Breast feeding can protect you against developing breast cancer.  We don’t know exactly how breast feeding is protective but, after the publication of a large Cancer Research UK study in 2002, we know that it definitely is.

The study compared breast feeding history in women who had breast cancer with women who hadn’t.  It was a very large study, involving the histories of 50,000 women with breast cancer and nearly 100,000 women without.  

The longer the women had fed for during their lifetime, the less likely they were to get breast cancer.  According to the researchers, this was a very striking finding.  They made sure that the women’s age; menopausal status, ethnic origin, number of births and their age at the birth of their first child were all taken into account.  Breast feeding still lowered breast cancer risk by 4.3% for every year of feeding.  There is also a 7% reduction in risk of breast cancer for each child born.  

A 4% lowering of risk doesn’t sound much but, as breast cancer is quite a common disease in developed countries, breast feeding every child for an extra 6 months would mean about 1,000 fewer cases of breast cancer in Britain each year.  

This research is a major step in explaining the difference in breast cancer rates between the Western world and developing countries.   In developing countries, women tend to have more children and to feed each of them for much longer.  

Interestingly, in Japan 90% of women who have children breast feed.  

Japan is often talked about in relation to the incidence of breast cancer because, although it is obviously a developed country, breast cancer rates are much lower than they are in Western countries.  Usually, people talk about diet as the explanation for this.  But it may well be cultural differences in feeding babies that explains it.

These findings are important for helping us to prevent future cases of breast cancer.  But the research may also help us in developing treatments.  Any new knowledge about how breast cancer is triggered can help scientists to develop treatments to tackle it.

Researchers are now looking into whether breast feeding can help to protect women who carry one of the breast cancer faulty genes - BRCA1 and BRCA2.  One Swedish study, published in 2004, concluded that breast feeding may reduce breast cancer risk for BRCA1 carriers who breast fed for more than a year in total, but there was no difference for BRCA2 carriers.  There are other studies and it isn’t possible to draw definite conclusions from just this one study.

First it is necessary to restore your confidence.

Look good… feel better program

A program called Look Good…Feel Better can help with self-confidence during and after breast cancer treatment. It offers useful tips dealing with changes to your skin, hair and general appearance. This program is for women and men.

Breast form (prosthesis)

A breast form is an artificial breast, which fits into your bra. It can help give the appearance of a normal breast, as well as helping balance and posture. Many women who have had a mastectomy choose to use a breast form, although some women prefer not to. Breast forms are often not necessary after breast conserving surgery

Sexuality and cancer

A breast cancer diagnosis and its treatment may affect your sexuality. This includes your interest in sex, your ability to give or receive sexual pleasure, how you see yourself and how you think others see you.

Breast surgery may make a woman feel like she has lost part of her female identity. A woman may feel less attractive or worry that her partner will reject her now that her breast has changed.

Healthy eating and exercise

Eating nutritious food will help you to keep as well as possible and cope with the cancer and treatment side effects. A dietitian can help to plan the best foods for your situation.

Relaxation techniques

Some people find relaxation, meditation or massage helps them feel better by releasing tension and anxiety. The hospital social worker or nurse will know whether the hospital runs any programs, or may know about local community programs. Your community health centre or breast cancer support group may also be able to help.

A cancer is made up of millions of cancer cells.  These form a tumour.  Some cells may break away and spread to another part of the body and form a new tumour.  Your doctor may call the new tumour a ‘metastasis’ or a ’secondary’.  The original cancer is known as a ‘primary’ tumour or the ‘primary’ cancer.

So a secondary breast cancer is when the cancer which started in the breast has spread to another part of the body.  The secondary cancer is made of the same type of cells as the primary cancer.  So if a woman has secondary breast cancer in her bones, for example, she has breast cancer cells which have spread from her breast and formed another tumour in a bone.

This is different from having a cancer that first started in the bone (a primary bone cancer).  In that case, the cancer is made up of bone cells that have become cancerous.

