The most common treatment options for breast cancer today are chemotherapy radiation, hormone therapy, targeted therapy, and surgery. Most treatment plans include a combination of these options. Depending on the specific treatment and your individual health history, side effects may vary. You should always talk with your doctor about your risk factors for side effects, any side effects you experience, and options for mitigating, or relieving, those side effects.

Remember that everyone experiences a cancer diagnosis, treatment, and treatment side effects differently—what may greatly affect one patient may not affect another. It is important to keep in constant contact with your care team to discuss any treatment side effects that may come up for you.

Table of Contents

Click on the following links to jump to side effects and management tips for each treatment type.

Chemotherapy Side Effects
Radiation Side Effects
Hormone Therapy Side Effects
Targeted Therapy Side Effects
Surgery Side Effects
Late-Term Side Effects
Tips on Talking with Your Care Provider
Where to Find Help and Support

Chemotherapy Side Effects

One of the most common treatments for breast cancer, chemotherapy uses one or more anti-cancer drugs to kill cancer cells in the body. Some chemotherapy side effects are well-known whereas others are less common and harder to recognize.

Based on type, dosage, and length of treatment, the most frequent chemo-related side effects include:

• Hair loss
• Mouth sores
• Fatigue
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Nail changes
• Easy bruising
• Pain and numbness (neuropathy) in the fingers and feet
• “Chemo brain” or difficulty with memory and concentration
• Increased risk of infection due to lower white blood cell counts
• Hormonal side effects, such as:
  • Vaginal dryness
  • Hot flashes
  • Potential or premature menopause
  • Fertility issues
  • Low white blood count
  • Low red blood count

Managing Chemotherapy Side Effects

While chemotherapy side effects can be very unpleasant, the good news is that many chemo-related side effects stop when treatment ends. In the meantime, there are ways you and your care team can help mitigate some of the side effects of chemotherapy. Always check with your medical professional before beginning a new regimen. In addition to the tips below, read What Helps During Chemo: Patients and Survivors Share Tips & Advice.

Try to eat a chemo-friendly diet

Chemotherapy often causes patients to feel nauseous, making it difficult to identify foods that sound appealing and sit well in the stomach. To combat treatment-related nausea, focus on eating smaller meals throughout the day and opt for bland foods such as crackers, toast, yogurt, oatmeal, and pasta. Eating peppermints or smelling peppermint can sometimes help. Need chemo-friendly recipe ideas? Download NBCF’s free cookbook, Healthy Recipes for Cancer Patients.

Chemotherapy can also cause painful sores in the mouth as well as changes in the taste buds, making certain foods taste bitter or metallic. Rinsing your mouth before and after eating can remove unpleasant tastes, and sucking on sour or citrus-flavored candies can help mask the metallic aftertaste left by chemo meds. Your doctor may prescribe a special solution for you to swish in your mouth to help heal these types of sores.

Staying hydrated by drinking plenty of water, decaffeinated teas, and juices is also important to help combat the chemo side effects of vomiting and diarrhea. But ultimately, eat what you can, when you can. Read more about how good nutrition can help minimize side effects and help the body heal with NBCF’s free eBook, Nutrition Care for Breast Cancer Patients.

Talk to your doctor about anti-nausea medications

There are several different over-the-counter and prescription medications that can be used to treat chemo-induced nausea. Most doctors will anticipate nausea as a chemotherapy side effect and write prescriptions before your first chemo treatment. But if your doctor doesn’t offer a prescription before treatment, it can be useful to ask for one.

Be sure to fill all prescriptions your doctor gives you and keep them on hand to take as prescribed. If a prescribed anti-nausea medication doesn’t work for you, contact your physician’s office and ask for an alternative to try.

Balance rest with movement or exercise

Fatigue is a very common side effect of chemotherapy, and it is important to give your body the rest it needs when you experience chemo-related fatigue. But on days when you feel up to it, try to get in some movement or exercise. This can look like walking to the mailbox or further, stretching to relieve sore muscles, or even doing something practical like organizing your closet. Research has shown that physical activity can help relieve pain, reduce fatigue, and stimulate appetite.

