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Last Updated: Friday, 31 March 2006, 21:06 GMT 22:06 UK
Q&A: Breast Cancer
Patient prepares for a mammogram
There are several different ways of treating breast cancer

Q: What do I need to know about breast cancer?

If you have been affected by any of the issues raised in the Panorama programme or are concerned that you may have been put at risk in Bradford you can contact our help-line, which we are running in conjunction with Breakthrough Breast Cancer and Breast Cancer Care, on 08080 100 200.

Alternatively you can call the Bradford Teaching Hospitals NHS Foundation Trust help-line on 01274 365922.

There is also a comprehensive guide to all forms of cancer available on the BBC health site.

Breast cancer is the most common form of cancer in women in the UK, affecting one in nine women at some point in their lives.

The guide you can link to below tells you how to look out for symptoms and what treatment will entail.

BBC Health website http://www.bbc.co.uk/health/womens_health/issues_breastcancer1.shtml

Similar guides exist for other forms of cancer on this site

http://www.bbc.co.uk/health/conditions/cancer/

Q: How is breast cancer treated?

There are several ways of treating breast cancer. Treatment is planned specifically for each individual woman; so different women receive different treatments.

Primary treatment refers to an operation to remove the tumour and other treatments aimed at killing any stray cancer cells in the breast or body. It usually involves some or all of the following options that may be given in various combinations: surgery, radiotherapy, chemotherapy or hormone therapy.

Surgery is usually the first treatment for most people diagnosed with breast cancer - to remove all or part of the breast.

If your cancer is quite small, you may be offered either breast conserving surgery (wide local excision or lumpectomy) usually followed by radiotherapy, or mastectomy (removal of the whole breast), after which radiotherapy is often not necessary.

If you have a mastectomy, a reconstruction (creation of a new breast) may be possible at the same time as your operation or at a later date.

Often, some or all of the lymph nodes (sometimes called the lymph glands) will also be removed from the armpit (the axilla) during your operation.

Breast cancer can sometimes spread to the lymph nodes and your doctor will want to assess whether this is the case. If cancer is found in on or more of the lymph nodes, the axilla needs to be treated by either removing all of the remaining lymph nodes (also known as axillary node clearance) or radiotherapy to the armpit.

Both you and your surgeon should be involved in making decisions about what surgery is best for you and your views should be taken into account.

It's often hard to take in all the information in at once, so it may be helpful to take a partner or friend with you to your consultation, or prepare a list of questions in advance.

Radiotherapy uses high energy x-rays to kill cancer cells. It is a localised treatment, which means it only kills cancer cells in the specific area where it is directed.

This is usually the affected breast, or area from where the breast was removed, and sometimes also the area of the lymph nodes in the armpit and above the collarbone.

Having radiotherapy after surgery for primary breast cancer has been shown to reduce the likelihood that the cancer will come back.

In general, radiotherapy is offered to women who have anything more than a very low risk of recurrence (risk of their cancer coming back) in the area of the breast and nearby lymph nodes (in the armpit and near the collarbone).

Radiotherapy is usually given after surgery and specialists believe it should start within four weeks of our being told that you need it, although current resources shortages mean that some women can wait longer than this.

Chemotherapy is treatment with one or more anti-cancer (cytotoxic) drugs, which aims to destroy cancer cells that may have spread beyond the breast and axillary lymph nodes, to other parts of the body.

Research studies have shown that chemotherapy can reduce the chance of breast cancer recurrence. The benefits are greatest among women whose disease has spread to the axillary lymph nodes.

Whether or not you should have chemotherapy will depend on a number of factors including your risk of recurrence, and your judgement on whether the side effects of this treatment outweigh the potential benefits for you.

Hormone therapies block the production of the female hormone oestrogen or reduce the ability of breast cancer cells to respond to this hormone.

Hormones are naturally occurring substances that control the growth and activity of cells in the body. The female hormone oestrogen can promote the growth of some breast cancer cells.

To see who will benefit from hormone therapy, a test measures whether or not breast cancer cells are using female hormones to assist their growth. This is known as the oestrogen receptor (ER) test.

If the ER test is negative, a similar test is sometimes carried out to see if cancer cells use another female hormone called progesterone to grow. If the ER test is positive you should be offered hormone therapy.

The most common hormone therapy used is Tamoxifen and patients benefit most from five years use.

