After treatment for breast cancer

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. 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 present 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 should contact your doctor or nurse for advice.

* Hormone replacement therapy (HRT)
* Fertility after treatment
* Lymphoedema

Hormone replacement therapy (HRT)

Women who have had breast cancer are usually advised not to take hormone replacement therapy as there is a risk that the oestrogen it contains can increase the chance of the cancer coming back.

However, if you have troublesome menopausal symptoms, medicines can be used to treat them. If the menopausal symptoms continue despite the medicines, your doctor can prescribe a short course of low-dose HRT to deal with these. It is important that your progress is very carefully monitored if you take HRT.

Fertility after treatment

Pregnancy

Research suggests that becoming pregnant after treatment for breast cancer does not make the breast cancer more likely to come back.

If you want to have a child, it is important for you and your partner to discuss this with your breast cancer specialist, who knows your full medical history and can talk over the risks and implications. It is usually advisable to wait a while after your initial treatment has finished before trying to become pregnant. The longer you are free of the cancer, the less likely it is to come back. However it is very important to carefully consider what might happen if, after having a baby, the cancer did come back, and whether you want to take that risk.

Infertility

Unfortunately, women who have had radiotherapy to their ovaries or an operation to remove their ovaries will not be able to have children. Sometimes chemotherapy can also cause infertility by bringing on an early menopause. Generally, the older a woman is when undergoing chemotherapy the more likely she is to be infertile afterwards.

This added blow can be very hard for some women to live with – whether or not they already have children. Fertility is a very important part of many people’s lives and not being able to have children can seem especially hard when you already have to cope with cancer. Some people find it helpful to talk through their feelings about this distressing situation. You can speak to a counsellor by contacting the Cancer Counselling Trust.
Egg or embryo storage

If your treatment is likely to make you infertile, and you would like to have children in the future, it is sometimes possible to remove eggs from the ovaries, fertilise them and store the embryos to use later. It is also sometimes possible to store eggs removed from your ovaries before treatment begins, although this is very experimental.

At a later date the fertilised eggs can be thawed and implanted into the uterus to start a pregnancy. These techniques may allow some women with breast cancer to have children in the future. If you want to have children it is very important to discuss this with your doctor before treatment begins. Your doctor can refer you to a fertility specialist for advice on the possible options available to you.

Contraception

As there is a risk that the hormones (oestrogen and progesterone) in the contraceptive pill may stimulate the growth of breast cancer cells, women who have had breast cancer are usually advised not to take the pill. Barrier methods of contraception such as condoms or the cap are more suitable. Lubricating jelly (available without prescription from the chemist) is completely safe to use with barrier contraceptives if extra moisture is needed during sex.

Your cancer specialist or GP can give you advice on contraception. Your GP can also fit you for a cap if this is the method of contraception you choose. Coils (IUDs) can be an effective method of contraception and your GP can fit you with a coil if you wish. Some women choose to be sterilised to prevent the risk of pregnancy.

The choice of an effective contraceptive is a very personal one. Your likes and dislikes, and those of your partner, are obviously important. Some women also have religious and moral considerations. Unfortunately, the withdrawal and rhythm methods of contraception are not safe enough to be effective as protection against pregnancy in this case. Some women find that, if necessary, talking through their situation with their religious leader, the FPA or a trained counsellor, helps them find acceptable alternatives.

Lymphoedema

If the lymph glands in your armpit have been removed by surgery, or you have had radiotherapy to the armpit, there is a risk of lymphoedema (swelling of the arm or hand). This is usually mild, and develops gradually a few months or several years after the treatment. Sometimes swelling of the arm may occur after the initial surgery, but this usually goes back to normal within a few weeks and is not lymphoedema.

If lymphoedema occurs, the arm and hand are more prone to infection. These simple tips can help you care for your skin and reduce the risk of infection:

* Treat even small grazes and cuts with antiseptic and keep them clean until they heal.
* See your GP at the first sign of any infection – if the cut is inflamed or feels warm and tender.
* Wear gloves for washing up, DIY and other household tasks.
* Try to avoid being scratched. Wear gloves and long-sleeved clothing when handling animals or gardening.
* Use a thimble if you sew.
* Avoid getting sunburnt.
* Use an electric razor if you shave under your arms, to avoid cuts.
* Keep your skin clean and dry and use moisturising cream daily to keep it supple.
* Use nailclippers instead of scissors to cut your nails.
* Never push back or cut the cuticles – use cuticle cream instead.