Practice yoga, meditation, or mindfulness

Along the same lines as movement and exercise, yoga and meditation provide gentle movement and stretching for the body, focus the mind to decrease anxiety, and provide a refuge during stressful times. Meditation can help anchor your mind to the present, particularly when it wants to race off in another direction. To learn how to strengthen your mind-body connection, download NBCF’s free guide, 10 Prompts to Mindfulness, and practice them when you feel stressed or overwhelmed during treatment.

Prepare for hair loss

For many patients, hair loss is inevitable with chemotherapy treatment. However, the severity of hair loss can differ depending on the type and dosage of chemo. While the loss of your hair can be traumatic, you can help alleviate the shock by being prepared in advance. You may choose to cut or shave your hair before it begins falling out, or you may wish to invest in a cooling cap to try to minimize the amount of hair lost during chemo. Remember, your hair will grow back after chemotherapy is complete, though it may be a different texture or even a different color than before.

Radiation Side Effects

Radiation is a cancer treatment that uses high-energy photon beams to target cancer cells; it can be used to shrink tumors prior to surgery or chemotherapy, or as a standalone treatment.

The most common side effects of radiation for breast cancer include:

• Fatigue
• Breast soreness
• Swelling of the area being radiated
• Skin irritation of the area being radiated

The severity of these side effects may increase as treatment progresses. Skin on and around the area being radiated can feel irritated and look red, with occasional peeling, similar to a sunburn. The area may continue to appear tan or discolored even after radiation.

Some people also experience changes in skin sensation and discomfort in the armpit area. More serious risks include lymphedema, or swelling of the arm/upper body when lymphatic fluid fails to drain properly.

Managing Radiation Side Effects

It can take a couple of weeks for the side effects of radiation, such as skin irritation, to appear. It’s important to let your care team know how you are doing throughout your radiation treatments so that they can recommend specific ways to lessen the severity of side effects.

Use lotions and creams

The main side effects of radiation affect the surface of the skin. Therefore, it is important to keep the area(s) being radiated moisturized and hydrated. Try using unscented and/or medical-grade lotions or creams on the irritated area, or ask your care team for prescription-strength creams to reduce radiation side effects.

Try to stay well-rested and mindful

Like chemotherapy, radiation treatment can cause physical and mental fatigue. Be sure to rest your body when you feel tired, and consider practicing mindfulness or meditation to strengthen the mind-body connection as you undergo radiation.

Exercise in the form of walking

Walking for 30 minutes, five times a week during and several weeks after completion of radiation can help to diminish the side effect of fatigue by more than 70%.

Hormone Therapy Side Effects

Hormone therapy can be used to treat breast cancer that is sensitive to hormones, such as estrogen or progesterone, by either preventing hormones from attaching to cancer cell receptors or decreasing the production of hormones altogether. Hormone therapy is typically recommended for patients with tumors that are hormone receptor-positive. Hormone therapy is usually taken for five years or longer.

While they vary based on the specific drug or type of hormone therapy used, common side effects of hormone therapy include:

• Hot flashes
• Vaginal dryness
• Night sweats
• Muscle and joint pain
• Osteoporosis
• Weight gain
• Headaches
• Nausea
• Fatigue
• Mood swings
• Low libido

Hormone therapy can also affect women’s menstrual cycles, sometimes causing irregular periods or the cessation of periods (menopause) in premenopausal women.

Managing Hormone Therapy Side Effects

While some of the side effects of hormone therapy are short term, many side effects may last much longer, possibly throughout the rest of a woman’s life. It is important to try to manage any short- or long-term side effects you may experience by working with your doctor. Other ways to manage side effects may include the following.

Eat a healthy, well-balanced diet

Good nutrition provides the fuel you need to heal and stay healthy. It can also help minimize the side effects of cancer treatment. To learn more about healthy and balanced eating for cancer patients and survivors, download the free NBCF eBook, Nutrition Care for Breast Cancer Patients.

