CANCER TYPE

Understanding
Breast Cancer
A guide for people with cancer, their families and friends

For information & support, call 13 11 20

Understanding Breast Cancer
A guide for people with cancer, their families and friends

First published May 2006. This edition September 2024.

© Cancer Council Australia 2024. ISBN 978 1 86507 000 1
Understanding Breast Cancer is reviewed approximately every 2 years.
Check the publication date above to ensure this copy is up to date.
Editor: Nicole MacKee. Designer: Ali Wright. Printer: IVE Group.

Acknowledgements
This edition has been developed by Cancer Council NSW on behalf of all other state and territory
Cancer Councils as part of a National Cancer Information Subcommittee initiative. We thank the
reviewers of this booklet: Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre, NSW;
Prof Bruce Mann, Specialist Breast Surgeon and Director, Breast Cancer Services, The Royal Melbourne
and The Royal Women’s Hospitals, VIC; Dr Shagun Aggarwal, Specialist Plastic and Reconstructive Surgeon,
Prince of Wales, Sydney Children’s and Royal Hospital for Women, NSW; Andrea Concannon, consumer;
Jenny Gilchrist, Nurse Practitioner Breast Oncology, Macquarie University Hospital, NSW; Monica Graham,
13 11 20 Consultant, Cancer Council WA; Natasha Keir, Nurse Practitioner Breast Oncology, GenesisCare,
QLD; Dr Bronwyn Kennedy, Breast Physician, Chris O’Brien Lifehouse and Westmead Breast Cancer Institute,
NSW; Lisa Montgomery, consumer; A/Prof Sanjay Warrier, Specialist Breast Surgeon, Chris O’Brien Lifehouse,
NSW; Dr Janice Yeh, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC. We also thank the health
professionals, consumers and editorial teams who have worked on previous editions of this title.

The photographs on page 37 have been reproduced with permission from A/Prof James French, Westmead
Breast Cancer Institute, NSW; Prof Elisabeth Elder, Westmead Breast Cancer Institute and The University of
Sydney, NSW; and Breast Cancer: Taking Control, [Link] © Boycare Publishing, 2010.

Note to reader
Always consult your doctor about matters that affect your health. This booklet is intended as a general
introduction to the topic and should not be seen as a substitute for medical, legal or financial advice. You
should obtain independent advice relevant to your specific situation from appropriate professionals, and you
may wish to discuss issues raised in this booklet with them. All care is taken to ensure that the information
in this booklet is accurate at the time of publication. Please note that information on cancer, including
the diagnosis, treatment and prevention of cancer, is constantly being updated and revised by medical
professionals and the research community. Cancer Council Australia and its members exclude all liability
for any injury, loss or damage incurred by use of or reliance on the information provided in this booklet.

Cancer Council
Cancer Council is Australia’s peak non-government cancer control organisation. Through the 8 state and
territory Cancer Councils, we provide a broad range of programs and services to help improve the quality of
life of people living with cancer, their families and friends. Cancer Councils also invest heavily in research and
prevention. To make a donation and help us beat cancer, visit [Link] or call your local Cancer Council.

Cancer Council acknowledges Traditional Custodians of Country throughout Australia and

recognises the continuing connection to lands, waters and communities. We pay our respects
to Aboriginal and Torres Strait Islander cultures and to Elders past, present and emerging.

Cancer Council Australia Level 2, 320 Pitt Street, Sydney NSW 2000 ABN 91 130 793 725
Telephone 02 8256 4100 Email info@[Link] Website [Link]
About this booklet
This booklet has been prepared to help you understand more about
early and locally advanced breast cancer, and includes a short section
on advanced (metastatic) breast cancer.

Many people feel shocked and upset when told they have breast
cancer. We hope this booklet will help you, your family and friends
understand how breast cancer is diagnosed and treated. We also
include information about support services.

We cannot give advice about the best treatment for you. You need to
discuss this with your doctors. However, this information may answer
some of your questions and help you think about what to ask your
treatment team (see page 67 for a question checklist).

This booklet does not need to be read from cover to cover – just read
the parts that are useful to you. Some medical terms that may be
unfamiliar are explained in the glossary (see page 68). You may also
like to pass this booklet to family and friends for their information.

How this booklet was developed – This information was developed with
help from a range of health professionals and people affected by breast
cancer. It is based on Australian clinical practice guidelines for early
breast cancer and international guidelines for advanced breast cancer.1-2

If you or your family have any questions or concerns, call

Cancer Council 13 11 20. We can send you more information
and connect you with support services in your area. You can
also visit your local Cancer Council website (see back cover).
Contents What is cancer? 4

The breasts 6

Key questions 8
What is breast cancer? 8
How common is breast cancer? 8
Does breast cancer run in families? 9
What are the risk factors for breast cancer? 10
What are the different types of breast conditions
and breast cancers? 12
What are the symptoms? 13
Which health professionals will I see? 13

Diagnosis 16
Mammogram 16
Ultrasound 17
Breast MRI scan 17
Biopsy 18
Further tests 19
Staging breast cancer 20
Grading breast cancer 21
Prognosis 21

Making treatment decisions 25

Treatment 27
Surgery 27
Radiation therapy 40
Chemotherapy 43
Hormone therapy 45
Targeted therapy 47 Key to icons
Immunotherapy 49 Icons are used
Treatment for advanced breast cancer 50 throughout this
booklet to indicate:

Managing side effects 52

Lymphoedema 52 More information
Cording 53
Nerve pain 53 Alert

Hair loss 54
Thinking and memory changes 54 Tips
Breast prostheses 55
Changes to body image and sexuality 56
Menopause and infertility 57

Looking after yourself 58

Life after treatment 60

Follow-up appointments 61
What if the cancer returns? 62

Caring for someone with cancer 63

Is this Cancer Council
booklet helpful?
Seeking support 64
Please follow this
Support from Cancer Council 65 QR code for a quick
Useful websites 66 3-minute survey,
or call 13 11 20 to
provide your feedback.
Question checklist 67

Glossary 68

How you can help 72

SCAN ME
 What is cancer?
Cancer is a disease of the cells. Cells are the body’s basic building
blocks – they make up tissues and organs. The body constantly makes
new cells to help us grow, replace worn-out tissue and heal injuries.

Normally, cells multiply and die in an orderly way, so that each new
cell replaces one lost. Sometimes, however, cells become abnormal
and keep growing. These abnormal cells may turn into cancer.

In solid cancers, such as breast cancer, the abnormal cells form

a mass or lump called a tumour. In some cancers, such as leukaemia,
the abnormal cells build up in the blood.

How cancer starts

Normal cells Abnormal cells Abnormal cells multiply

4 Understanding Breast Cancer

 Not all tumours are cancer. Benign tumours tend to grow slowly
and usually don’t move into other parts of the body or turn into
cancer. Cancerous tumours, also known as malignant tumours, have
the potential to spread. They may invade nearby tissue, destroying
normal cells. The cancer cells can break away and travel through the
bloodstream or lymph vessels to other parts of the body.

The cancer that first develops in a tissue or organ is called the primary
cancer. It is considered localised cancer if it has not spread to other
parts of the body. If the primary cancer cells grow and form another
tumour at a new site, it is called a secondary cancer or metastasis. A
metastasis keeps the name of the original cancer. For example, breast
cancer that has spread to the liver is called metastatic breast cancer,
even though the main symptoms may be coming from the liver.

How cancer spreads

Malignant cancer

Cancer cells
break away

Cancer cells
travel to lymph
nodes and
other parts
of the body
(metastasis)

Grows own Invades

blood vessels surrounding
(angiogenesis) tissue
Lymph vessel
Blood vessel

What is cancer? 5
 The breasts
The breasts sit on top of the upper ribs and a large chest muscle. They
cover the area from the collarbone (clavicle) to the armpit (axilla) and
across to the breastbone (sternum). Some breast tissue extends into
the armpit and is called the axillary tail. Female breasts are mostly
made up of:
• lobes – each breast has 12–20 sections called lobes
• lobules – each lobe contains glands that can produce milk; these milk
glands are called lobules or glandular tissue
• ducts – the lobes and lobules are connected by fine tubes called
ducts; the ducts carry milk to the nipples when breastfeeding
• fatty/fibrous tissue – all breasts contain some fatty or fibrous tissue
(including connective tissue called stroma), no matter their size.

Most younger women have dense or thicker breasts because they

contain more lobules than fat. Male breasts have ducts and fatty/fibrous
tissue. They usually contain no, or only a few, lobes and lobules.

The lymphatic system – The lymphatic system is an important part

of the immune system, which protects against disease and infection. The
lymphatic system drains excess fluid from body tissues into the blood. It
is made up of a network of thin tubes called lymph vessels. These vessels
connect to groups of small, bean-shaped lymph nodes (or glands).

There are lymph nodes throughout the body, including in the armpits,
neck, abdomen, groin and chest (near the breastbone). The first place
breast cancer cells usually spread to is the lymph nodes in the armpits
(axillary lymph nodes) or to the lymph nodes near the breastbone
(internal mammary lymph nodes).

6 Understanding Breast Cancer

The breasts

Front view

Collarbone
(clavicle)

Breastbone
(sternum)
Axillary lymph node

Areola
Nipple
Internal mammary
lymph node

Side view

Lobe

Lobule

Duct

Nipple

Muscle

Fatty tissue
Rib

The breasts 7
 Key questions
Q: What is breast cancer?
A: Breast cancer is the abnormal growth of cells in the breast. It
usually starts in the lining of the breast ducts or lobules, and can
grow into cancerous (malignant) tumours. Most breast cancers
are found when they are invasive. This means that the cancer has
spread from the breast ducts or lobules into the surrounding breast
tissue. Invasive breast cancer can be early, locally advanced or
advanced (metastatic). Advanced breast cancer is when cancer cells
have spread (metastasised) outside the breast and nearby lymph
nodes to other parts of the body. About 5% of cancers are advanced
when breast cancer is first diagnosed.

Q: How common is breast cancer?

A: About 20,700 people are diagnosed with breast cancer in Australia
every year.3

Women – In Australia, breast cancer is the most common cancer

in women (apart from common skin cancers), with 1 in 8 women
diagnosed by age 85. Young women can get breast cancer, but it is
more common over the age of 40, and the risk increases with age.
In rare cases, pregnant or breastfeeding women can get breast cancer.
See a doctor about any persistent lump noticed during pregnancy.

Men – About 220 men (most aged over 60) are diagnosed with breast
cancer each year. It is treated in the same way as for women. For
more information, visit [Link], or
[Link]/resource-hub/articles/breast-cancer-in-men.

8 Understanding Breast Cancer

 Transgender, non-binary and gender-diverse – Any transgender
woman taking medicines to boost female hormones and lower male
hormones has a higher breast cancer risk (compared with a man). A
transgender man who has had breasts removed in a nipple-sparing
mastectomy can still get breast cancer, although the risk is low.
▶ See our LGBTQI+ People and Cancer booklet.

Q: Does breast cancer run in families?

A: Most people with breast cancer do not have a strong family history,
but a small number may have inherited a gene fault (also called a
mutation) that increases their breast cancer risk.

BRCA1 and BRCA2 – These are the most common gene mutations
linked to breast cancer. Women in families with BRCA1 or BRCA2 are
at increased risk of breast and ovarian cancers. Men in families with
BRCA2 may be at increased risk of breast and prostate cancers.

Other genes linked to breast cancer – These include ATM, BARD1,

CDH1, CHEK2, PALB2, PTEN, RAD51C, RAD51D, and TP53. More
gene mutations linked to breast cancer are being found all the time.
A genetic test called an extended gene panel test checks for the most
common types of genes linked with breast cancer.

To find out if you have inherited a gene mutation, talk to your doctor
or breast cancer nurse about visiting a family cancer clinic or genetic
oncologist. Your specialist may also be able to order genetic tests.
In particular, women diagnosed before 40 years, those with triple
negative breast cancer diagnosed before 60 years, and men with
breast cancer should ask for a referral. Genetic testing is covered by
Medicare for some, but not all, people; ask your doctor about this.