Secondary breast cancer can appear differently in different women.  For example, a woman with secondary breast cancer affecting a bone will have different symptoms from a woman with secondary breast cancer affecting her liver.  This is because, although their bones and liver are affected by the same type of cancer cells, their growth will have different effects in different parts of the body.

 What is triple negative breast cancer?

Triple negative breast cancers are cancers that don’t have receptors for oestrogen, progesterone or Her2.  During a biopsy or surgery for breast cancer, your doctor will take a sample of cells so they can be tested for these receptors.  The results help your doctor to decide on the most suitable treatment for you.

 

Only around 15 out of every 100 breast cancers (15%) are triple negative.  Doctors and researchers have only recently found out about triple negative breast cancer.  They are continually finding out more about what makes cells grow and how best to treat particular types of breast cancer.

An American study in 2006 found that triple negative breast cancer is more common in African American women than white American women. 

The new research has given this idea of increasing breast cancer by eating grapefruit. It can increase the risk of breast cancer by almost a third, a study suggests.It is thought the fruit boosts blood levels of oestrogen, the hormone associated with the risk of the disease.

According to the research, eating as little as a quarter of a grapefruit a day raises the danger by 30 per cent among older women.

Researchers said: “This is the first report of a commonly consumed food that may increase the risk of breast cancer among post-menopausal women.

“Whole grapefruit intake was significantly associated with breast cancer in the present study - generally a 30 per cent increase among women who consume the equivalent of one quarter of a grapefruit or more per day.

“There is evidence that grapefruit increases plasma oestrogen concentrations.

“Since it is well established that oestrogen is associated with breast cancer risk, it is plausible that regular intake of grapefruit would increase a woman’s risk of breast cancer.”

The study, carried out by the universities of Southern California and

Hawaii, was based on more than 50,000 post-menopausal women from five ethnic groups, including 1,657 with breast cancer. The results, published in the British Journal of Cancer, will further increase fears over the disease, which accounts for more than a quarter of all cancers in women.

A number of lifestyle factors have been linked to breast cancer risk.

Earlier this year, it was revealed that a single alcoholic drink daily may increase a woman’s risk of developing aggressive forms of breast cancer by 9 per cent.

A major European study also recently showed that eating junk food raises women’s risk of developing a range of cancers.

And older women with the fattiest diets have a 15 per cent increase in their chances of developing breast cancer, according to a separate

U.S. study.

This is to describe the possible effects of pregnancy before, during, and after a diagnosis of breast cancer, as well as some of the possible consequences of such a diagnosis on the pregnancy itself. For more in-depth information on breast cancer and its detection and treatment, see the American Cancer Society document, “Breast Cancer.”

Breast cancer is not very common during pregnancy, but because more women are choosing to have children later in life, it is expected to become more common in the future (because the risk of breast cancer increases with age). Today, based on research findings from 2006, breast cancer is diagnosed in about 1 out of 3,000 pregnant women.Women whose bodies are exposed to higher levels of estrogen over longer periods of time seem to be at a slightly higher risk for breast cancer.

Pregnancy may delay a breast cancer diagnosis, but most studies have found that the outcome among pregnant and non-pregnant women with breast cancer is about the same if the cancers are diagnosed at the same stage. pregnant women who had a mastectomy did not have a worse prognosis than women who were not pregnant and had a mastectomy. Survival after 5 and 10 years was almost identical in these 2 groups. Therefore, pregnancy and the related breast changes did not worsen the mother’s chances of surviving breast cancer.

What Research Is Currently Being Done on Breast Cancer? The American Cancer Society (ACS) is involved in the fight against breast cancer in many areas. A few areas of research now being investigated by American Cancer Society grantees are:

• the role of insurance and government policies in breast cancer screening among low-income women
• the psychological factors in chemotherapy-related fatigue
• the use of DNA microchips to identify genes involved in breast cancer development and progression
• how diet interacts with genetics to influence breast cancer risk
• the development of mouse models with human breast cancer genes to test drugs
• the mechanism of action of a new breast cancer therapeutic vaccine
• how an estrogen receptor-positive tumor becomes estrogen receptor-negative
• the quality of life among younger breast cancer survivors

the possible effects of certain breast cancer treatments on thinking and memory

Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.