Stay active through movement or exercise

Weight gain, muscle and joint pain, and osteoporosis are common long-term side effects of hormone therapy. To combat these, try to incorporate movement or exercise into your daily routine. Studies show that 150 minutes of exercise a week, or approximately 20 minutes per day, can help reduce the severity of these common side effects.

Use vaginal lubricants or moisturizers

If vaginal dryness becomes bothersome, or if you experience pain or discomfort during intercourse due to vaginal dryness, try using water-soluble vaginal lubricants prior to sex. If dryness or discomfort continues to be an issue, contact your gynecologist. Vaginal moisturizers may be used to routinely to maintain a healthy vaginal wall. Some doctors may even prescribe a very low dose of estrogen, known as Estrodiol, in a vaginal tablet form to be used twice a week. It has very low blood absorption and can restore vaginal wall health.

Stop smoking and reduce alcohol intake

Both smoking and drinking alcohol have negative effects on health, especially for a breast cancer patient or survivor. Stopping smoking and reducing alcohol intake can reduce the severity of treatment side effects by improving your overall health and wellness. It also reduces the risk of breast cancer recurrence.

Talk to your doctor about natural supplements

Many natural supplements, such as Vitamin D, calcium, magnesium, and even probiotics can help reduce the side effects of hormone therapy. Talk to your doctor about any potential drug interactions before adding new vitamins or supplements to your treatment plan.

Targeted Therapy Side Effects

A newer breast cancer treatment option, targeted therapy uses drugs that can block the growth of breast cancer cells by targeting specific proteins on breast cancer cells without harming other cells. It is often used in combination with chemotherapy—some of the side effects overlap and some are different. They include:

• Nausea and vomiting
• Fatigue
• Diarrhea
• Mouth sores
• Rashes and/or dry skin
• Pain and numbness (neuropathy) in the fingers and feet
• Cardiac changes

Your doctor will also monitor for signs of heart, lung, liver, and clotting issues during treatment.

Managing Targeted Therapy Side Effects

As with chemotherapy, the severity and duration of targeted therapy side effects vary depending on the type of therapy and the individual receiving it. It’s important to speak with your doctor or care team about side effects you should expect with targeted therapy, and ways to manage them as they come up throughout your treatment.

For women on biologic targeted therapies for HER2+ breast cancer, heart tests are periodically done to help ensure there are no cardiac side effects happening. Cardiac side effects from this classification of drugs can happen up to 10 years after taking the last treatment. 

Surgery Side Effects

Surgery remains the most common treatment for breast cancer, and can consist of lumpectomy, mastectomy, breast reconstruction, and lymph node removal. As with any surgery, side effects can include pain and discomfort, stiffness, and swelling.

Other potential side effects from breast cancer surgery are:

• Nerve pain
• Fatigue
• Change in sensation to the area around the surgical site
• Skin changes and bruising
• Nausea
• Scar tissue at the surgical site
• Lymphedema

Soon after surgery, if you experience fluid discharge from the surgical site, an elevated temperature, or a wound that is warm to the touch, these can be signs of infection and you should contact your doctor immediately.

For more information on different types of breast cancer surgery, including potential side effects, download NBCF’s free eBook, Breast Cancer Surgery: What You Need to Know.

Managing Surgery Side Effects

It is important that you follow all instructions from your surgeon and care team in the post-op period. This will include taking all prescribed medication as directed, caring for the wound site, and attending surgical follow-up appointments.

Stretching and physical therapy

Once you have been given the all-clear and are released from your surgeon’s care, follow up with your physician or care team for any stretches or exercises you need to do to keep the surgical site from stiffening up (or “cording”) and to increase your range of motion. Your doctor may suggest you add a physical therapist to your care team to accomplish this. Physical therapy can help relieve pain, decrease fatigue, and stimulate appetite. Massage and acupuncture may also be part of your post-surgical wellness toolkit.

A physical therapist or your care team can also help you manage lymphedema symptoms through wearing a professionally fitted compression sleeve on the affected area or through professional massage.