Key questions 9
 What are the risk factors for breast cancer?
Many factors can increase your risk of breast cancer, but they do not mean that
you will develop it. You can also have none of the known risk factors and still get

Personal factors Lifestyle factors Family history

• Being female is the • Being overweight or • About 5–10% of breast

biggest risk factor – 99% gaining weight after cancers are due to an
of breast cancer cases menopause. Losing inherited breast cancer
are diagnosed in women. weight to a healthy gene such as BRCA1 or
• Risk increases with range can lower this. BRCA2 (see page 9).
age for both men • Drinking alcohol – the • Most people with
and women. more that you drink, breast cancer do not
• More than 3 in 4 breast the higher your risk. If have a strong family
cancer cases are in you choose to drink, history. However, having
women over the age the Australian alcohol several close relatives
of 50. Free breast guidelines suggest (e.g. mother, sister,
screening is available. you drink no more than aunt) on the same side
10 standard drinks a of the family who have
• Dense breast tissue (as
week, and no more than had breast or ovarian
seen on a mammogram)
4 standard drinks on cancer may increase
increases your risk.
any one day. your risk.
• Breast implants do not
• Not getting enough • Several close relatives
increase breast cancer
exercise or not being on the same side of the
risk, but some implants
physically active. family with prostate or
are linked with a type of
• Smoking tobacco. pancreatic cancer may
cancer called lymphoma.
increase your risk.
See [Link]/products/
medical-devices/breast-
implant-hub.

10 Understanding Breast Cancer

breast cancer. If you are worried, speak to your doctor. For more information,
see [Link] or [Link]/iprevent.

Hormonal factors Medical history Reproductive factors

• Long-term use of • Having been previously • Never having given

menopausal hormone diagnosed with breast birth to a child.
therapy (MHT) containing cancer, LCIS or DCIS • Starting your first
both oestrogen and (see next page). period (menstruating)
progesterone. • Some non-cancerous before the age of 12.
• Taking the oral conditions of excessive • Being older than
contraceptive pill (the growth of breast age 30 when you
pill) for a long time may cells (atypical ductal gave birth to your
slightly increase the risk. hyperplasia or ADH). first child.
• You or your mother using • Having radiation therapy • Never having
diethylstilboestrol (DES) to the chest area for breastfed a child.
during pregnancy. Hodgkin lymphoma.
• Going through
• Transgender women • Males with a rare menopause after
taking gender-affirming genetic syndrome the age of 55.
hormones for more called Klinefelter
than 5 years. syndrome. Those with
this syndrome have
3 sex chromosomes
(XXY) instead of the
usual 2 (XY).

Key questions 11
 What are the different types of breast conditions
and breast cancers?
Non-invasive breast conditions
These are conditions where the abnormal cells have not invaded nearby
tissues. Also called carcinoma in situ.

• abnormal cells in the breast ducts

ductal carcinoma • may develop into invasive breast cancer
in situ (DCIS) • treatment is similar to that for invasive breast
cancer, but chemotherapy is not used

• abnormal cells in the breast lobules

• does not develop into cancer but increases the risk
of developing cancer, including in the other breast
lobular carcinoma
• usually treated with surgery, and hormone therapy
in situ (LCIS)
may be used
• more regular mammograms or other scans needed
to check for any changes

Invasive breast cancers

Invasive means that the cancer cells have grown and spread beyond the
breast ducts/lobules and into the surrounding tissue. The 2 main types of
invasive breast cancer are named after the breast area that they start in.

invasive ductal • starts in the breast ducts

carcinoma (IDC) • about 80% of breast cancers are IDC

invasive lobular • starts in the breast lobules

carcinoma (ILC) • about 10% of breast cancers are ILC

Less common breast cancers include inflammatory breast cancer, medullary

carcinoma, mucinous carcinoma, Paget disease of the nipple (or breast) and
papillary carcinoma. Phyllodes tumour is a rare breast condition that may be
benign or malignant.
If invasive breast cancer spreads beyond the breast tissue and the nearby
lymph nodes, it is called advanced or metastatic breast cancer. See page 50,
or visit [Link] or [Link].

12 Understanding Breast Cancer

Q: What are the symptoms?
A: Breast cancer sometimes has no symptoms, so regular checks
(see page 16) are important for women aged 40 and over. Breast
changes may not mean cancer, but see a doctor if you notice:
• a lump, lumpiness or thickening, especially in just one breast
• a change in the size or shape of the breast or swelling
• a change to the nipple – change in shape, crusting, sores or ulcers,
redness, pain, a clear or bloody discharge, or a nipple that turns
in (inverted nipple) when it used to stick out
• a change in the skin – dimpling or indentation, a rash or itchiness,
scaly appearance, unusual redness or other colour changes
• swelling or discomfort in the armpit or near the collarbone
• ongoing, unusual breast pain not related to your period.

Q: Which health professionals will I see?

A: You may be sent for tests after a screening mammogram, or your
general practitioner (GP) may arrange tests to check your symptoms.
If these tests do not rule out cancer, you will usually be referred
to a specialist or breast clinic. If breast cancer is diagnosed, you
will see a breast surgeon or a medical oncologist, who will talk to
you about your treatment options. Often these will be discussed
with other health professionals at a multidisciplinary team (MDT)
meeting. During and after treatment, you will see a range of health
professionals who specialise in different aspects of your care (see
pages 14–15). You may not see all members of the MDT.

For an overview of what to expect at every stage of your cancer

care, visit [Link]/cancercareguides/breast-cancer. This
is a short guide to what is recommended, from diagnosis to
treatment and beyond.

Key questions 13
 Health professionals you may see
arranges initial tests to investigate symptoms; assists
you with treatment decisions and works in partnership
GP
with your specialists in providing ongoing care when
cancer is diagnosed

diagnoses breast cancer and other breast conditions,

breast physician especially when initial test results are unclear; provides care
and support during and after treatment

analyses mammograms, ultrasounds and other scans;

radiologist
performs fine needle and core biopsies to confirm diagnosis

radiographer/
performs mammograms, breast ultrasound and other scans
sonographer

diagnoses breast cancer, performs surgical (excisional)

biopsies in some clinics; performs breast surgery; some
breast surgeon breast surgeons also perform breast reconstruction;
oncoplastic breast surgeons specialise in using plastic
surgery techniques to reconstruct breast tissue after surgery

reconstructive
performs breast reconstruction after mastectomy
(plastic) surgeon

radiation treats cancer by prescribing and overseeing a course

oncologist of radiation therapy

treats cancer with drug therapies such as chemotherapy,

medical
hormone therapy, targeted therapy and immunotherapy
oncologist
(systemic treatment)

breast care provides breast cancer care; also provides information

nurse and facilitates referrals during and after treatment

chemotherapy administers drugs and provides care, information

nurse and support throughout treatment

14 Understanding Breast Cancer

 assesses your health before the operation, administers
anaesthetist anaesthetic and looks after you during and after surgery;
plans your pain relief

radiation therapist plans and delivers radiation therapy

physiotherapist,
help restore movement and mobility, and improve fitness
exercise
and wellbeing
physiologist

occupational assists in adapting your living and working environment to

therapist help you resume usual activities after treatment

educates people about lymphoedema prevention

lymphoedema and management, and provides treatment if
practitioner lymphoedema occurs; is often a physiotherapist
or occupational therapist

links you to support services and helps you with

social worker
emotional, practical and financial issues

helps with nutrition concerns and recommends changes

dietitian
to diet during treatment and recovery

psychologist, help you manage your emotional response to diagnosis

counsellor and treatment

provides advice for people with a strong family history

genetic counsellor of breast cancer or for people with a genetic condition
linked to cancer

sexual health helps you manage the sexual side effects of cancer
counsellor and its treatments

Key questions 15
 Diagnosis
If you notice any breast changes or a swelling in your armpit, your GP
will ask about your medical history and any family history of breast
cancer. They will do a physical examination, checking both breasts and
the lymph nodes in your armpit and above your collarbone. Your GP
may also arrange some imaging tests, such as a diagnostic mammogram
and/or an ultrasound and, if required, a biopsy. This is called a triple test.

Sometimes, a specialist will arrange these and additional tests, such

as a breast MRI scan. You will also be referred for further tests if a
screening mammogram has shown anything unusual.

Mammogram
A mammogram is a low-dose x-ray of the breast tissue. It can check any
lump or other breast changes found during a physical examination. It
can also show changes that are small or cannot be felt during a physical
examination. If you have breast implants, it is important to let staff know
before the mammogram.

Your breast is placed between 2 x-ray plates. The plates press together
firmly to spread out the breast tissue so that clear pictures can be taken.
You will feel some pressure, which can be uncomfortable, but the
mammogram only takes 10–15 seconds. Both breasts will be checked.

A national screening program provides a free mammogram for

all women aged over 40. For more information, call 13 20 50 or
visit [Link]/bsa.

16 Understanding Breast Cancer

 Before a scan, tell the doctor if you have any allergies or had a
reaction to dyes during previous scans. Also tell them if you have
diabetes or kidney disease or are pregnant or breastfeeding.

Tomosynthesis – Also known as three-dimensional mammography,

tomosynthesis takes x-rays of the breast from many angles and combines
them into a three-dimensional (3D) image. This may be better for finding
small breast cancers, particularly in dense breast tissue.

Contrast enhanced mammogram (CEM) – This combines

tomosynthesis with a dye (contrast) that is injected into a vein in your
arm. A CEM may be helpful for people with dense breast tissue.

Ultrasound
An ultrasound uses soundwaves to create a picture of breast tissue. It
does not use radiation. It is often the first test done in women under
30 years with breast changes, or if a screening mammogram has picked
up breast changes, or if you or your GP can feel a lump.

A gel will be spread on your breast, and then a small device (transducer)
is moved over the breast and armpit. This sends soundwaves that echo
when they meet something dense, like a tumour. A computer creates a
picture from these echoes. The scan takes 15–20 minutes and is painless.

Breast MRI scan

A magnetic resonance imaging (MRI) scan uses a large magnet and
radio waves to take pictures of the breast tissue. It does not use radiation.
It is mainly used for people at high risk of breast cancer or who have
very dense breast tissue or breast implants. It may also be used if other
imaging test results are unclear or to help plan surgery.

Diagnosis 17
 Before a breast MRI scan, you will usually have an injection of a dye
(called contrast) to help show any abnormal breast tissue. You will lie
face down on a table, which will slide into a large, cylinder-shaped
machine. The scan can take up to 40 minutes. It is painless but loud,
so you will wear earplugs. Some people feel claustrophobic. If you are
concerned, talk to your doctor. You may be offered a mild sedative.

Biopsy
If breast cancer is suspected, a small sample of cells or tissue is taken
from the lump or area of concern. A specialist doctor called a pathologist
then checks the sample under a microscope for any cancer cells.

There are different ways of taking a biopsy and you may need more
than one type. The biopsy may be done in a specialist’s rooms, at a
radiology practice, in hospital or at a breast clinic. After any type of
biopsy, your breast may feel sore and be bruised for a few days.
• Fine needle aspiration (FNA) – A thin needle is inserted into an
abnormal lymph node or other tissue, often with an ultrasound to
help guide the needle into place. Tiny pieces of tissue can then be
sucked out through the needle. A local anaesthetic may be used
to numb the area.
• Core biopsy – Several pieces of tissue are removed with a needle.
Local anaesthetic is used to numb the area, and a mammogram,
ultrasound or MRI scan is used to guide the needle into the right area.
• Vacuum-assisted core biopsy – A needle attached to a suction-type
instrument is inserted into the breast through a small cut in the skin.
A larger amount of tissue is removed with a vacuum biopsy, making it
more accurate in some cases. The needle is usually guided into place
with a mammogram, ultrasound or MRI. A local anaesthetic is used,
but you may feel some discomfort. Stitches are not usually needed.

18 Understanding Breast Cancer

• Surgical (excision) biopsy – If a needle biopsy is not possible, or the
diagnosis remains unclear, you may have a surgical biopsy to remove
all or part of a lump. A wire or small surgical clip may be inserted
to act as a guide during the surgery. The tissue is then removed under
general anaesthetic. This is usually done as day surgery.

Further tests
If the tests described on pages 16–19 show that you have breast cancer,
you may have further tests to check whether the cancer has spread to
other parts of your body. You will have a blood test to check your general
health, and in some cases, it will test for specific tumour markers.

You may also have some of the following types of scans.

Bone scan – A bone scan is used to see if the breast cancer has spread
to your bones. A small amount of radioactive solution is injected into a
vein, usually in your arm. This solution is attracted to abnormal areas
of the bone. After a few hours, the bones are viewed with a scanning
machine. The scan is painless and the solution is not harmful.

CT scan – A CT (computerised tomography) scan uses x-ray beams to

take pictures of the inside of the body. Before the scan, dye (contrast) will
be injected into a vein in your arm. This dye helps to make the pictures
clearer. For the scan, you lie flat on a table while the scanner takes
pictures. The scan takes about 30 minutes and is painless.

PET scan – In a PET (positron emission tomography) scan, a small

amount of low-level radioactive solution is injected into a vein in the
arm or hand. Any cancerous areas take up more of the radioactive
solution and may show up brighter in the scan.

Diagnosis 19
 Staging breast cancer
The tests described on pages 16–19 show the size of the breast cancer and
if it has spread to other parts of the body. This is called staging. It helps
you and your health care team decide what treatment is best.

