed through the same cut (incision) during this operation (called axillary node clearance or dissection).
Mastectomy performed today is less disfiguring than the radical mastectomy of the past. It is carried out in a way that makes it easier for your breast to be reconstructed. After a mastectomy, most women will have a horizontal scar across their chest.
Breast reconstruction can be performed at the same time as a mastectomy (immediate reconstruction) or after all your treatments for cancer are completed, as a separate operation (delayed reconstruction).
For many women, it is now possible to have a smaller operation, such as a 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 usually happens six to eight weeks after surgery. This makes sure any cancer cells that are still present in your 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. This is often done through a separate incision (cut) in your armpit.
Breast-conserving operations have been routinely performed 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, whether this is possible depends on the size of the breast cancer and the size of the breast.
It is helpful to weigh up the advantages and disadvantages of each method for yourself.
Radiation treatment may not be needed.
In some cases, if the tumour is large, close to the underlying muscle or if there are many lymph nodes involved, 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).
The breast is saved.
Small-breasted women may find that the breast-conserving operation 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
You may experience some of the following:
Wound infection. The wound may feel tender, swollen and warm to touch. There may be redness in the area and/or discharge from the wound. You may feel unwell with fever. If this happens, you need to see your doctor to get some antibiotics.
Bruising and haematoma (a collection of blood within the tissues surrounding the wound causing swelling, discomfort and hardness). Your body will reabsorb the blood within a few weeks.
If you have lymph glands removed, you are more likely to have pain in your armpit or down your arm. You will get advice about exercises to reduce the pain and improve your arm movement after surgery.
This is 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 your lymph vessels. Cording may restrict movement and continue for many months. Physiotherapy and exercise may help.
Reduced sensitivity of the inner side of your upper arm. This is due to nerve damage. It is usually temporary and improves or disappears about three months after surgery.
Swelling caused by fluid build-up (seroma). This may need to be drained for days, and in some cases, several weeks.
Swelling of your arm (lymphoedema) after your lymph glands have been removed from your 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.
It’s a good idea to discuss possible side effects with your doctor before your operation. Tell your breast care nurse or doctor if you have any of these side effects after your surgery.
After your operation, your surgeon will discuss your tumour with other specialists to decide what further treatment, if any, will be recommended to you. This might include radiation treatment, chemotherapy and/or hormone treatment.
After surgery 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 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.
These simple measures 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, and use a good sunscreen (SPF 30+) on uncovered areas.
Get help with heavy jobs like moving furniture or carrying heavy luggage or handbags, and avoid using heavy backpacks for any length of time.
It may help to wear a support sleeve when flying.
If it can be avoided, don’t 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 your arm at any point in the future. Contact your doctor if this occurs.
Lymphoedema therapists and physiotherapists can also advise you about the need to wear a support sleeve if your arm does swell up.
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 after your operation, 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 your breast
After a mastectomy, your breast can be reconstructed either straight away or later. A surgeon's decision about which method of reconstruction to recommend is based on many factors.
You should discuss reconstruction fully with your specialist and ask any questions you have before the operation. 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.
Radiation treatment is the use of radiation (rays of energy called photons or little particles called electrons) to destroy cancer cells. You will see a radiation oncologist who will discuss your 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 your breast cancer was located, taking the overall treatment time up to five to six weeks. Partial breast irradiation is being investigated as an alternative to whole breast irradiation for some patients.
Sometimes radiation is given after mastectomy and axillary (armpit) surgery to reduce the likelihood of developing recurrence in/over the chest wall or in the axillary (armpit) or supraclavicular (above the collarbone) 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 directly where it is situated or in other parts of the breast. The aim is to try to control the disease or reduce your 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.
some reddening or sunburning of your skin. Follow the advice of your radiation therapists about 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 your breast. Radiation to your lymph nodes can increase the risk of developing lymphoedema (swelling of your arm).
If you are having radiation treatment you should get both extra rest and regular exercise to help you cope with the tiredness. Try to wear loose cotton clothing whenever possible to reduce any irritation to the area having the radiation.
Before you start having the radiation treatment, talk with your doctor or the radiation therapy staff about any possible side effects and how to manage them.