Women who undergo mastectomy without reconstruction may experience phantom limb sensation or pain. The brain treats the breast as if it were a limb, like an arm or leg. When someone has a limb amputated, they may comment that they can “still feel” the limb, or that the missing limb feels hot or sore. The same symptoms can happen following mastectomy. For women who have had a mastectomy but experience phantom limb sensation in the form of nipple itching, scratching in the underarm area has proven to help diminish this symptom. Wearing a breast prosthesis can also help mitigate, or lessen, phantom breast pain or sensation. For more information on how to prepare for a mastectomy or other breast surgery, read Checklist for Recovery After Mastectomy.

Late-Term Side Effects

Many side effects abate at the conclusion of breast cancer treatment, but there are potential “late” side effects that can appear several months or even years down the road. These can include bone health issues and osteoporosis, lymphedema, phantom breast pain, decreased strength, heart issues, weight fluctuations, nerve damage, decreased range of motion, and longer-term fatigue.

While not every breast cancer treatment side effect can be reversed, they can be addressed and treated. Talk with your healthcare team about the possibility of late-term side effects and how to prepare for and manage them.

Tips on Talking with Your Care Provider

When discussing the side effects of breast cancer treatment with your care team, it helps to be organized.

Consider keeping a journal that notes what side effects you have, how long they typically last, and how much they disrupt your daily life. The more information you gather, the easier it will be for your healthcare provider to offer support and symptom management.

Don’t be afraid to be honest: Your team has to know about your side effects to help you treat them. If you feel uncomfortable speaking to a male doctor about hormone therapy side effects, ask to speak to a female doctor or nurse on staff instead.

Where to Find Help and Support

When you or a loved one is going through breast cancer treatment, the treatments themselves and any related side effects can sometimes feel overwhelming. No matter what your symptoms or side effects, having someone to talk to can make a tremendous difference. NBCF support groups create a safe space for patients and survivors to give and receive help.

Medically reviewed June 2023

Sources

American Cancer Society
Breastcancer.org
Mayo Clinic
National Cancer Institute

The post Side Effects of Breast Cancer Treatment and How to Manage Them appeared first on National Breast Cancer Foundation.

Bone health is important for overall health and wellness—and even more so for breast cancer patients and survivors. Breast cancer survivors had a 68 percent higher risk of osteoporosis and osteopenia compared with cancer-free women in a Breast Cancer Research study.

Hormonal therapy for breast cancer can also increase rates of bone fractures—yet another reason it is critical to pay attention to bone health. As breast cancer survival rates increase and survivors live longer, good bone health remains a vital part of maintaining quality of life.

The more you know about your risk of osteoporosis, the more you can focus on protecting your bones before, during, and after treatment. In this guide, we’ll cover the ins and outs of osteoporosis, the link between breast cancer treatment and osteoporosis, and how to take care of your bone health properly to reduce the risk of getting osteoporosis. 

Jump to:
– What is Osteoporosis?
– The Link Between Breast Cancer and Osteoporosis
– Breast Cancer Treatments that can Impact Bone Health
– Signs of Bone Loss Due to Breast Cancer Treatments
– Discussing Your Bone Health with Your Physician
– Managing Bone Health After Breast Cancer Treatment

What is Osteoporosis?

Osteoporosis is a condition where bones lose strength and density following hormonal changes, quality of bone changes, and vitamin D or calcium deficiency, leading to an increased risk of fractures. While you can’t reverse bone damage caused by osteoporosis, you can improve bone density and prevent fractures.

Osteoporosis is a silent disease that often lacks symptoms: You may not know you have it until you fall and break a bone. Globally, 1 out of 3 women and 1 out of 5 men over the age of 50 will suffer a fracture related to osteoporosis. In the United States, more than 53 million people either have osteoporosis or are at high risk due to low bone mass, according to the National Institutes of Health.

For those diagnosed with osteoporosis, the risk of breaking a bone is based on family history, medical conditions, and medications, among other factors.  The American Bone Health Fracture Risk Calculator can help you assess your 10-year fracture risk.

What causes osteoporosis?

As with many conditions, the risk of osteoporosis increases with age and is related to your family medical history. Another key factor is lower estrogen levels, which can be impacted by breast cancer treatment. Estrogen protects against bone loss so women who have gone through menopause, had their ovaries removed, or experienced various breast cancer treatments have an increased risk of osteoporosis. We will cover this topic in greater detail later in this guide.