To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.

Different ways to prevent cancer are being studied, including:

• Changing lifestyle or eating habits.
• Avoiding things known to cause cancer.

Taking medicines to treat a precancerous condition or to keep cancer from starting.

 

Breast cancer is the second most common type of cancer in American women.Women in the

United States get breast cancer more than any other type of cancer except skin cancer. The number of new cases has increased every year over the last 30 years. Breast cancer is second to lung cancer as a cause of cancer death in American women. However, deaths from breast cancer have decreased a little bit every year for the past several years. Breast cancer also occurs in men, but the number of new cases is small.

While having this deadly disease, it is very important to cope with the situation. A diagnosis of breast cancer can be overwhelming. It may take some time to sort through all your emotions. But you can still be in charge of your life. You’ll have many decisions to make in the weeks and months ahead. The more you know, the better prepared you’ll be to make the best choices. As soon as you find out you have breast cancer, start educating yourself about its treatment.

In addition to talking to your medical team — your breast specialist, surgeon, medical oncologist (a specialist in chemotherapy and hormone therapy) and radiation oncologist (a specialist in radiation therapy) — you may also want to talk to a counselor or medical social worker. Or you may find it helpful and encouraging to talk to other women with breast cancer.

There are also excellent books on breast cancer and many reputable resources on the Internet. Be sure to look for the most current information because breast cancer treatments change rapidly.

Telling others
One of your first decisions will likely be how and when to tell those closest to you. If you have children, telling them — no matter what their ages — can be difficult, but honesty is the best approach. You don’t have to give all the details. How much and what you say will depend on each child’s age and ability to understand. But trying to hide your illness isn’t a good idea. Instead, tell your children you’re doing everything possible to get well.

The decision to tell friends and co-workers isn’t an easy one. Especially in the beginning, you may not want anyone outside your family to know. But over time, you may find it helpful to confide in a few close friends or co-workers.

Keep in mind that people may not always react as you expect. Some may have many of the same feelings you do — anger, fear, grief. Others may be incredibly supportive. And some may not say much at all or may even avoid you. That’s not because they don’t care, but because they may not know what to say. Let them know that there are no right words and that their concern is enough.

Maintaining a strong support system
More and more studies show that strong relationships are crucial in dealing with life-threatening illnesses. In fact, friends and family are often an integral part of your treatment. Sometimes, though, you may want or need different kinds of support. If so, you may find the concern and understanding of other women with breast cancer especially comforting. Breast cancer survivors have developed a tremendous support network. Your doctor or a medical social worker may be able to put you in touch with a group near you. Or you can contact a cancer organization, such as the American Cancer Society, to find out what’s available in your area.

Dealing with intimacy
Western culture places a great emphasis on women’s breasts. They’re associated with attractiveness, femininity and sexuality. Because of these attitudes, breast cancer may affect your self-image and erode your confidence in intimate relationships. Although it can be difficult, you need to talk to your partner about your concerns — preferably before your surgery.

Taking care of yourself
During your treatment, you’ll need to plan your schedule carefully. Allow yourself time to rest. And don’t be afraid to ask for help. Your friends and family want to help, but they may not always know what to do. Be specific about your needs. For example, you might ask a friend to pick up your children from school, shop for groceries or prepare meals. If you need to, be prepared to relinquish your role as caretaker for a while. This doesn’t mean you’re helpless or weak. Far from it. It means you’re using all your energy to get well.

At the same time, you’ll likely want to stay as independent as possible. Sometimes in their desire to help, other people may try to take over your life. Or they may act as if you’re terribly fragile. Both can be detrimental to your recovery. Don’t hesitate to tell friends and loved ones how you want to be treated.

Following risk factors are involved in breast cancer:Estrogen (endogenous)Endogenous estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman’s exposure to estrogen is increased in the following ways:

• Early menstruation: Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen.
• Late menopause: The more years a woman menstruates, the longer her breast tissue is exposed to estrogen.
• Late pregnancy or never being pregnant: Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant.