The most common staging system used for breast cancer is the TNM
system. Letters and numbers describe how big the tumour is (T), if
cancer has spread to nearby lymph nodes (N), or if it has spread to the
bones or other organs, which is known as having metastasised (M).

The staging system also describes other details about the breast tumour
such as oestrogen and progesterone receptor status, HER2 status (see
pages 22–23) and the grade of the cancer (see opposite page). Staging is
usually done after surgery so the treatment team have full information
about the cancer and whether it has spread to lymph nodes. The cancer
may be classified as:
• Early breast cancer (stage 1 or 2) – The cancer is contained in the
breast and may or may not have spread to lymph nodes in the armpit.
• Locally advanced breast cancer (stage 3) – The cancer is larger than
5 cm, has spread to tissues around the breast such as the skin or muscle
or ribs, or has spread to a large number of lymph nodes.
• Metastatic breast cancer (stage 4) – The cancer has spread to other
parts of the body from the breast. Also called secondary or advanced
breast cancer, it is different from locally advanced breast cancer.

Gene expression profile tests help the doctors understand

more about the cancer and the best way to treat it (see page 23).
These tests may also be called molecular assays or genomic
tests. They are different from genetic tests, which check if you
have inherited a gene mutation linked to breast cancer. For
more information about genetic tests, see page 9.

20 Understanding Breast Cancer

Grading breast cancer
The grade describes how active the cancer cells are and how fast the cancer
is likely to be growing.

grade 1 Cancer cells look a little different from normal

(low grade) cells. They are usually growing slowly.

grade 2 Cancer cells do not look like normal cells. They

(intermediate grade) are growing faster than grade 1 cancer cells.

grade 3 Cancer cells look very different from normal cells.

(high grade) They are usually growing fast.

Prognosis
Prognosis means the expected outcome of a disease. You may wish to
discuss your prognosis with your doctor, but it is not possible for anyone
to predict the exact course of the disease.

To work out your prognosis, your doctor will consider the stage and
grade of the cancer, as well as features such as the cancer’s hormone
receptor and HER2 status (see pages 22–23).

The survival rates for people with breast cancer have increased
significantly over time due to more people taking part in breast
screening, better tests and scans, and improved medicines and
treatments. Doctors often use 5-year survival rates as a way to discuss
prognosis. This is because research studies often follow people for
5 years; it does not mean you will survive for only 5 years. It also does
not mean that the cancer cannot come back after 5 years.

Compared with other cancers, breast cancer has one of the highest
5-year survival rates when diagnosed early.

Diagnosis 21
 Tests on breast tissue
If tests on the biopsy sample confirm you have breast cancer, extra tests on the
biopsy sample will be done to understand more about the breast cancer and help
plan treatment. The results will be included in the pathology report.

Hormone receptor status HER2 status

ER+ and/or PR+ HER2+

70–80% 15–20%
of all breast of all breast
cancers cancers

The hormones oestrogen and HER2 (human epidermal growth factor

progesterone are produced naturally receptor 2) is a protein that is found on
in the body. A receptor is a protein on the surface of some cells and controls
the surface of the cell. Normal breast how cells grow and divide. HER2 levels
cells have oestrogen receptors (ER) and are worked out with an initial test of the
progesterone receptors (PR). Breast protein, and then can be confirmed with
cancers that have these receptors are an in-situ hybridisation (ISH) test, which
known as ER positive (ER+) or PR positive is done before giving targeted therapy.
(PR+). This means that oestrogen or
Tumours with high levels of these receptors
progesterone enters the cell, where it may
are called HER2 positive (HER2+). Tumours
stimulate cancer cells to grow.
with low levels are called HER2 negative
ER+ and PR+ cancers are usually (HER2– or HER2 low).
treated with hormone therapy drugs
It is often recommended that people with
(also known as endocrine therapy) that
HER2+ breast cancer have chemotherapy
block the receptor, or drugs that reduce
and targeted therapy before they have
the amount of hormones that the body
surgery (neoadjuvant treatment, see
makes (aromatase inhibitors).
page 28). Depending on how the cancer
If the cancer has low levels of oestrogen responds to the neoadjuvant treatment and
receptors, hormone therapy drugs are surgery, you may also have chemotherapy
sometimes used. These drugs are not used or targeted therapy after surgery (adjuvant
for cancers with no oestrogen receptors. treatment, see page 28).

22 Understanding Breast Cancer

 What are gene expression
profile tests?
Gene expression profile tests may
be done on the biopsy sample.
These tests look at which genes are
Triple negative breast cancer active in the cancer cells. The results
ER–, PR– and HER2– provide information about the risk of
cancer returning.

These tests may also be called

10–20% genomic tests or molecular assays.
of all breast They are different to genetic tests,
which are used to look for inherited
cancers
gene faults (see page 9).

Some breast cancers do not have The gene expression profile

oestrogen (ER–), progesterone (PR–) or tests available in Australia are
HER2 (HER2–) receptors. These are called Oncotype DX, EndoPredict, PAM50,
triple negative breast cancers. and MammaPrint.

Triple negative breast cancers do not The test results will help the doctor
respond to hormone therapy or to work out if chemotherapy will be
the targeted therapy drugs used for helpful after surgery. It can take
HER2+ cancers in early breast cancers. 14 days for the results to come back,
so it’s important to order these tests
These types of cancer usually respond as soon as possible. It may be helpful
well to chemotherapy, so this may be used for your surgeon to order these tests
before and/or after surgery (neoadjuvant/ before you see your oncologist.
adjuvant treatment, see page 28).
Ask your doctor if a gene expression
Some other types of targeted therapy may profile test is an option for you. The
be used for triple negative breast cancer. standard pathology tests done on
all breast cancers may be all that is
Recently, various types of immunotherapy
needed for your treatment plan.
have been shown to work well for some
triple negative cancers. These may be Gene expression profile tests may
used before surgery for larger cancers or not be covered by Medicare; check
for cancers that also affect lymph nodes. what you may have to pay.

Diagnosis 23
 Key points about diagnosing breast cancer

Main tests Tests to diagnose breast cancer include:

• physical examination
• mammogram (breast x-ray)
• ultrasound
• breast MRI scan
• biopsy (taking a tissue sample).

Further tests Further tests can give more information about

the cancer to help guide treatment. These tests
may include:
• blood tests
• bone scan
• CT scan
• PET scan.

Staging and The stage shows how far the cancer has spread.
grading Early breast cancer is stage 1 or 2. Locally advanced
breast cancer is stage 3. Cancer that has spread to
other parts of the body is stage 4.

Key information • Hormone receptor status (ER+/– and PR+/–)

about the shows whether the cancer may respond to
cancer hormone therapy.
• HER2 status (HER2+/–) shows whether the
cancer may respond to chemotherapy and
targeted therapy.
• Gene expression profile tests (also called genomic
tests or molecular assays) look at gene patterns in
cancer cells. They can help show if chemotherapy
would be useful in early breast cancer.

24 Understanding Breast Cancer

Making treatment
decisions
Sometimes it is difficult to decide on the type of treatment to have.
You may feel that everything is happening too fast, or you might be
anxious to get started.

Check with your specialist how soon treatment should begin, as

it may not affect the success of the treatment to wait a while.
Ask them to explain the options, and take what time you can before
making a decision.

Know your options – Understanding the disease, the available

treatments, possible side effects and any extra costs can help you
weigh up the options and make a well-informed decision. Check if the
specialist is part of a multidisciplinary team (see page 13) and if the
treatment centre is the most appropriate one for you – you may be able
to have treatment closer to home, or it might be worth travelling to a
centre that specialises in a particular treatment.

Record the details – When your doctor first says you have cancer,
you may not remember everything you are told. Taking notes can
help. If you would like to record the discussion, ask your doctor first.
It is a good idea to have a family member or friend go with you to
appointments to join in the discussion, write notes or simply listen.

Ask questions – If you are confused or want to check anything, it

is important to ask your specialist questions. Try to prepare a list
before appointments (see page 67 for suggestions). If you have a lot
of questions, you could talk to a breast care nurse.

Making treatment decisions 25

 Consider a second opinion – You may want to get a second opinion
from another specialist, to confirm or clarify your specialist’s
recommendations, or to reassure you that you have explored all of your
options. Specialists are used to people doing this. Your GP or specialist
can refer you to another specialist and send your initial results to that
person. You can get a second opinion even if you have started treatment
or still want to be treated by your first doctor. You might decide you
would prefer to be treated by the second specialist.

It’s your decision – Adults have the right to accept or refuse any
treatment that they are offered. For example, some people with
advanced cancer choose treatment that has significant side effects, even
if it gives only a small benefit for a short period of time. Others decide
to focus their treatment on quality of life. You may want to discuss your
decision with the treatment team, GP, family and friends.
▶ See our Cancer Care and Your Rights booklet.

Should I join a clinical trial?

Your doctor or nurse may suggest you led to better outcomes for people
take part in a clinical trial. Doctors run diagnosed with cancer.
clinical trials to test new or modified
treatments and ways of diagnosing You may find it helpful to talk to
disease to see if they are better your specialist, clinical trials nurse
than current methods. For example, or GP, or to get a second opinion.
if you join a randomised trial for a If you decide to take part in a
new treatment, you will be chosen clinical trial, you can withdraw at
at random to receive either the best any time. For more information,
existing treatment or the modified visit [Link].
new treatment. Over the years, trials ▶ See our Understanding Clinical
have improved treatments and Trials and Research booklet.

26 Understanding Breast Cancer

Treatment
This chapter focuses on treatment for early and locally advanced
breast cancer. For information on the treatment of advanced breast
cancer, see page 50.

Treatment for early or locally advanced breast cancer varies from

person to person. The treatment that is best for you will depend on your
test results, where the cancer is in the breast, the stage and grade of the
cancer (see pages 20–21), and whether the cancer is hormone receptor
and/or HER2 positive or triple negative (see pages 22–23). Your doctor
will also consider your age and general health, and your preferences.

Treatment for early and locally advanced breast cancer usually includes
surgery. Before surgery, however, you may have other types of treatment
to shrink the cancer. This is called neoadjuvant treatment (see next page).

Surgery
The type of surgery your doctor suggests will depend on the type and
stage of the cancer, where it is in the breast, the size of your breast, and
what you prefer. In most cases, you will have one or more lymph nodes
removed from the armpit (called axillary surgery, see pages 32–33).
Some people also choose to have a new breast shape made during the
operation (breast reconstruction, see page 31).

The 2 different types of surgery used for breast cancer are:

• breast-conserving surgery – when only part of the breast is removed
(see page 29)
• mastectomy – when the whole breast is removed (see page 30).

Treatment 27
 Depending on your situation, you may have a choice between the
2 types of surgery. Research has shown that for most early breast
cancers, having breast-conserving surgery followed by radiation
therapy (see pages 40–42) works just as well as a mastectomy.

The operations have different benefits, risks and side effects. Talk
to your doctor about the best option for you.

Treatment before surgery

While surgery is often the main may mean you can choose to have
treatment for both early and locally breast-conserving surgery rather
advanced breast cancer, you may than a mastectomy.
have other treatments before surgery.
In some cases – particularly for
Called neoadjuvant treatment, it people with HER2+ or triple negative
may be discussed at an MDT (see cancers – neoadjuvant treatment can
page 13). Chemotherapy is often kill all cancer cells. Called a complete
used before surgery (neoadjuvant pathological response, it improves
chemotherapy or NAC). Or, you the chance of a good outcome.
may have hormone therapy, targeted
therapy or immunotherapy (see Ask your doctor if neoadjuvant
pages 45–49), or a combination treatment is an option for you. People
of these treatments. with early breast cancer may find the
Neoadjuvant Patient Decision Aid
Neoadjuvant treatment can help helpful. Visit [Link].
to reduce the size of the cancer
before surgery and improve your After surgery, you may have
chance of having a good outcome. radiation therapy, chemotherapy,
It may also mean you can have less hormone therapy, targeted therapy
complex surgery. or immunotherapy. This is called
adjuvant treatment. It helps to
For locally advanced breast cancer, destroy any cancer cells that
for example, neoadjuvant treatment remain after surgery.

28 Understanding Breast Cancer

Breast-conserving surgery
Removing only part of the breast is called breast-conserving surgery.
It is also known as a lumpectomy or wide local excision.

The surgeon removes the tumour and some of the healthy tissue
around it, so that you can keep as much of your breast as possible.
The operation will leave a scar, and it may change the size and shape
of the breast and the position of the nipple.

Pathology tests on breast tissue

A pathologist looks at the removed tissue under a microscope to check
for an area of healthy cells around the cancer (called a clear margin).
The pathologist will also give information about:
• the size and grade of the cancer (see pages 20–21)
• whether the cells are hormone receptor positive and/or HER2+ or
triple negative (see pages 22–23)
• whether the cancer has spread to any lymph nodes (see pages 32–33).