Other risk factors for osteoporosis include previous fractures not caused by injury, immobility, smaller size/body weight, certain medications and medical conditions, including diabetes, Crohn’s disease, celiac disease, and hyperthyroidism.

The Link Between Breast Cancer and Osteoporosis

Research has shown that breast cancer and osteoporosis are inextricably linked. Breast cancer can weaken bones by causing inflammation that spurs the breakdown of bones and slows new bone growth. This is another reason why breast cancer awareness efforts and breast cancer early detection programs are vitally important.

Does breast cancer increase the risk of osteoporosis?

Breast cancer treatment can reduce bone density and increase the risk of osteoporosis and fractures.

Breast Cancer Treatments that can Impact Bone Health

Several common breast cancer treatments can affect both premenopausal and menopausal women in terms of bone health and strength.

Chemotherapy

Some chemotherapy treatments lower estrogen levels and can lead to early menopause. For women who have not yet experienced menopause, shutting down the ovaries can help prevent breast cancer from recurring, however, this can also result in bone loss and increased risk of fractures.

Ovarian Suppression

Ovarian suppression treatments stop the ovaries from making estrogen, reducing bone strength. Estrogen production does resume when the medications are discontinued.

Breast cancer treatment can also include surgical removal of the ovaries, which is a permanent form of ovarian suppression that can increase the risk of osteoporosis.

Radiation Therapy

Radiation therapy is used to kill cancer cells that may be left in the breast after surgery, and it can also increase the risk of bone loss and fractures, including a greater risk of rib fractures due to radiation exposure in that area.

Tamoxifen

Tamoxifen is a medication used to prevent estrogen from helping cancer grow. For those who haven’t reached menopause, it slightly increases the risk of osteoporosis, however, it reduces risk for postmenopausal women.

Aromatase Inhibitors

Aromatase inhibitors are hormone therapies that prevent the formation of estrogen, and are sometimes used to treat estrogen receptor-positive breast cancer in postmenopausal women. These evidence-based treatments keep cancer cells from getting the hormones they need to grow. Side effects can include muscle and joint pain, menopausal symptoms, and loss of bone density, which can increase risk of fractures.

Signs of Bone Loss Due to Breast Cancer Treatments

Interestingly, most people don’t know they have bone loss until they experience a fracture—just one of the reasons that screening is so important.

While the general recommendation for osteoporosis screening is age 65 for women and 70 for men, anyone who has had treatments known to affect bone loss or density or those who have experienced fractures not caused by an injury should be checked earlier.

A bone density scan can help track the trajectory of potential loss during breast cancer treatment. If you are uncertain, ask your doctor if you should be screened for osteoporosis.

Measuring Bone Health

A variety of tools can assess bone health and provide baseline information, before, during, and after breast cancer treatment.

Physical Exam

In addition to your medical history, a physical exam focused on bone health may include a spine exam and measurement to determine if you have lost height since your last assessment.

Urine and Blood Tests

Blood and urine tests can help to pinpoint potential causes of bone loss. They can take a closer look at blood calcium levels, thyroid function, vitamin D levels, a 24-hour urine calcium measurement, and various biomarker tests. These tests can also help your doctor determine if another medical condition may be contributing to bone loss.

Bone-Density Scans

Bone-density scans use X-rays to measure bone strength, predict the likelihood of fracture, and diagnose osteoporosis. The gold standard and most common test is known as a DEXA scan, or dual-energy X-ray absorptiometry, which is quick, safe, and painless. A scanner, using low X-ray levels, passes over the body to measure bone mineral density, particularly in the spine and hip. It calculates bone density based on the amount of radiation absorbed by the bone; an osteoporosis diagnosis indicates that bone density is below the expected range (or a T-score of less than -2.5).

If you have been diagnosed with breast cancer, your doctor will likely recommend a baseline DEXA scan prior to beginning treatment and regular scans as you get treatment for breast cancer. This information will determine if medication, lifestyle changes, or other protective measures should be taken to prevent further bone loss. If you haven’t had a bone-density scan and are recovering from breast cancer or have received treatment for breast cancer, talk with your doctor about whether you are a candidate.