Estrogen (exogenous)Estrogen that is made outside the body, in a laboratory, is called exogenous estrogen. Taking exogenous estrogen together with progesterone increases the risk of breast cancer. Exogenous estrogen may be taken in the following ways:

• Hormone replacement therapy: Hormones (estrogen, progesterone, or both) given to postmenopausal women or women who had their ovaries removed, to replace the estrogen no longer produced by the ovaries.
• Oral contraceptives (the “pill”): The most commonly used oral contraceptive contains estrogen.

X-raysRadiation can cause breast cancer. Treatment with radiation during childhood seems to increase breast cancer risk more than treatment as an adult. For example, radiation used to treat Hodgkin disease by age 16, especially radiation to the chest and neck, increases the risk of breast cancer.

Radiation therapy to treat cancer in one breast does not appear to increase the risk of developing cancer in the other breast.

ObesityObesity increases the risk of breast cancer in postmenopausal women.

AlcoholDrinking alcohol may increase the risk of breast cancer.

GeneticsWomen who have inherited certain mutations in the BRCA1 and BRCA2 genes have a higher risk of breast cancer. BRCA1 and BRCA2 are tumor suppressor genes. If these genes have a mutation and don’t work as they should, the risk of breast cancer is increased. Research is being done to identify other high-risk genes.

The following protective factors may decrease the risk of breast cancer:Estrogen (decreased exposure)Decreasing the length of time a woman’s breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:

• Pregnancy: Estrogen levels are lower during pregnancy. The risk of breast cancer appears to be lower if a woman has her first full-term pregnancy before she is 20 years old.
• Breast-feeding: Estrogen levels may remain lower while a woman is breast-feeding.
• Ovarian ablation: The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries, which make estrogen. Also, drugs may be taken to lower the amount of estrogen made by the ovaries.
• Late menstruation: Beginning to have menstrual periods at age 14 or older decreases the number of years the breast tissue is exposed to estrogen.
• Early menopause: The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen.

Aromatase inhibitorsIn postmenopausal women, taking aromatase inhibitors decreases the amount of estrogen made by the body and may lower the risk of breast cancer. Before menopause, estrogen is made by the ovaries and other tissues in a woman’s body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body’s estrogen. Possible harms from taking aromatase inhibitors include osteoporosis and effects on brain function (such as talking, learning, and memory).

ExerciseExercising four or more hours a week may decrease hormone levels and help lower breast cancer risk. The effect of exercise on breast cancer risk is greater in younger women of normal or low weight. Care should be taken to exercise safely, because exercise carries the risk of injury to bones and muscles.

Prophylactic mastectomy Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer may be lowered in these women. However, it is very important to have a cancer risk assessment and counseling before making this decision. In some women, prophylactic mastectomy may cause anxiety, depression, and concerns about body image.

Prophylactic oophorectomySome women who have a high risk of breast cancer may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause menopause or the symptoms of menopause.

The following have been proven not to be risk factors for breast cancer or their effects on breast cancer risk are not known:AbortionThere does not appear to be a link between abortion and breast cancer.

EnvironmentStudies have not proven that being exposed to certain substances in the environment (such as chemicals, metals, dust, and pollution) increases the risk of breast cancer.

DietDiet is being studied as a risk factor for breast cancer. It is not proven that a diet low in fat or high in fruits and vegetables will prevent breast cancer. For more information on diet and health, see the Fruits and Veggies website.

StatinsStudies have not found that taking statins (cholesterol-lowering drugs) affects the risk of breast cancer.

Few new technologies are there to screen the breast cancer. Mammography is the current standard test for breast cancer screening. MRI is also recommended along with mammograms for some women at high risk for breast cancer. Other tests, such as ultrasound, are now being studied as well.

Magnetic resonance imaging (MRI): For certain women at high risk for breast cancer, screening MRI is recommended along with a yearly mammogram. MRI is not generally recommended as a screening tool by itself, as it may miss some cancers that mammograms would detect.

MRI uses magnets and radio waves, instead of x-rays, to produce very detailed, cross-sectional images of the body. The most useful MRI exams for breast imaging use a contrast material (gadolinium DTPA) that is injected into a small vein in the arm before or during the exam. This improves the ability of the MRI to clearly show breast tissue details.