If your removed tissue shows multiple cancers, each cancer will be

tested separately. The pathology report will help your doctors work
out what other treatment may be best for you. If there are cancer cells
found close at the edge of the tissue (which is called an involved or
positive margin), there is a higher risk of the cancer returning.

You may need to have further surgery to remove more tissue (called
a re-excision or wider excision). Your doctor may also suggest that
you have a mastectomy (see page 30).

After having breast-conserving surgery, you will usually then have

radiation therapy to destroy any cancer cells that may be left in the
breast or armpit (see pages 40–42).

Treatment 29
 Mastectomy
Surgery to remove the whole breast is called a mastectomy. One breast
may be removed (single or unilateral mastectomy) or both breasts (double
or bilateral mastectomy). A mastectomy may be recommended if:
• there is cancer in more than one area of the breast
• the cancer is large compared with the size of the breast
• it is difficult to get a clear margin around the tumour
• you have inflammatory breast cancer
• you have had radiation therapy to the same breast before and so
cannot have it again
• the cancer has come back or you have a new cancer in the same breast
• you have the BRCA1 or BRCA2 gene mutation.

You may prefer to have a mastectomy instead of breast-conserving

surgery – even if you have a very small cancer. You will not usually
have radiation therapy after a mastectomy, although it may be offered
in some situations.

The nipple is often removed in a mastectomy. In some cases, however,

the surgeon may perform a skin-sparing or nipple-sparing mastectomy.
This means that more of the normal skin (with or without the nipple)
is kept. If you have decided to have a reconstruction (see opposite
page), and can have a skin-sparing or nipple-sparing mastectomy,
the reconstruction is sometimes done at the same time.

If you don’t have a reconstruction, you have the option of wearing a soft
breast form with a specially designed bra while your surgical wound
heals. Breast Cancer Network Australia (BCNA) provides a free bra and
temporary soft form. Speak to your breast care nurse for more details.
After the wound has healed and the area is comfortable, you have the
option to be fitted for a permanent breast prosthesis (see page 55).

30 Understanding Breast Cancer

What about the other breast?
If you need a mastectomy because of developing another breast cancer,
of cancer in one breast, you may so you may choose to have a double
think it’s safer to have the other mastectomy (bilateral mastectomy) to
breast removed as well. For most remove both breasts.
people, the risk of getting cancer
in the other breast is low. Whether to have a double
mastectomy is a complex decision.
If you have the BRCA1 or BRCA2 gene It is best to talk with your treatment
or another rare breast cancer gene team about the risks and benefits
mutation, this does increase the risk before making a final decision.

Breast reconstruction
Breast reconstruction is surgery to make a new breast shape (also
called a breast mound). There are different ways to construct a breast
shape. It can be done using:
• implants
• a flap of your own skin, fat or muscle (an autologous reconstruction)
• a breast implant and your own tissue.

A breast reconstruction can be done at the same time as a mastectomy

(immediate reconstruction); or you may prefer to wait for several months
or years before having a reconstruction (delayed reconstruction). If you
are not having an immediate reconstruction but might consider it in the
future, discuss this with your surgeon before surgery. This will help them
to plan the mastectomy.

Some people decide not to have a reconstruction and prefer to “go flat”,
while others choose to wear a breast prosthesis (see page 55).
▶ See our Breast Prostheses and Reconstruction booklet.

Treatment 31
 Removing lymph nodes
Cancer cells that spread from the breast usually first spread to the
axillary lymph nodes, which are in and around the armpit. Removing
some or all of these lymph nodes helps your doctor to check for any
cancer spread. The operation to remove lymph nodes is called axillary
surgery. It is usually done during breast surgery but may be done in a
separate operation. There are 2 main types of axillary surgery.

Sentinel lymph node biopsy (SLNB) – When breast cancer spreads

outside the breast, it first goes to a particular lymph node or nodes
in the armpit or near the breastbone (sternum). These are called the
sentinel nodes. A sentinel node biopsy finds and removes them so
they can be tested for cancer cells (see opposite page).

If there are no cancer cells in the sentinel nodes, no more lymph nodes
are removed. If there is more than a small amount of disease in the
sentinel nodes, you may have axillary lymph node dissection or radiation
therapy (see pages 40–42).

Axillary lymph node dissection (ALND) – If cancer is found in the lymph

nodes, then most or all of the axillary lymph nodes (usually 10–25) may
be removed to reduce the risk of the cancer coming back (recurrence)
in the armpit. The nodes are tested and the results guide what other
treatment may be needed. ALND is also called axillary lymph node
clearance (AC). Radiation therapy may be used instead of ALND.

Side effects – You may have arm or shoulder stiffness, weakness and
pain; numbness in the arm, shoulder, armpit and parts of the chest; fluid
collecting near the surgical scar (seroma); lymphoedema (see page 52);
and cording (see page 53). Side effects are usually worse after ALND than
after an SLNB because more lymph nodes are removed in an ALND.

32 Understanding Breast Cancer

Finding the sentinel nodes
To work out which lymph nodes are sentinel nodes, one or a combination
of these procedures is used:

1. Lymphatic 2. Dye injection 3. Handheld probe

mapping (not always used)

A small amount of a If dye is being used, it will As well as looking at

harmless radioactive be injected into the breast. where the dye travels to
solution is injected into The dye, which may be first (if used), the surgeon
the skin over the breast blue or green, moves into uses a small handheld
cancer tumour. the lymphatic vessels and device called a probe
stains the sentinel nodes during the surgery to
A CT scan is then taken to
first. This is done under detect the radioactive
show which lymph nodes
general anaesthetic during solution injected during
the radioactive solution
the surgery. the lymphatic mapping.
flows to first. These are
most likely to be the Because of the dye, you This helps to check that
sentinel nodes. may notice blue-green the sentinel nodes have
urine (wee) and bowel been located and the
Lymphatic mapping
movements (poo) when surgeon can then remove
is done either the day
you go to the toilet the them for testing.
before or on the day of
next day. You may also
the surgery.
have a blue patch on
the breast for weeks or
longer. Your skin may look
a bit grey but will fade
once the dye washes out
in your urine.

Treatment 33
 What to expect after surgery
If you have any questions about your recovery and how best to look after yourself
when you get home, ask the doctors and nurses caring for you. If you are referred
to a breast care nurse, they can give you information about what to expect after
surgery and provide support.

Managing dressings and tubes

A dressing will cover the wound to keep it clean. This may be
changed while you are in hospital but is usually removed after
about a week. You may have one or more drainage tubes to
drain fluid from the surgical site into a bottle. These can stay
in place for up to one week, or occasionally 2 weeks. Nurses
will show you how to look after the wound and drainage tubes
at home, or a community nurse, GP or your surgeon may help
you. If you notice redness or discharge around the surgical
area or develop a fever over 38°C, let your treatment team
know immediately.

Recovery time Avoid heavy lifting Shower

carefully

The time it takes to recover Do not do vigorous physical

from surgery will depend on activity or heavy lifting in the
the type of surgery you have initial weeks after surgery.
had and your health. You Your treatment team will
may feel better after a few let you know when you can Keep the wound
days, or it may take several resume normal activities. clean, and gently
weeks or longer if you have You may be given some pat it dry after
had a mastectomy with gentle exercises to reduce showering.
a reconstruction. the risk of shoulder stiffness. Avoid baths.

34 Understanding Breast Cancer

Your hospital stay will depend on the surgery you have and how well you recover:
• breast-conserving surgery – you usually go home the same day, or may
stay overnight
• mastectomy – you usually stay in hospital for 1–2 nights
• reconstruction after mastectomy – you usually stay in hospital for several days.

Manage pain Prevent blood clots

While in hospital, you will
have pain relief through a drip
(intravenous or IV), an injection
or as tablets. You will also be
given pain medicine when
you go home. You are likely
to need stronger pain relief
after an ALND (see page 32)
or a mastectomy than after
breast-conserving surgery.

Apply moisturiser Avoid cuts

While in bed, you should
try to do some deep
breathing exercises, and
move your legs around to
help prevent blood clots in
the deep veins of your legs
(deep vein thrombosis or
Gently massage the area DVT). As soon as you are
with moisturiser once able, you will be asked to
any stitches or adhesive get up and walk around.
strips are removed and You may wear elastic
the wound has completely Your treatment team (compression) stockings or
healed. About 6 weeks may advise you to wait use other devices to help
after surgery, your surgeon until the wound has prevent clots. Your doctor
may suggest that you use completely healed if you might prescribe medicine
silicone gels and sheets want to shave or wax that reduces the risk of
to reduce scarring. your armpits. blood clots forming.

Treatment 35
 What your breast looks like after surgery
How your breast will look after surgery depends on the type of surgery
that you have, as well as the size of your breast and your body shape. It
can take up to a few weeks for any bruising and swelling of the surgery
area to go away.

After breast-conserving surgery – The size and position of the scar

will depend on how much tissue was removed. The scar will usually be
less than 10 cm and near where the cancer was or around the areola or
near the breast fold. But this can vary depending on your breast size
and how much breast tissue needs to be removed. It can also change if
you need to have further surgery to remove more tissue. If a larger area
needs to be removed, surgical techniques known as oncoplastic surgery
can reshape the breast after breast-conserving surgery.

After a mastectomy – The scar will be across the skin of the chest.
If you have surgery to remove the lymph nodes, the scar will also be
in the armpit. At first the scar will be firm, slightly raised and red.
Over the next few months, it will flatten and fade.

Impact on self-esteem
Scars or changes to how your breast looks can affect how you feel
about yourself (self-image and self-esteem, see pages 56–57). If you
have had a mastectomy (or part of your breast removed), it’s common
to feel a sense of loss. It may also affect your sense of identity.

Seeking support – Talking to someone who has had breast cancer

surgery can be helpful. Cancer Council’s Cancer Connect program
may be able to link you to others who have had a similar experience.
Speaking with a counsellor or psychologist for emotional support and
coping strategies can also help. Call Cancer Council 13 11 20 for details.

36 Understanding Breast Cancer

Breast appearance after surgery
What your breast will look like after surgery varies from person to person. It will
depend on the type of surgery you have and how much tissue is removed. The
pictures below give some examples of how your breast might look but ask your
surgeon for more photographs to help you choose the best approach for you.

Breast-conserving surgery
Two years after surgery to left breast. The
scar can still be seen but has healed and faded
a little. The size of the scar varies but can be
around 10 cm. The surgery was followed by
radiation therapy.

Mastectomy
Left breast removed, with no reconstruction.
All possible breast tissue has been removed and
the scar runs horizontally across the chest wall.
This photo is some time after surgery and shows
results once the scar has healed.

Nipple-sparing mastectomy with an

implant reconstruction
Left breast removed with a nipple-sparing
mastectomy, followed by a breast reconstruction
using an implant. If it is not possible to keep
the nipple, there is the option of having a nipple
reconstruction later.

Mastectomy with a flap reconstruction

Right breast removed, followed by a breast
reconstruction using tissue from the back.
Tissue from the abdomen, buttock or thigh
can also be used for a reconstruction. You can
choose to have a nipple reconstruction later.

Treatment 37
 Side effects of surgery
Some common side effects are discussed below. Talk to your treatment
team about the best ways to deal with them. For more information, see
the Managing side effects chapter (pages 52–57).

Fatigue – Cancer treatment and the emotional impact of the diagnosis

can be tiring. Fatigue is common and may continue for weeks or
months. Research shows that exercise during and after cancer treatment
is safe and can help improve fatigue. Cancer Council may run an
exercise program near you – call 13 11 20. You can also ask your GP if
you are eligible for some Medicare-funded sessions with an exercise
physiologist or a physiotherapist.
▶ See our Understanding Fatigue and Cancer fact sheet and Exercise
for People Living with Cancer booklet.

Shoulder stiffness – Arm and shoulder pain, weakness, stiffness

and reduced movement are common after surgery and after radiation
therapy. Ask your treatment team when you can start exercising
your arm. A physiotherapist or exercise physiologist can show you
exercises to reduce shoulder stiffness or pain. This may help prevent
lymphoedema (see page 52).
▶ See our Arm & Shoulder Exercises After Surgery poster.

Numbness and tingling – Surgery can bruise or injure nerves. You may
feel numbness and tingling in the armpit, upper arm or chest area. You

McGrath Breast Care Nurses are registered nurses specifically

trained to support people with breast cancer from the time of
diagnosis and throughout treatment. There are more than
200 McGrath nurses across Australia. For more information,
visit [Link].

38 Understanding Breast Cancer

may also notice a loss of feeling in your breast or nipple. These changes
often improve within a few weeks but may take longer. Sometimes the
numbness or tingling may not go away completely. A physiotherapist
or occupational therapist can give you exercises that may help.