Bone Fracture Risk Assessment

Your physician can help you assess your risk for future fractures. In addition, the American Bone Health Fracture Risk Calculator can give you an idea of your risk factors.

Discussing Your Bone Health with Your Physician

Your doctor can answer questions you have regarding bone health and bone density and discuss potential lifestyle changes, treatments, and options.

In addition to any questions you may already have, as a breast cancer survivor, you may want to ask your physician the following:

• How can I reduce my risk of fractures?
• What changes can I make to my diet or exercise routine to better protect my bones?
• Are there any tests that I should have?
• How are my current treatments potentially affecting my bone health?
• What is the next step?

Managing Bone Health After Breast Cancer Treatment

If your bone mineral density declines during treatment for breast cancer, you can make lifestyle changes or talk with your physician about medications designed to keep your bones as strong as possible.

Lifestyle Changes for Healthy and Strong Bones

Fortunately, your lifestyle can positively impact your bone health for decades to come. Consider the following to keep your bones healthy and strong both during and after breast cancer treatment.

Diet and Nutrition

A balanced diet of whole foods supports good bone health. Ideally, you should get most of your essential nutrients from your diet, rather than supplements, and enjoy a variety of colorful whole foods. Good nutrition will not only keep your bones strong but also help you keep up your weight, also important for preventing fractures.

The following three nutrients are especially important for bone health and should be a part of your daily diet:

1. Calcium: Dairy products contain the most calcium per serving size. Calcium is also found in dark-green leafy vegetables, fish with bones, dried beans and peas, and calcium-fortified juice and cereal. Try to consume one calcium-rich food per meal, and consider taking a calcium supplement. The amount of calcium you need changes with age so make sure you are consuming an adequate amount for your current needs.
2. Vitamin D: Although vitamin D can be produced when your skin is exposed to sunshine, the sun is not a reliable source of vitamin D for most people. To maintain a good level of vitamin D, people need anywhere from 15 to 50 mcg (600 to 2,000 international units) a day. For healthy adults, the National Academy of Medicine suggests 15–20 mcg (600–800 IU). However, if you have osteoporosis, the Endocrine Society suggests a higher level: up to 50 mcg (2,000 IU) per day. The best whole-food sources include fatty fish, foods fortified with vitamin D, beef liver, and egg yolks, as well as a vitamin D supplement. Low levels of vitamin D is also a risk factor for developing breast cancer, unrelated to one’s bone health. Discuss testing your vitamin D levels with your physician to determine if they are in a normal range.
3. Magnesium: This mineral helps your body regulate calcium and vitamin D and is found in green vegetables, nuts and seeds, legumes, whole grains, and avocados. The Recommended Dietary Allowance is 320 mg for adult women.

Protein is also a critical building block for bone health—it helps build and repair muscles—and it is recommended to consume protein with every meal. Keeping your muscles strong will support your bones as you age and help prevent falls and injuries. How much protein you need depends on your age and weight. The USDA recommends .36 grams per pound of body weight. A person who weighs 150 pounds, for example, needs about 54 grams of protein a day. People who are more active need more protein.

Lean meats and dairy products are great sources of protein as are lentils, nuts, and seeds. To get complete proteins from a plant-based diet, you may need to combine foods to get all your amino acids. For example, you can pair black beans with brown rice or whole-grain bread.

Looking for more information on nutrition? Download our free Nutrition Care for Breast Cancer Patients eBook.

Exercise

Weight-bearing exercise supports good bone health. Some common examples include walking, dancing, stair climbing, gardening, and strength training. When you do weight-bearing exercise, you put stress on the bones, which then triggers the cells to build more bone, leading to greater bone strength. Thirty minutes of weight-bearing exercise a day can make a big difference in your bone strength and health.

While biking and swimming are good cardiovascular activities, they don’t put weight on the bones and don’t enhance bone strength. There is no need to discontinue these activities if you enjoy them; simply add in more weight-bearing movements as well.