MRI is also more expensive than mammography. Most major insurance companies will likely pay for these screening tests if a woman can be shown to be at high risk, but it’s not yet clear if all companies will. At this time there are concerns about costs of and limited access to high-quality MRI breast screening services for women at high risk of breast cancer.

Breast ultrasound: Ultrasound, also known as sonography, is an imaging method in which high-frequency sound waves are used to look inside a part of the body. A handheld instrument placed on the skin transmits the sound waves through the breast. Echoes from the sound waves are picked up and translated by a computer into an image that is displayed on a computer screen. You are not exposed to radiation during this test.

Breast ultrasound is sometimes used to evaluate breast problems that are found during a screening or diagnostic mammogram or on physical exam. Breast ultrasound is not routinely used for screening. Some studies have suggested that ultrasound may be a helpful addition to mammography when screening women with dense breast tissue (which is hard to evaluate with a mammogram), but the use of ultrasound instead of mammograms is not recommended.

Ultrasound is useful for evaluating some breast masses and is the only way to tell if a suspicious area is a cyst without placing a needle into it to aspirate (pull out) fluid. Cysts cannot be accurately diagnosed by physical exam alone. Breast ultrasound may also be used to help doctors guide a biopsy needle into some breast lesions.

Ductogram: This test, also called a galactogram, is sometimes helpful in determining the cause of bloody nipple discharge. In this test a thin plastic tube is placed into the opening of the duct at the nipple. A small amount of contrast medium is injected that outlines the shape of the duct on an x-ray image, which will show if there is a mass inside the duct.

Full-field digital mammograms (FFDM): Full field digital mammography is similar to standard mammography in that x-rays are used to produce an image of your breast. The differences are in the way the image is recorded, viewed by the doctor, and stored. Standard mammograms are recorded on large sheets of photographic film. Digital mammograms are recorded and stored on a computer. After the exam, the doctor can view them on a computer screen and adjust the image size, brightness, or contrast to see certain areas more clearly. Digital images can also be sent electronically to another site for a remote consult with breast specialists. While many centers do not offer the digital option at this time, it is expected to become more widely available in the future.

Because digital mammograms cost more than standard mammograms, studies are now under way to determine which form of mammogram will benefit more women in the long run. Some studies have found that women who have FFDM have to return less often for additional imaging tests because of inconclusive areas on the original mammogram. A recent large study from the National Cancer Institute found that FFDM was more accurate in finding cancers in women younger than 50 and in women with dense breast tissue, although the rates of inconclusive results were similar between FFDM and film mammography. It is important to remember that standard film mammography also is effective for these groups of women, and that they should not miss their regular mammogram if digital mammography is not available.

Computer-aided detection and diagnosis (CAD): Over the past 2 decades, computer-aided detection and diagnosis (CAD) has been developed to help radiologists detect suspicious changes on mammograms. This is done most commonly with screen-film mammograms and less often with digital mammograms. Generally the computer device will scan the mammogram first. It can find tumors that the radiologist can’t spot. The radiologist, knowing the results of the CAD, will then review the films to look for lesions the CAD missed. The radiologist will then decide the seriousness of the lesions the CAD found. Early research results suggest that CAD systems help radiologists diagnose more early stage cancers than mammograms alone.

Scintimammography: In scintimammography, a radioactive tracer is injected into a vein to detect breast cancer cells. The tracer attaches to breast cancers and is detected by a special camera. This is a very new technique and is still considered experimental. It may or may not be helpful in evaluating abnormal mammograms.

For more information about these and other breast imaging tests, see the American Cancer Society document, “Mammograms and Other Breast Imaging Procedures.”

If you think you are at higher risk for developing breast cancer, talk to your doctor about what is known about these tests and their potential benefits, limitations, and harms. Then make a decision together about what is best for you.

There are many factors on which treatment of breast cancer depends, it includes:

   the stage and grade of the cancer    

  your age      

whether or not you have had the menopause     

 the size of the tumour     

whether the cancer cells have receptors for certain hormones (such as oestrogen) or particular proteins (such as HER2).