Seroma – Fluid may collect in or around the surgical scar and cause
a balloon-like swelling. This is most common after a mastectomy. A
seroma can also develop in the armpit after an ALND. The build-up of
fluid can be uncomfortable but is not harmful. Some breast care nurses,
your specialist or GP, or a radiologist can drain the fluid using a fine
needle and a syringe. This procedure is not painful, but it may need to
be repeated over a few appointments.

Lymphoedema – Fluid building up in the tissue of the arm or breast

may cause swelling after any lymph node surgery. It is common to
have some swelling of your arm or breast after surgery, but this usually
settles in the weeks afterwards. If this swelling builds up over weeks
or months, this usually means you have lymphoedema. It can happen
any time, even years after surgery (or radiation therapy) to the lymph
nodes. See page 52 for ways to prevent and manage the symptoms
of lymphoedema.
▶ See our Understanding Lymphoedema fact sheet.

Post-mastectomy pain – It is rare to have prolonged pain after a

mastectomy but you may find the scar uncomfortable for some time.
If pain or discomfort is ongoing, let your treatment team know.

Cording – Also known as axillary web syndrome, cording is caused

by hardened lymph vessels. It feels like a tight cord running from your
armpit down the inner arm, sometimes to the palm of your hand. See
page 53 for ways to manage cording.

Treatment 39
 Radiation therapy
Also known as radiotherapy, radiation therapy uses a controlled dose
of radiation to kill cancer cells or damage them so they cannot grow,
multiply or spread. The radiation is usually in the form of x-ray beams. It
does not cause you to become radioactive during the period of treatment.
Radiation therapy may be recommended:
• after breast-conserving surgery – usually a part of standard treatment
• after a mastectomy – you may have radiation to the chest wall and
lymph nodes above the collarbone, and sometimes lymph nodes next
to the breastbone
• if the sentinel node has cancer cells – you may have radiation to the
armpit instead of ALND (see page 32)
• after neoadjuvant chemotherapy and before surgery (see pages 27–31)
• after adjuvant chemotherapy (see pages 43–44).

You will usually start radiation therapy within 8 weeks of surgery. If

you’re having chemotherapy after surgery, radiation therapy will begin
about 3–4 weeks after chemotherapy has finished.

Planning radiation therapy

Treatment is carefully planned to cause the most harm to the cancer
cells and to limit damage to the surrounding healthy tissues. Planning
involves several steps, which may occur over a few visits.

You will have a planning session at the radiation therapy centre. During
this appointment, you will have a planning CT scan of the area to
be treated. Sometimes marks are put on your skin so the radiation
therapists can ensure you are lined up correctly each time you are
treated. These marks are usually small dots (tattoos), and they may
be temporary or permanent. Talk to your radiation therapists if you
are worried about these tattoos. Invisible tattoos are available in some

40 Understanding Breast Cancer

centres. If you have had breast-conserving surgery, the surgeon can
sometimes place tiny markers (called fiducial markers) in your breast
tissue to show where the cancer used to be. This helps the radiation
oncology team to deliver the radiation therapy more precisely.

You may be asked to try a deep inspiration breath hold (DIBH) technique.
This involves taking and holding a deep breath for 20–30 seconds during
treatment. DIBH helps to inflate the lungs and move the heart away from
the radiation field, reducing the risk of heart damage.

Having radiation therapy

You will probably have radiation therapy daily from Monday to Friday
for 1–6 weeks. Most people have radiation therapy as an outpatient and
go to the treatment centre each day.

Each radiation therapy session will be in a treatment room. Setting up

the machine can take 10–30 minutes, but the actual treatment takes only
1–5 minutes. You will lie on a table under the machine and your breast
will be exposed. The radiation therapist will leave the room and then
switch on the machine, but you can talk to them through an intercom.

Radiation therapy is not painful, but you will need to lie still while it
is given. Most people will be lying on their back with their arms up. If
DIBH is recommended for you, the radiation beam will only be turned
on when you are in the DIBH position.

If you are having radiation therapy at a private centre, Medicare will

cover some of the cost, but your private health insurance may not, so
you may have to pay some of the cost yourself (out-of-pocket costs).
If you are worried about the cost, speak to your treatment team about
having treatment in a public hospital.

Treatment 41
 Side effects of radiation therapy
Radiation therapy may cause the following side effects:

Skin problems – You may have some redness around the treated area.
The skin may become dry and itchy, blister, or become moist and weepy.
It usually returns to normal 4–6 weeks after radiation therapy ends.
Sometimes skin can become very irritated or peel (radiation dermatitis).
You may need dressings, or special creams or gels, to help the area heal.

Tiredness – You may start to feel tired 1–2 weeks after radiation therapy
begins. Fatigue usually gets better a few weeks after treatment finishes.

Aches – You may feel minor aches or shooting pain in the breast area
during or after radiation therapy. It should ease over time.

Swelling – Some people have swelling or fluid build-up in the breast

(breast oedema or lymphoedema) that can last for up to a year or
longer. Radiation therapy to the armpit increases the risk of swelling
in the arm (lymphoedema, see page 52).

Hair loss – Radiation therapy to the breast won’t make you lose the hair
on your head, but you will usually lose hair from the treated armpit.

Other side effects – Late effects can develop months or years after
radiation therapy. Part of the lung behind the treatment area may
become inflamed, causing a dry cough or shortness of breath. There
is a slight risk of heart problems, but this usually happens only if you
have treatment to your left breast or if you smoke. Hardening of tissues
(fibrosis) may happen months or years after treatment. In rare cases,
radiation therapy may cause a second cancer.
▶ See our Understanding Radiation Therapy booklet.

42 Understanding Breast Cancer

Chemotherapy
Chemotherapy uses drugs to kill cancer cells or slow their growth. It
may be used before or after surgery (see page 28). It is often used for
breast cancers that are not sensitive to hormone therapy, are HER2+ or
triple negative, or for inflammatory breast cancers. Chemotherapy is
sometimes used for hormone receptor positive breast cancers.

Having chemotherapy
Different types of chemotherapy drugs are used. The choice of drugs
will depend on the type of cancer, how far it has spread and what
other treatments you are having. Usually, you will have a combination
of drugs. Common drugs include carboplatin, cyclophosphamide,
docetaxel, doxorubicin, epirubicin and paclitaxel. Your treatment team
may also refer to the drugs by their brand names, or letters like AC or
TC. Your medical oncologist will talk to you about the most suitable
types of chemotherapy drugs, as well as their risks and side effects.
For more information, visit [Link].

Generally, chemotherapy is given through a vein (intravenously).

You will usually be treated as an outpatient, but occasionally you may
have to stay in hospital overnight. Chemotherapy is usually given once
every 1–3 weeks for 3–6 months.

Side effects of chemotherapy

Chemotherapy damages cells as they divide. This makes the drugs
effective against cancer cells, which divide rapidly. However, some
normal cells – such as hair follicles, blood cells and cells inside
the mouth or bowel – also divide rapidly. Side effects happen
when chemotherapy damages these normal cells. Unlike cancer
cells, normal cells can recover, so most side effects are temporary.
See the next page for common side effects.

Treatment 43
 Nausea – You may feel sick for a few hours or days after each treatment.
Not everyone feels sick, and you’ll be given medicine to help prevent it.
Some medicines may cause constipation; talk to your doctor about this.

Diarrhoea – You may have loose, watery stools and feel like you urgently
need to go to the toilet. You may be given medicine to manage diarrhoea.

Hair loss – You may lose the hair from your head and other areas of the
body (e.g. eyebrows, underarms and pubic area). Cold caps may prevent
hair loss on your head in some cases (see page 54).

Swelling (oedema) – Some medicines used with chemotherapy drugs can

cause excess fluid (fluid retention) to build up in the body. This can affect
the arms and the trunk, but it usually gets better when treatment ends.

Changes to fertility – Chemotherapy can cause infertility in females

and males. If you may want to have children in the future, it’s essential
that you talk to your cancer specialists about your options and ask for a
referral to a fertility specialist before treatment starts (see page 57).

Heart problems – The risk is small but chemotherapy can sometimes

damage the heart muscle (cardiomyopathy). Your heart health will be
checked before, during and after treatment. If you are at risk of heart
damage, you may be offered other types of drugs.

Peripheral neuropathy – You might develop tingling in your hands or

feet. This is called peripheral neuropathy (see page 53).

Other side effects – These include an increased infection risk, fatigue,

mouth ulcers, constipation, and memory changes (see page 54).
▶ See our Understanding Chemotherapy booklet.

44 Understanding Breast Cancer

Hormone therapy
Hormone therapy, also called endocrine therapy or hormone-blocking
therapy, slows or stops the effect of oestrogen. It is used to treat breast
cancer that is hormone receptor positive (see page 22). Hormone therapy
is often used to lower the risk of the cancer coming back. It may also be
used to reduce the risk of certain conditions, including LCIS and some
DCIS (see page 12), developing into invasive breast cancer.

There are different types of hormone therapy. The type used will depend
on your age, type of breast cancer and if you have reached menopause.

Tamoxifen
Tamoxifen can be used at any age, whether you have been through
menopause or not. You need to take a daily tablet for 5–10 years.

Side effects – In females, tamoxifen can cause menopausal symptoms

(see page 57), although it doesn’t bring on menopause. It may also cause
changes in thinking and memory, and vaginal discharge. There is a
very small risk of developing cancer of the uterus (endometrial cancer),
particularly if you have gone through menopause. Always let your
treatment team know if you have any unusual vaginal bleeding. In males,
side effects can include low sex drive (libido) and erection problems.

Tamoxifen increases the risk of blood clots. See a doctor immediately

if you have swelling, soreness or warmth in an arm or leg, or a sudden
shortness of breath or chest pain.

You are unlikely to have all of these side effects, and they usually
improve with time. Your doctor and breast care nurse can help you to
manage side effects. Tell your doctor if you take an antidepressant. Some
types of antidepressant drugs may affect how well tamoxifen works.

Treatment 45
 Aromatase inhibitors
After menopause, the ovaries stop making oestrogen. However, both
females and males make small amounts of oestrogen in body fat and
the adrenal glands. Taking aromatase inhibitors will help reduce
how much oestrogen is made in the body. This is important because
oestrogen can cause some cancers to grow.

Aromatase inhibitors (e.g. anastrozole, exemestane and letrozole) are

mostly used if you have been through menopause, have had your ovaries
removed, or are male. They may be used if you have not been through
menopause but have a high risk of the cancer returning. You may also
be given a drug to stop the production of oestrogen (e.g. goserelin, see
opposite page). This can be started before or after chemotherapy but
must be continued while you take the aromatase inhibitor.

Side effects – Aromatase inhibitors can cause menopausal symptoms

such as vaginal dryness and low mood (see page 57). These drugs
may also cause itchiness, joint pain, and weakening of the bones
(osteoporosis). Your bone health will be monitored during treatment
and you may be prescribed a drug to protect your bones. Consider seeing
a physiotherapist or exercise physiologist for an exercise plan. If you
have arthritis, aromatase inhibitors may worsen joint stiffness and pain.
Exercise or medicines from your doctor may help. Your doctor may also
suggest changing to one of the other types of aromatase inhibitor.

Ovarian suppression
If you have not been through menopause, drugs or surgery can stop the
ovaries from producing oestrogen. This is called ovarian suppression. It
may also be recommended as an additional treatment for people taking
tamoxifen or for premenopausal women taking an aromatase inhibitor
instead of tamoxifen.

46 Understanding Breast Cancer

Temporary ovarian suppression – The drug goserelin stops oestrogen
being made. It is given as an injection into the abdomen (belly) once a
month for 2–5 years to bring on temporary menopause. Side effects are
similar to those of permanent menopause (see page 57). The drug may
also help protect the ovaries during chemotherapy, so it is often given
to women who want to preserve their fertility.

Permanent ovarian treatment – Ovarian ablation is rarely needed, but

this procedure permanently stops the ovaries from producing oestrogen.
It usually involves surgery to remove the ovaries (oophorectomy).
Sometimes radiation therapy is used.

Ovarian ablation will bring on permanent menopause. This means you

will no longer be able to fall pregnant naturally.

Targeted therapy
Targeted therapy drugs attack specific features of cancer cells to stop
the cancer growing and spreading. Different types of targeted therapy
drugs are used for different types of breast cancer.

HER2-targeted agents
For early or locally advanced HER2+ breast cancer, the most common
targeted therapy drug used is trastuzumab. Your treatment team may
refer to trastuzumab by a brand name (e.g. Herzuma, Kanjinti or
Ogivri). It is also known as Herceptin, although this version is now
rarely used in Australia.