Other hormone therapy drugs may also be used including a class of drugs called aromatase inhibitors e.g. arimidex (anastrozole) letrozole (femara). These drugs may be used instead of Tamoxifen - or alternatively as a cross-over therapy after two to three years of Tamoxifen.

Q: Why is radiotherapy important?

Radiotherapy uses high energy x-rays to kill cancer cells. It is a localised treatment, which means it only kills cancer cells in the specific area where it is directed.

This is usually the affected breast, or area from where the breast was removed, and sometimes also the area of the lymph nodes in the armpit and above the collarbone.

Radiotherapy to the breast should normally be given to women who have had breast conserving surgery. In general, women treated with surgery and radiotherapy have a one in ten chance of the cancer recurring in the breast after five years.

For some women - depending on their age at diagnosis and how early the cancer is detected - this can be reduced to a less than one in twenty chance. If no radiotherapy is given, the risk of recurrence in the same breast is higher - about a three in ten chance of recurrence within five years.

Whilst the chances of the breast cancer coming back in women who don't have radiotherapy after breast conserving surgery is higher compared to women who did have radiotherapy this does not mean that your cancer will definitely recur.

You may also have received treatment such as chemotherapy or hormone therapy which can also lower the risk of cancer coming back.

Q: When is radiotherapy not given?

Treatment is planned specifically for each individual woman; so different women receive different treatments.

Most but not all women require radiotherapy after breast conserving surgery. There may be some instances when radiotherapy treatment is not appropriate for clinical reasons. If a mastectomy is performed (removal of the whole breast), radiotherapy is often not needed.

Radiotherapy may not be offered to elderly patients over 70 or to women who have very small breast tumours with no spread of disease that have a very low risk of the cancer coming back in the breast or armpit.

It is also not appropriate for pregnant women to receive radiotherapy.

Q: How long after surgery does radiotherapy usually take place?

Waiting a few weeks for your radiotherapy treatment should not adversely affect your treatment for breast cancer.

Current guidelines recommend that radiotherapy centres should have sufficient staff and capacity to guarantee access to radiotherapy within four weeks of identification of need.

However, we know that some women are waiting significantly longer than this due to shortages in both radiotherapy equipment and staff.

If you are concerned about how long your are having to wait for radiotherapy treatment, you should raise your concerns with your GP, breast consultant or breast care nurse.

Q: If I didn't have radiotherapy am I more likely to get breast cancer again?

Every breast cancer is different and because of this the treatment approach required for each will be different. Breast cancer can present at an early, intermediate or advanced stage and it can grow slowly or rapidly.

All of these factors will contribute to how likely it is that your cancer will come back. Because different types of cancer need different treatment and the most appropriate treatment for you may not be the same as that for someone else.

Radiotherapy to the breast should normally be given to women who have had breast conserving surgery. In general, women treated with surgery and radiotherapy have a one in ten chance of the cancer recurring in the breast within five years.

For some women - depending on their age at diagnosis and how early the cancer is detected - this can be reduced to a less than one in twenty chance.

If no radiotherapy is given, the risk of recurrence in the same breast is higher - about a three in ten chance of recurrence within five years.

Whilst the chances of the breast cancer coming back in women who don't have radiotherapy after breast conserving surgery is higher compared to women who did have radiotherapy this does not mean that your cancer will definitely recur.

You may also have received treatment such as chemotherapy or hormone therapy which can also lower the risk of cancer coming back.

If you are at all concerned about the treatment you have received you should contact your GP, breast consultant or breast care nurse.

Q: Will radiotherapy help me live longer?

There is now evidence that radiotherapy can have a small but significant impact on long-term survival.

A study published in the Lancet in December last year found that after having radiotherapy the 15-year risk of dying in women with early breast cancer dropped from 36% to 31%.

Put differently, the study found that for every four local recurrences avoided by radiotherapy, one death is avoided.

Q: Where can I go for more information or support?

The following organisations can provide you with additional information.

The BBC is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites.

Useful websites

Breakthrough Breast Cancer

http://www.breakthrough.org.uk

Breast Cancer Care

http://www.breastcancercare.org.uk/Home

Lavender trust

http://www.lavendertrust.org.uk/Home

Breast Cancer Research

http://www.breastcancer.org/

CancerBACUP

http://www.cancerbacup.org.uk/Home

Cancer Research UK

http://www.cancerresearchuk.org/

Macmillan Cancer Relief

http://www.macmillan.org.uk/

NHS Breast Screening Programme

http://www.cancerscreening.nhs.uk/breastscreen/index.html

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