Most breast cancers will be treated with surgery to remove the tumour. All, or part, of the breast tissue may be removed. If the whole breast is removed, breast reconstruction may be carried out, either at the same time as the initial surgery or later. Sometimes chemotherapy or hormonal therapy may be given to shrink a cancer before surgery. This is known as neoadjuvant therapy.After surgery, radiotherapy may be given to the breast tissue, to make sure any cancer cells that may be left in the area are destroyed. After surgery, the doctors can tell the stage and the grade of the cancer, and they can look at several other factors to predict how likely the cancer is to come back or spread.

surgery

Your doctor will discuss with you the most appropriate type of surgery for you, depending on the size and position of the cancer. Before any operation, make sure that you have fully discussed with your surgeon why they have recommended a particular type of surgery for you, what the surgery involves, and that you have all the information you need.
Lumpectomy (wide local excision) Segmental excision (quadrantectomy) Mastectomy Choice of treatment Checking the lymph glands Lymphoedema Scars  radiotherapyAt the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch, and make sure you are comfortable. During your treatment you will be left alone in the room but you will be able to talk to the radiographer who will be watching you from the next room. Radiotherapy is not painful but you do have to lie still for a few minutes while the treatment is being given.

chemotherapy
In women whose cancer is very unlikely to come back, chemotherapy may only reduce the chance of recurrence by a small amount. In women whose chance of the cancer coming back is higher, chemotherapy may greatly reduce the chance of recurrence. Your doctor can let you know how likely chemotherapy is to make a difference in your case. They can also let you know about the possible side effects.

hormonal therapies

There are many different types of hormonal therapy and they work in slightly different ways. They are often given after surgery and radiotherapy for breast cancer, to reduce the chance of the cancer coming back. Hormonal therapy is usually given after chemotherapy. Hormonal therapies are only effective in women whose cancer cells have receptors for oestrogen and/or progesterone on their surface. This is known as being oestrogen- receptor positive (ER+) or progesterone-receptor positive (PR+).
Hormonal therapy treatment options Tamoxifen Aromatase inhibitors Zoladex® (Goserelin) Ovarian ablation

Herceptin® (Trastuzumab)

Trastuzzumab (also known as Herceptin®) is a treatment that may be given to some women with breast cancer. It is a type of drug known as a monoclonal antibody. It works by attaching to HER2 receptors (proteins) on the surface of breast cancer cells. This reduces the stimulation for cancer cells to divide. It may also allow the body’s defences to fight better against the cancer cells.Research trials have shown that Herceptin can reduce the chance of breast cancer coming back after initial treatment for early breast cancer. However, it is only effective for women whose breast cancer cells have a large number of the HER2 receptors on their surface. Around 1 in 4 women will have a large number of HER2 receptors on their cancer cells - this is known as being HER2-positive. When your breast cancer is diagnosed, the cells will be tested for HER2 protein. In women who have early breast cancer and are HER2 positive, Herceptin may be used alongside, or after, other treatments. In women who have advanced breast cancer, Herceptin may be used to control the cancer for some time. You can discuss with your doctor whether it may be a suitable treatment for you.

After treatment

After your treatment has ended, you will need to have regular check-ups (which will include a physical examination) and mammograms. These check-ups will usually be once a year, but may be more frequent at first. You may also need to see your specialist or GP every few months if you are having ongoing treatment with hormonal therapy, or if you have any side effects following surgery, radiotherapy or chemotherapy treatment. If you have had a mastectomy, the breast prosthesis fitter will also be at your first appointment.The appointments are a good opportunity to discuss with your doctor any worries or problems you may have. However, if you notice any new symptoms or are anxious about anything else between your appointments, you can contact your doctor or nurse for advice. Many people find that they get very anxious for a while before the appointments. This is natural and it may help to get support from family, friends or a support organisation during this time.For women whose treatment is over apart from regular check-ups, our section on life after cancer gives useful advice on how to keep healthy and adjust to life once the treatment has ended.