Trastuzumab works by attaching itself to HER2+ breast cancer cells,

destroying the cells or reducing their ability to divide and grow. It also
encourages the body’s own immune cells to help find and destroy cancer

Treatment 47
 cells. Usually used in combination with chemotherapy drugs for early
breast cancer, trastuzumab can increase the effect of the chemotherapy.

Trastuzumab can be given through a drip into a vein (infusion) or as an

injection under the skin. The first infusion takes about 90 minutes (called
the loading dose). The following infusions each take 30–60 minutes.
You will usually have a dose every 3 weeks, for up to 12 months. The first
4–6 doses are given while you are having chemotherapy treatment.

Side effects – Side effects are usually caused by the chemotherapy

drugs, and often ease once chemotherapy finishes and you are having
trastuzumab only. Side effects from trastuzumab are uncommon, but can
include headache, fever and diarrhoea. In some cases, trastuzumab can
affect how the heart works, so you will have tests to check your heart
function before and during treatment.

Several new drugs have been developed to treat HER2+ breast

cancer with or after trastuzumab. These include: pertuzumab,
which is given before surgery (neoadjuvant); and trastuzumab
emtansine (T-DM1), which is given after surgery (adjuvant). Your
doctor will let you know if these drugs are appropriate for you.

CDK inhibitors
Abemaciclib is a type of cyclin-dependent kinase (CDK) inhibitor. It is
used with hormone therapy. Abemaciclib may be used after surgery and
chemotherapy for larger, high-risk ER+, HER2– breast cancers, for cancers
involving several lymph nodes, or cancers at high risk of returning.
Another drug (ribociclib) may soon become more widely available.

Side effects – Nausea or diarrhoea may occur, but this can be managed.
Your blood count may be affected, so regular blood tests are needed.

48 Understanding Breast Cancer

PARP inhibitors
There are several new drugs for people who have inherited a BRCA
mutation, or whose cancer has developed BRCA mutations. These are
called poly (ADP-ribose) polymerase (PARP) inhibitors and include the
drug olaparib. Ask your doctor if this may be suitable for you.
▶ See our Understanding Targeted Therapy fact sheet.

Immunotherapy
Immunotherapy is a treatment that uses the body’s own immune system
to fight cancer. A drug called pembrolizumab may be used for people
with certain types of triple negative breast cancer. Pembrolizumab
is used together with a chemotherapy drug. Pembrolizumab is
given through a vein (intravenously), and treatments usually take
about 30 minutes.

Side effects – These may be caused by the immunotherapy, the

chemotherapy or both. Common side effects include a rash, fatigue,
diarrhoea (which can be severe), breathlessness, joint pains, diabetes,
nerve problems, muscle weakness and dry eyes. It can cause
inflammation in other organs, including the thyroid, pituitary gland,
liver, kidneys and pancreas. It can also affect the adrenal gland, which
can lead to low levels of certain hormones (e.g. cortisol). If you notice
these or any other side effects, it’s important to let your treatment team
know – some side effects can be life-threatening if left untreated.

Most side effects, however, can be managed if they are reported early.
Sometimes, immunotherapy may need to be stopped or interrupted. Side
effects from immunotherapy can occur for up to 12 months after the last
dose was given. Pregnancy should be avoided during this time.
▶ See our Understanding Immunotherapy fact sheet.

Treatment 49
 Treatment for advanced breast cancer
Advanced breast cancer is different In some cases, radiation therapy
from locally advanced breast (see pages 40–42) may be used
cancer (see page 20). Locally to reduce the size of the cancer
advanced breast cancer is cancer and to relieve pain.
(larger than 5 cm) that has spread
to tissue around the breast or to Surgery is not often used for
a large number of lymph nodes. advanced breast cancer, but it may
Advanced breast cancer is cancer be used to treat cancer in the bones,
that has spread to more distant body lungs, brain or liver.
parts. It is also called metastatic or
secondary breast cancer. While it’s not possible to cure
advanced breast cancer at this
Breast cancer can spread to many time, these treatments may improve
different parts of the body, but it is quality of life for many months and
most likely to spread to the bones, sometimes years.
liver, lungs or brain.
For more information related to
The treatment for advanced breast advanced breast cancer, see our
cancer varies from person to other resources:
person. It will depend on the type of • Living with Advanced Cancer
breast cancer and where in the body • Understanding Cancer Pain
the cancer has spread. • Understanding Secondary
Bone Cancer
The treatment for advanced • Understanding Secondary
breast cancer aims to control the Liver Cancer
spread of the cancer and relieve • The Thing About Advanced
any symptoms you may develop. Cancer podcast series.
You may have one or more of the
following treatments: Breast Cancer Network Australia
• hormone therapy (see has more detailed information
pages 45–47) about advanced breast cancer.
• chemotherapy (see pages 43–44) Visit [Link].
• targeted therapy (see pages 47–49)
• immunotherapy (see page 49).

50 Understanding Breast Cancer

Key points about treating breast cancer
Choice of The treatments you are offered will depend on
treatment many factors, such as test results on the cancer,
the stage and grade, whether it is hormone receptor
positive, HER2+ or triple negative, and your age
and general health.

Treatments Before surgery, chemotherapy is usually offered

before surgery to people with locally advanced, HER2+ or triple
negative, or inflammatory breast cancer. This is called
neoadjuvant chemotherapy. Some people also have
hormone therapy, targeted therapy or immunotherapy
before surgery.

Surgery Early and locally advanced breast cancer is usually

treated with surgery:
• breast-conserving surgery – removes only the
tumour and a tissue margin
• mastectomy – removes the whole breast
• axillary surgery – removes some or all of the lymph
nodes from the armpit to check for cancer; can be
done through a sentinel lymph node biopsy (SLNB)
or axillary lymph node dissection (ALND).

You also may have a breast reconstruction, which

re-creates the shape of your breast during or after a
mastectomy. You may choose to delay this surgery or
not have a breast reconstruction.

Treatments After surgery you may have chemotherapy, radiation

after surgery therapy, hormone therapy for hormone receptor
positive breast cancer, or targeted therapy for HER2+
breast cancer. Immunotherapy may also be used.

Treatment 51
 Managing side effects
It will take time to recover from the physical and emotional changes
caused by your treatment. Side effects can vary. Some people will
experience just a few side effects, while others will have more.

Lymphoedema
Lymphoedema is the swelling (oedema) that develops when lymph fluid
builds up in the tissues of part of the body, such as an arm or breast.
When lymph nodes have been damaged or removed, lymph fluid may
not be able to drain properly and builds up in the tissues.

Some breast cancer treatments may cause lymphoedema (e.g. surgery

to remove lymph nodes and radiation therapy to the armpit). Many
people who are at risk, however, never develop lymphoedema.

Lymphoedema can affect people at any time – during active treatment

or months or even years afterwards. Regular screening check-ups may
be recommended for some people, so ask your treatment team if this
might be an option for you. Signs to look for include the swelling of
part of your arm or your whole arm; a feeling of tightness, heaviness or
fullness in the fingers, wrist or the arm; and aching in the affected area.
These signs may begin gradually or come and go.

Some people experience pain, redness or fever, which can be caused

by an infection called cellulitis in the area with lymphoedema. If you
have any of these symptoms, see your doctor as soon as possible.
Lymphoedema is easier to manage when diagnosed and treated early.
▶ See our Understanding Lymphoedema fact sheet.

52 Understanding Breast Cancer

Cording
Cording (axillary web syndrome) can develop weeks or months after
any type of breast surgery. Caused by hardened lymph vessels, cording
feels like a tight cord running from your armpit down the inside of
the arm, sometimes to the palm of your hand. You may see and feel
raised cord-like structures across your arm, chest or breast, which
may limit how you move. Gentle stretching exercises in the first weeks
after surgery can help improve movement. Massage, physiotherapy, or
low-level laser treatment by a lymphoedema practitioner may also help
reduce pain and tightness. Cording usually improves over a few months.

Nerve pain
Mastectomy, SLNB and ALND (see pages 30, 32) can cause nerve pain
in the arm or armpit, and mastectomy can cause nerve pain in the
chest wall. This may feel like pins and needles, tingling, or stabbing
pain. It usually settles within a few weeks. If nerve pain is ongoing,
ask your doctor about ways to manage it.

Some chemotherapy drugs can damage nerves in the hands and feet. This
is called peripheral neuropathy or chemotherapy-induced peripheral
neuropathy (CIPN). It can cause weakness, numbness, pins and needles
and, occasionally, burning or shooting pain. These symptoms usually
improve over a matter of months, but they can be permanent.

If you have any of these symptoms, tell your health care team. Your
doctor will help you manage pain from any permanent nerve damage.
A physiotherapist and occupational therapist can help you improve
or manage symptoms, and a psychologist or counsellor can teach you
coping strategies to manage any ongoing pain.
▶ See our Understanding Peripheral Neuropathy and Cancer fact sheet.

Managing side effects 53

 Hair loss
If you lose your hair during chemotherapy, you may choose to wear
a wig, scarf, turban or hat while your hair is growing back. Or you
might feel comfortable leaving your head bare. You could try out a
few options over time and see what feels like the right thing for you.
Generally, hair starts to grow back after your treatment ends.

Some treatment centres offer cold caps (also called scalp cooling),
which may prevent total head hair loss, but this depends on the
chemotherapy drugs used. Ask your treatment team if cold caps
might be an option for you.
▶ See our Hair Loss fact sheet.

Thinking and memory changes

Some people with breast cancer notice changes in how they think
and remember information. This is called cancer-related cognitive
impairment or may be referred to as “chemo brain”, “cancer fog” or
“brain fog”. The exact cause is unknown, but studies suggest these
changes may be caused by the cancer, emotions such as anxiety and
depression, cancer treatment, anaesthetic given for surgery, and side
effects such as fatigue, insomnia, pain and hormone changes.

For most people, thinking and memory problems get better within the
first year of finishing treatment. Others may have long-term effects.
If you have severe or lasting changes to your thinking and memory
skills, you can see a clinical psychologist or neuropsychologist for
cognitive rehabilitation. Speak to your health care team about the
services available at your hospital or from a psychologist.
▶ See our Understanding Changes in Thinking and Memory fact sheet
and listen to our “Brain Fog and Cancer” podcast episode.

54 Understanding Breast Cancer

Breast prostheses
A breast prosthesis is a synthetic breast or part of a breast that is
worn in a bra or attached to the body with adhesive. It helps give the
appearance of a breast shape and can be used after breast surgery.

Temporary prosthesis – In the first month or two after surgery,

you may choose to wear a temporary light breast prosthesis called
a soft form. This will be more comfortable next to the scar. A free bra
and soft form are available through Breast Cancer Network Australia
as part of the My Care Kit. To order a kit, speak to your breast
care nurse.

Permanent prosthesis – When you have recovered from treatment,

you can be fitted for a permanent breast prosthesis. A permanent
breast prosthesis is mostly made from silicone gel and has the shape,
feel and weight of a natural breast. It is recommended that you see
a trained fitter who can help you choose the right prosthesis. To
find a fitter near you, call Cancer Council 13 11 20 or ask your breast
care nurse for recommendations.
▶ See our Breast Prostheses and Reconstruction booklet.

Feelings of loss and change

It’s common to feel emotional after over time. The busyness of cancer
a cancer diagnosis. You may feel treatment may mean you do not feel
a sense of grief or loss – for your grief until it is over. If concerned, call
health and wellbeing, your dreams or Cancer Council 13 11 20 to talk to
freedoms, even what you can wear. someone about how you are feeling.
Grief can feel like waves of sadness ▶ See our Emotions and Cancer
or being teary, and usually settles booklet.

Managing side effects 55

 The Look Good Feel Better program can help you to manage
the appearance-related effects of cancer treatment and boost
self-esteem. Call 1800 650 960 or visit [Link].

Changes to body image and sexuality

Breast cancer can affect how you feel about yourself (self-esteem) and
make you feel self-conscious. You may feel less confident about who you
are and what you can do. These feelings are common; give yourself time
to adapt. If you are finding it hard to adjust to changes, ask for support.
Most cancer centres have psychologists who may be able to help.

Breast and chest appearance – You may find that having a breast
reconstruction or wearing a breast prosthesis (see page 55) improves
your self-confidence. Or you may prefer to not have a reconstruction and
“go flat”. You may be able to have an areola and nipple tattooed onto the
breast after a mastectomy and breast reconstruction. Or you may choose
a decorative tattoo to cover scars. For some people, this is a way to take
control of their body and express themselves.

Low libido – Breast cancer and its treatment (particularly hormone

treatment) can also reduce your desire for sex (libido). You may miss the
pleasure you felt from the breast or nipple being stroked or kissed during
sex. This may be the case even if you have a reconstruction. If breast
stimulation was important for arousal before surgery, you may need to
explore other ways of becoming aroused. Some cancer treatment centres
have sexual health clinics and other resources that may be able to help.