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 your body.
Chemotherapy treats your whole body (systemic therapy) compared with surgery and radiation treatment, which are local treatments to a specific area in your body (such as your breast, chest wall or armpit).
Treatment is often in cycles at three-weekly intervals, and may last for six cycles (which means it takes nearly six 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 that cannot be detected. The purpose of this treatment is to reduce the chance of the breast cancer coming back (known as a recurrence).
If you are also having radiation treatment, that will happen after your chemotherapy, and will start about four weeks after your last cycle of chemotherapy. If you have been recommended hormone therapy, that will start after your radiation treatment.
You are most likely to benefit from chemotherapy when there are cancer cells in the lymph glands in your armpit. There is also a benefit from chemotherapy if you have a more aggressive cancer (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.
Chemotherapy side effects vary according to the particular drugs used. They may include the following:
infections – the drugs can lower your ability to fight infections
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, your periods may become irregular or stop while you are having treatment. If you are approaching menopause, your periods may not return once your treatment has stopped.
your ability to become pregnant; however, this is not always the case. 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 your doctor will discuss this with you.
When to see your doctor
If you are feverish (your temperature is 38° C or more), or if you feel unwell in any way, don’t wait to see what happens – take action quickly. Your body won’t be able to fight infection as well as it normally does. Contact your cancer doctor or nurse, and follow the advice they give you.
Discuss any side effects that you experience with your doctor. Side effects are usually temporary and there are ways of reducing the impact of any unpleasant symptoms. For example, if you have temporary hair loss you are entitled to a benefit to buy a wig.
Monoclonal antibodies are drugs that recognise and bind to specific proteins (receptors) that are found in particular cancer cells or in the bloodstream.
One of these is Trastuzumab (Herceptin). It is given intravenously once every week or three weeks, and is usually well tolerated. It may cause some impairment of your heart’s pumping function, especially when used with a chemotherapy drug that affects the heart. A heart echo test will be done every 12 weeks to check this.
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 your ovaries. Once you stop taking goserelin, your periods will usually return.
Post-menopausal women may be offered oral hormone treatments, either tamoxifen or an aromatase inhibitor anastrozole (Arimidex) or letrozole (Femara). These reduce the production of hormones in your body (other than from the ovaries).
Side effects of hormone treatments may include:
menopausal symptoms such as hot flushes, vaginal dryness or 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.
Specific hormone drugs may cause additional side effects. Discuss these with your doctor before you start treatment and if you notice any symptoms once you start.
Aromatase inhibitors can cause a loss of minerals from your bones (osteoporosis). You may be asked to have a bone density study before starting or sometime 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 whether or not 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.
Following breast cancer treatment, it is natural to have many questions and concerns that reach beyond simply 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.Regular follow-up health checks for women who have had breast cancer are recommended for 10 years, starting on a three-monthly basis. Your healthcare team will provide ongoing care and offer, or direct you to, sound advice.
Common concerns following breast cancer treatment
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.
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 (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.
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.
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 & 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.
Intimacy & sexuality
Breast cancer treatment can cause tiredness and stress, both of which can affect your sex drive (libido). The possible onset of menopause caused by treatment can also cause symptoms (eg, hot flushes, dry skin, vaginal dryness) which also affect libido. If you are being affected by menopause, talk to your doctor about possible treatments.
Being intimate after breast surgery takes time and trust. At first, you may feel uncomfortable getting undressed in front of your partner. The best approach is to try to communicate how you are feeling. Your partner may also be going through a difficult time. Let them know if you have any pain or skin tightening. Counselling may help overcome any issues around confidence or intimacy.
Depression & 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.
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.
33 tips on creating a great future after breast cancer
Baring it All is an eBook that gives practical tips to assist in rebuilding your life after cancer and guide you gently towards a life that you love.
About the author
Andrea Fairbairn is a Pacific Island New Zealand woman who’s had breast cancer twice. She was diagnosed with breast cancer in 2007 and again in 2011. From her breast cancer experiences, she wanted to share her vision of making breast cancer easier and a positive life changing moment, rather than all nausea and hair loss.