Vaginal dryness – Some treatments for breast cancer (particularly

hormone therapy) can cause vaginal dryness, which can make penetrative
sex painful. For most people, sex is more than arousal, intercourse and
orgasms. It involves feelings of intimacy and acceptance, as well as being

56 Understanding Breast Cancer

able to give and receive love. Even if some sexual activities may not
always be possible, there are many ways to express closeness.
▶ See our Sexuality, Intimacy and Cancer and LGBTQI+ People and
Cancer booklets and listen to our “Sex and Cancer” podcast episode.

Menopause and infertility

Chemotherapy can cause your periods to stop for a short time, or it
may cause them to stop permanently (early menopause). Symptoms
of menopause include hot flushes, trouble sleeping, vaginal dryness,
reduced sex drive (libido), tiredness, dry skin, mood swings, weight
gain and osteoporosis. Talk to your doctor or breast care nurse
about how to relieve symptoms. If vaginal dryness does not respond
to simple measures, talk to your doctor about vaginal oestradiol.
Several non-hormonal medicines work well for hot flushes.

If chemotherapy causes menopause, you will not be able to have

children naturally. Talk to your doctor before treatment starts,
as there may be ways to reduce the risk of early menopause or
preserve your fertility.

If you find out you might not be able to get pregnant and have a child,
you may feel a great sense of loss. Talking to a counsellor or someone
in a similar situation may help. For information about counselling
services and support groups in your area, call Cancer Council 13 11 20.
▶ See our Fertility and Cancer booklet.

After treatment you should not use any hormone-based

contraceptives (“the pill” or hormone implants or injections).
It is best to use condoms, diaphragms or intrauterine
contraceptive devices (IUDs).

Managing side effects 57

 Looking after yourself
Cancer can cause physical and emotional strain, so it’s important
to look after your wellbeing. Cancer Council has free booklets and
programs to help you during and after treatment. Call 13 11 20 to find
out more, or visit your local Cancer Council website (see back cover).

Eating well – Healthy food can help you cope with treatment and side
effects and maintain a healthy weight. Many people gain weight during
and after breast cancer treatment, which studies show increases the
risk of cancer coming back. A dietitian can explain how to manage any
special dietary needs or eating problems. If you choose to drink alcohol,
the guidelines recommend no more than 10 standard drinks a week and
no more than 4 standard drinks on any one day.
▶ See our Nutrition for People Living with Cancer booklet.

How staying active can help

You may think it’s important to rest Exercise reduces the risk of weight
during treatment and recovery, gain, which is associated with some
but research shows that exercise breast cancer treatments. The
benefits most people at this time. right exercise for you depends on
There is also strong evidence that what you are used to, how you feel,
exercise can reduce the risk of and your doctor’s advice. See an
breast cancer returning. accredited exercise physiologist
or physiotherapist for help in
Being active can also help manage developing an exercise program
side effects such as tiredness, to suit you.
improve circulation, boost mood, ▶ See our Exercise for People Living
and speed up recovery. with Cancer booklet.

58 Understanding Breast Cancer

Work and money – Cancer can change your financial situation,
especially if you have extra medical expenses or need to stop working.
Getting professional financial advice and talking to your employer
can give you peace of mind. You can also check whether any financial
assistance is available to you by asking a social worker at your hospital
or treatment centre or calling Cancer Council 13 11 20.
▶ See our Cancer and Your Finances and Cancer, Work and You booklets.

Relationships – Having cancer can affect your relationships with

family, friends and colleagues in many different ways. Cancer is
stressful, tiring and upsetting, and this may strain your relationships.
The experience of cancer may also result in positive changes to your
values, priorities or outlook on life. Give yourself time to adjust to
what’s happening, and do the same for those around you. It may help
to discuss your feelings with each other.
▶ See our Emotions and Cancer booklet.

Complementary therapies – Complementary therapies are designed

to be used alongside conventional medical treatments. Therapies
such as massage, relaxation and acupuncture can increase your sense
of control, decrease stress and anxiety, and improve your mood. Let
your doctor know about any therapies you are using or thinking about
trying, as some may not be safe or evidence-based.
▶ See our Understanding Complementary Therapies booklet.

Alternative therapies are therapies used instead of conventional

medical treatments. These are unlikely to be scientifically tested,
may prevent successful treatment of the cancer and can be
harmful. Cancer Council does not recommend the use of
alternative therapies as a cancer treatment.

Looking after yourself 59

 Life after treatment
For most people, the cancer experience does not end on the last day of
treatment. Life after cancer treatment can present its own challenges.
You may have mixed feelings when treatment ends, and worry that
every ache and pain means the cancer is coming back.

Some people say that they feel pressure to return to “normal life”.
It is important to allow yourself time to adjust to the physical and
emotional changes, and establish a new daily routine at your own pace.
Your family and friends may also need time to adjust.

Cancer Council 13 11 20 can help you connect with other people who
have had breast cancer, and provide you with information about the
emotional and practical aspects of living well after cancer.
▶ See our Living Well After Cancer booklet.

Dealing with feelings of sadness

If you have continued feelings of get a Medicare rebate for sessions
sadness, have trouble getting up in with a psychologist. Cancer Council
the morning or have lost motivation may also run a counselling program
to do things that previously gave you in your area.
pleasure, you may be experiencing
depression. This is quite common For information about coping
among people who have had cancer. with depression and anxiety, call
Beyond Blue on 1300 22 4636 or
Talk to your GP, because counselling visit [Link]. For 24-hour
or medication – even for a short crisis support, call Lifeline 13 11 14 or
time – may help. Some people can visit [Link].

60 Understanding Breast Cancer

Follow-up appointments
After treatment ends, you will have regular appointments with your
cancer specialist and GP to monitor your ongoing health. This is
known as shared care. Your doctors will see how you are going on
hormone therapy (if this is part of your ongoing treatment), help you
to manage any long-term side effects such as lymphoedema, peripheral
neuropathy or heart issues, and check that the cancer has not come
back or spread.

During these check-ups, you will usually have a physical examination.

You will also be able to discuss how you’re feeling and mention any
concerns you may have.

Check-ups after breast cancer treatment are likely to happen every

3–6 months for 2 years. They will become less frequent after that if
you have no further problems.

You are likely to have a mammogram and, if needed, an ultrasound

every year. You won’t need a mammogram if you’ve had a double
mastectomy. If there is a concern the cancer may have come back, you
may have a bone scan and a CT, PET or MRI scan. After 5 years with
no sign of cancer, women aged 40 and over can continue to have a free
mammogram through the national breast cancer screening program.

When a follow-up appointment or test is approaching, many people find

that they think more about the cancer and may feel anxious (“scanxiety”).
Talk to your treatment team or call Cancer Council 13 11 20 if you are
finding it hard to manage this anxiety.

Between follow-up appointments, let your doctor know immediately

of any symptoms or health problems.

Life after treatment 61

 What if the cancer returns?
Sometimes, breast cancer does come back after treatment, which is
called a recurrence. This is why regular check-ups are important.
In most cases, early breast cancer will not come back (recur) after
treatment. Although the risk is higher with locally advanced breast
cancer, many people will not experience a recurrence.

There are some things that increase the risk that cancer may come
back. These include if the cancer was large or the grade was high when
first diagnosed, if it was found in the lymph nodes, or if the surgical
margin was not clear. Your risk may also be increased if the cancer
was hormone receptor negative or if adjuvant treatment (e.g. radiation
therapy, chemotherapy, hormone therapy) was recommended after
surgery but was not started or completed. This does not mean the
cancer will definitely come back or spread.

Regularly looking at and feeling your breasts to know what is normal

(being “breast aware”) can help find cancer in the treated or other breast.

If you have had a double mastectomy with or without a reconstruction,

you should also regularly look at and feel your new shape and get to
know your “new normal”. Tell your specialist, breast care nurse or GP
if you notice any changes. Breast cancer can also return in other parts
of the body, such as the bones, liver or lungs. Most symptoms will not
be a recurrence, but if you notice any changes to your health, see your
doctor and let them know that you have had breast cancer.

It is important to continue taking the drugs your doctor prescribes,

even months or years after your treatment. Talk to your doctor before
you stop taking any drugs, as these drugs may be helping to stop
the cancer returning.

62 Understanding Breast Cancer

Caring for someone
with cancer
You may be reading this booklet because you are caring for someone
with cancer. What this means for you will vary depending on the
situation. Being a carer can bring a sense of satisfaction, but it can
also be challenging and stressful.

It is important to look after your own physical and emotional

wellbeing. Give yourself some time out and share your concerns with
somebody neutral such as a counsellor or your doctor, or try calling
Cancer Council 13 11 20. There is a wide range of support available to
help you with the practical and emotional aspects of your caring role.

Support services – Support services such as Meals on Wheels, home

help or visiting nurses can help you in your caring role. You can find
local services, as well as information and resources, through the
Carer Gateway. Call 1800 422 737 or visit [Link].

Support groups and programs – Many cancer support groups and

cancer education programs are open to carers as well as to people
with cancer. Support groups and programs offer the chance to share
experiences and ways of coping.

Carers Australia – Carers Australia provides information and

advocacy for carers. Visit [Link].

Cancer Council – You can call Cancer Council 13 11 20 or visit your

local Cancer Council website to find out more about carers’ services.
▶ See our Caring for Someone with Cancer booklet.

Caring for someone with cancer 63

 Seeking support
A cancer diagnosis can affect every aspect of your life. You will
probably experience a range of emotions – fear, sadness, anxiety, anger
and frustration are all common reactions. Cancer also often creates
practical and financial issues.

There are many sources of support and information to help you, your
family and carers navigate all stages of the cancer experience, including:
• information about cancer and its treatment
• access to benefits and programs to ease the financial impact
of cancer treatment
• home care services, such as Meals on Wheels, visiting nurses
and home help
• aids and appliances
• support groups and programs
• counselling services
• exercise programs.

The availability of services may vary depending on where you live,

and some services will be free but others might have a cost.

To find good sources of support and information, you can talk to the
social worker or breast care nurse at your hospital or treatment centre,
or get in touch with Cancer Council 13 11 20.

“ My family members don’t really understand what

it’s like to have cancer thrown at you, but in my
support group, I don’t have to explain.” SAM
64 Understanding Breast Cancer
Support from Cancer Council
Cancer Council offers a range of services to support people affected
by cancer, their families and friends. Services may vary by location.

Cancer Council 13 11 20 Information

resources
Our experienced health
professionals will answer any
questions you have about your
situation and link you to local
services (see inside back cover).

Cancer Council
produces booklets and
Legal and financial support fact sheets on more
than 40 types of cancer,
If you need advice on legal as well as treatments,
or financial issues, we may be emotional and practical
able to refer you to qualified issues, and recovery. Call
professionals. These services 13 11 20 or visit your local
are free for people who Cancer Council website.
can’t afford to pay. Financial
assistance may also be
available. To find out more,
call Cancer Council 13 11 20.
Practical help

Peer support services

You might find it helpful to
share your thoughts and Cancer Council can help
experiences with other you find services or offer
people affected by cancer. guidance to manage
Cancer Council can link you the practical impacts of
with individuals or support cancer. This may include
groups by phone, in person, helping you access
or online. Call 13 11 20 or visit accommodation and
[Link]/OC. transport services.

Seeking support 65
 Useful websites
You can find many useful resources online, but not all websites are reliable.
These websites are good sources of support and information.

Australian
Cancer Council Australia [Link]

Cancer Council Online Community [Link]/OC

Cancer Council podcasts [Link]/podcasts

Guides to Best Cancer Care [Link]/cancercareguides

Australasian Lymphology Association [Link]

Australasian Menopause Society [Link]

Australian Breast Device Registry [Link]

Breast Cancer Network Australia [Link]

Breast Cancer Trials [Link]

Breast Surgeons of Australia and NZ [Link]

Breconda (breast reconstruction) [Link]

Cancer Australia [Link]

Management of Early Breast Cancer [Link]

McGrath Foundation [Link]

National Breast Cancer Foundation [Link]

International
American Cancer Society [Link]

Breast Cancer Now [Link]

Cancer Research UK [Link]

Macmillan Cancer Support (UK) [Link]

66 Understanding Breast Cancer

Question checklist
Asking your doctor questions will help you make an informed choice.
You may want to include some of the questions below in your own list.

Diagnosis
• What type of breast cancer do I have?
• Has the cancer spread? If so, where has it spread? How fast is it growing?
• Are the latest tests/treatments for this cancer available in this hospital?
• Will a multidisciplinary team be involved in my care?
• Are there clinical guidelines for this type of cancer?

Treatment
• What treatment do you recommend? What is the aim of the treatment?
• Are there other treatment choices for me? If not, why not?
• If I don’t have the treatment, what should I expect?
• How long do I have to make a decision?
• I’m thinking of getting a second opinion. Can you recommend anyone?
• How long will treatment take? Will I have to stay in hospital?
• Are there any out-of-pocket expenses not covered by Medicare or my
private health cover? Can the cost be reduced if I can’t afford it?
• How will we know if the treatment is working?
• Are there any clinical trials or research studies I could join?

Side effects
• What are the risks and possible side effects of each treatment?
• Will I have a lot of pain? What will be done about this?
• Can I work, drive and do my normal activities while having treatment?
• Will the treatment affect my sex life and fertility?
• Should I change my diet or physical activity during or after treatment?
• Are there any complementary therapies that might help me?

After treatment
• How often will I need check-ups after treatment?
• If the cancer returns, how will I know? What treatments could I have?

Question checklist 67
 Glossary
adjuvant treatment breast-conserving surgery
A treatment given after surgery to lower the Surgery that removes a lump without
risk of the cancer coming back. removing the entire breast. Also called
advanced cancer a lumpectomy or wide local excision.
Cancer that is unlikely to be cured. In most breast form
cases, the cancer has spread to other parts The term used by manufacturers for a
of the body (secondary or metastatic cancer). breast prosthesis.
Treatment can often still control the cancer breast oedema
and manage symptoms. Swelling caused by too much fluid in the
areola breast tissue.
Coloured rim of tissue around the nipple. breast prosthesis (plural: prostheses)
aromatase inhibitors An artificial breast worn inside a bra or
Drugs that help reduce the amount of attached to the body with adhesive to
oestrogen made in the body. re-create the shape of a natural breast.
atypical ductal hyperplasia (ADH) Also called a breast form.
An abnormal but non-cancerous condition breast reconstruction
of the cells in the lining of the milk ducts. Surgery to rebuild the breast shape after
axilla the breast, or part of it, is removed.
The armpit.
axillary dissection or surgery cancer-related cognitive impairment
The removal of some lymph nodes Thinking and memory problems that may be
in the armpit. experienced after treatment. Also called
axillary lymph nodes chemo brain, cancer fog or brain fog.
Lymph nodes in and around the armpit. cellulitis
axillary web syndrome An infection of the skin. It can occur after
See cording. lymph glands have been removed.
chemotherapy
biopsy A cancer treatment that uses drugs to kill
Removal of a sample of tissue for examination cancer cells or slow their growth.
under a microscope to diagnose a disease. clear margin
bone scan When the surrounding tissue removed during
A technique to create images of bones on surgery does not contain cancer cells.
a computer screen. A small amount of cold cap (scalp cooling)
radioactive dye is injected into a vein. It A cap that is connected to a cooling system
collects in abnormal areas of the bone and and worn on the head during chemotherapy
is detected by a scanning machine. to help prevent hair loss.
BRCA1 or BRCA2 mutation contrast enhanced mammogram (CEM)
A gene fault or mutation that increases the Imaging that combines a 3D mammogram
risk of breast, ovarian or prostate cancer. (tomosynthesis) with an injection of dye.

68 Understanding Breast Cancer

cording hormone receptors
Tight cords of tissue running down the inside Proteins on the surface of the cell that bind
of the arm. Also called axillary web syndrome. to specific hormones.
CT scan hormones
Computerised tomography scan. This uses Chemicals in the body that send information
x-rays to create a detailed, cross-sectional between cells to control growth and
picture of the body. reproduction.
hormone therapy
diethylstilboestrol (DES) A treatment that blocks the body’s natural
A synthetic hormone drug identified as a hormones, which sometimes help cancer
cause of breast cancer. cells grow. Also called endocrine therapy
ductal carcinoma in situ (DCIS) or hormone-blocking therapy.
Abnormal cells in the breast ducts that may
increase invasive breast cancer risk. inflammatory breast cancer
ducts Cancer that affects the lymphatic vessels in
The tubes that carry milk to the nipple. the skin of the breast, causing the breast to
become red and swollen.
early breast cancer invasive breast cancer
Cancer that has not spread beyond the Cancer that has spread from the lining of the
breast or the axillary lymph nodes. breast ducts or lobules into the breast tissue
around them.
gene expression profile test invasive ductal carcinoma (IDC)
A test that provides information about the Cancer that started in the breast ducts but
risk of the cancer coming back and whether has spread into the tissue around them.
chemotherapy will be of benefit. May also be invasive lobular carcinoma (ILC)
called a genomic test or molecular assay. Cancer that started in the breast lobules but
genes has spread into the tissue around them.
The microscopic units that determine how
the body’s cells grow and behave. Genes Klinefelter syndrome
are found in every cell of the body and are A genetic syndrome in males caused by
inherited from both parents. having 2 X chromosomes (XXY) instead
genetic test of one (XY).
Aims to detect faulty genes that may increase
the risk of developing certain cancers. lobe
grade A section of the female breast that
A number that describes how similar cancer contains lobules.
cells look to normal cells and how quickly lobular carcinoma in situ (LCIS)
the cancer is likely to grow. Abnormal cells in the breast lobules
that increase the risk of developing
HER2 breast cancer.
Human epidermal growth factor receptor 2. lobules
A protein found on all cells in the body. The milk-producing glands in the breast.

Glossary 69
 locally advanced breast cancer
Cancer that is larger than 5 cm, has spread neoadjuvant treatment
to tissues around the breast such as the skin, Chemotherapy or other treatment given
muscle or ribs, or has spread to a large before surgery to help make treatment
number of lymph nodes. more successful.
lumpectomy nipple-sparing mastectomy
See breast-conserving surgery. A type of mastectomy where the breast skin,
lymphatic system nipple and areola are not removed.
A network of vessels, nodes and organs that non-invasive breast condition
removes excess fluid from tissues, absorbs Precancerous breast condition that is only in
fatty acids, transports fat and produces the ducts or lobules of the breast. Also called
immune cells. carcinoma in situ.
lymph nodes (lymph glands)
Small, bean-shaped structures that collect oestrogen
and destroy bacteria and viruses. A sex hormone made mainly by the ovaries.
lymphoedema For post-menopausal women, the hormone is
Swelling caused by a build-up of lymph fluid. produced in the fat cells.
lymph vessels oncoplastic breast-conserving surgery
Thin tubes that carry clear fluid known as An operation in which the cancer is removed,
lymph all over the body. and plastic surgery techniques are used to
preserve the appearance of the breast as
mammogram much as possible.
A low-dose x-ray of the breast tissue. osteoporosis
margin/surgical margin Thinning and weakening of the bones that can
An edge of tissue removed during surgery. lead to bone pain and fractures.
Clear or negative margin means no cancer ovarian suppression
cells were found on the edge of the tissue. Methods to stop the ovaries from functioning.
Positive margin means cancer cells were
found on the edge of the tissue and further Paget disease of the nipple
surgery is usually required. Cancer that develops in the breast ducts and
mastectomy spreads to the skin of the nipple and areola.
Surgery to remove the whole breast. peripheral neuropathy
menopause Weakness, numbness, tingling or pain,
When periods (menstruation) end. usually in the hands and feet, caused by
metastasis (plural: metastases) damage to the nerves that are located
Cancer that has spread from a primary away from the brain and spinal cord
cancer in another part of the body. Also (the peripheral nerves).
known as secondary or advanced cancer. PET scan
MRI scan Positron emission tomography scan. A scan
Magnetic resonance imaging scan. A scan in which a person is injected with a small
using magnetic fields and radio waves to take amount of radioactive glucose solution to help
detailed cross-sectional pictures of the body. show up cancerous areas.

70 Understanding Breast Cancer

progesterone
A sex hormone made mostly by the ovaries. It targeted therapy
prepares the lining of the uterus for pregnancy. Drugs that target specific cancer cell features
to stop the cancer growing and spreading.
radiation therapy tomosynthesis
The use of targeted radiation to kill or A digital x-ray mammogram machine that
damage cancer cells so they cannot grow, creates a three-dimensional image.
multiply or spread. Also called radiotherapy. triple negative breast cancer
reconstructive surgeon (plastic surgeon) A breast cancer that does not have receptors
A doctor who has had advanced surgical for the hormones oestrogen or progesterone
training in the restoration of skin and tissue or for the growth factor HER2.
to near-normal appearance and function. triple test
recurrence Collection of 3 tests to diagnose breast
The return of a disease after a period of cancer. Includes physical examination,
improvement (remission). breast imaging (such as mammogram and
ultrasound) and biopsy results.
screening tumour
An organised program to identify disease A new or abnormal growth of tissue on or
in people before any symptoms appear. in the body.
sentinel lymph node biopsy (SLNB)
Removal of the sentinel node. ultrasound
sentinel node A scan that uses soundwaves to create
The first lymph node that breast cancer cells a picture of part of the body.
may spread to outside the breast.
seroma wide local excision
A collection of fluid under a wound after See breast-conserving surgery.
surgery. Not harmful but may need draining.
skin-sparing mastectomy
A mastectomy in which the whole skin of the
breast, except the nipple and areola, is kept.
Can’t find a word here?
staging For more cancer-related words, visit:
Performing tests to work out how far a • [Link]/words
cancer has spread. • [Link]/glossary.

References
1. Cancer Australia, Guidance for the Management of Early Breast Cancer: Recommendations and
Practice Points, Cancer Australia, Surry Hills, 2020, available from [Link].
2. A Gennari et al., “ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of
patients with metastatic breast cancer”, Annals of Oncology, vol. 32, iss. 12, pp. 1475–1495.
3. Australian Institute of Health and Welfare (AIHW), Cancer Data in Australia, AIHW, Canberra, 2023,
viewed 11 July 2024, available from [Link]/reports/cancer/cancer-data-in-australia.

Glossary 71
 How you
can help
At Cancer Council, we’re dedicated to improving cancer control. As
well as funding millions of dollars in cancer research every year, we
advocate for the highest quality care for cancer patients and their
families. We create cancer-smart communities by educating people
about cancer, its prevention and early detection. We offer a range of
practical and support services for people and families affected by
cancer. All these programs would not be possible without community
support, great and small.

Join a Cancer Council event: Join one of our community fundraising

events such as Daffodil Day, Australia’s Biggest Morning Tea, Relay
For Life, Girls’ Night In and other Pink events, or hold your own
fundraiser or become a volunteer.

Make a donation: Any gift, large or small, makes a meaningful

contribution to our work in supporting people with cancer and their
families now and in the future.

Buy Cancer Council sun protection products: Every purchase

helps you prevent cancer and contribute financially to our goals.

Help us speak out for a cancer-smart community: We are a

leading advocate for cancer prevention and improved patient
services. You can help us speak out on important cancer issues
and help us improve cancer awareness by living and promoting
a cancer-smart lifestyle.

Join a research study: Cancer Council funds and carries out

research investigating the causes, management, outcomes and
impacts of different cancers. You may be able to join a study.

To find out more about how you, your family and friends can help,
please call your local Cancer Council.

72 Understanding Breast Cancer

Cancer Council
13 11 20
Being diagnosed with cancer can be overwhelming. At
Cancer Council, we understand it isn’t just about the treatment
or prognosis. Having cancer affects the way you live, work and
think. It can also affect our most important relationships.

When disruption and change happen in our lives, talking

to someone who understands can make a big difference.
Cancer Council has been providing information and support
to people affected by cancer for over 50 years.

Calling 13 11 20 gives you access to trustworthy information that is

relevant to you. Our experienced health professionals are available
to answer your questions and link you to services in your area, such
as transport, accommodation and home help. We can also help
with other matters, such as legal and financial advice.

If you are finding it hard to navigate through the health care

system, or just need someone to listen to your immediate
concerns, call 13 11 20 and find out how we can support you,
your family and friends.

If you need information in a language other than English,

an interpreting service is available. Call 131 450.

If you are deaf, or have a hearing or speech impairment,

you can contact us through the National Relay Service.
[Link]

Cancer Council services and programs vary in each area.

13 11 20 is charged at a local call rate throughout Australia (except from mobiles).
 UNDERSTANDING BREAST CANCER
For information & support
on cancer-related issues,
call Cancer Council 13 11 20

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Visit your local Cancer Council website

Cancer Council ACT Cancer Council Queensland Cancer Council Victoria

[Link] [Link] [Link]
Cancer Council NSW Cancer Council SA Cancer Council WA
[Link] [Link] [Link]
Cancer Council NT Cancer Council Tasmania Cancer Council Australia
[Link]/nt [Link]/tas [Link]

This booklet is funded through the generosity of the people of Australia.

To support Cancer Council, call your local Cancer Council or visit your local website.