It is also important to avoid anything that increases your risk of falls, such as rollerblading. However, many exercises can improve your balance, tai chi and yoga, in particular. You may even find group fitness classes that are designed for bone health, breast cancer patients, chair work, and more.

Supplements and Vitamins

In addition to a multivitamin, daily supplementation with calcium and vitamin D resulted in substantial hip and other fractures in studies—vitamin D helps the body absorb calcium, so they are a great pair. Magnesium, vitamin K, and zinc also play a role in bone health. Talk with your doctor about the best vitamins and supplements for you.

Alcohol and Smoking

Both alcohol and smoking have a detrimental effect on bone density.

According to the American Academy of Orthopaedic Surgeons, smoking reduces blood supply to the bones, slows the production of bone-forming cells, impairs calcium absorption, and reduces the protective effect of estrogen. In addition, alcohol intake of greater than 3 ounces per day speeds up bone loss. If you smoke or drink alcohol, it is advisable to address these factors as part of your fracture prevention plan and seek medical attention if necessary.

It is never too late to talk with your doctor about bone density or to focus on bone strength, particularly if you are a breast cancer survivor. Strong bones can help to prevent injuries and fractures and support your overall health and wellness.

Medically reviewed June 2023

Sources:
American Bone Health
National Institutes of Health

The post Bone Health Guide for Breast Cancer Survivors appeared first on National Breast Cancer Foundation.

What Is A Lumpectomy?

A lumpectomy usually removes the least amount of breast tissue needed to get the tumor out and a margin of healthy tissue around it. The surgeon removes the cancer and a small portion or margin of the surrounding tissue, but not the breast itself. Even though the lumpectomy is the least invasive breast cancer surgery, it can still be very effective, and further surgery may not be needed.

What happens when more tissue needs to be taken?

If more tissue needs to be taken, the surgeon may perform a partial mastectomy. This procedure requires the surgeon to remove a larger portion of the breast than in the lumpectomy — perhaps a whole segment or quadrant of tissue — in order to eliminate the cancer. Occasionally, the surgeon will remove some of the lining over the chest muscles as well.

Medically reviewed June 2023

The post Lumpectomy appeared first on National Breast Cancer Foundation.

In the past, breast cancer surgery often required removing the entire breast, chest wall, and all axillary lymph nodes in a procedure called a total radical mastectomy. Now, less severe surgery options exist and are common.

If the cancer is detected early enough, there are usually options that will remove the cancer while preserving breast tissue. The common options are a lumpectomy (most often followed by breast radiation treatments), a partial mastectomy, and a simple mastectomy.

The More Common Mastectomy Procedures Today Are:

Total Simple Mastectomy

A total simple mastectomy involves removal of the entire breast, nipple, areola, and sentinel lymph node(s). This type of mastectomy removes the breast skin as well, which is what makes it different than a skin-sparing mastectomy.

Skin-Sparing Mastectomy

This procedure requires removal of the breast tissue, nipple, areola, and sentinel lymph node (or nodes) but not the breast skin. Many women who intend to have breast reconstruction will opt for this procedure. In a skin-sparing mastectomy, the breast is hollowed out, allowing for it to then be filled with an implant or fatty tissue from elsewhere in the body, such as fat from the stomach, buttocks, or inner thigh.

Skin-Sparing, Nipple and Areola Sparing Mastectomy

This type of mastectomy is like the skin-sparing mastectomy but also preserves the nipple and areola. In order to preserve the nipple and areola, the breast cancer tumor must be at least 2 centimeters away from these anatomic structures. Commonly the incision is made underneath the breast in the area known as the mammary fold.

Modified Radical Mastectomy

This procedure requires removal of the entire breast, nipple, areola, and axillary lymph nodes but often leaves the chest wall intact.

It is important to know that doing a mastectomy does not result in longer survival than doing a lumpectomy. Both accomplish the same goal which is surgical removal of the primary breast cancer tumor.

Medically reviewed June 2023

The post Mastectomy appeared first on National Breast Cancer Foundation.

How Does The Lymph System Relate To Breast Cancer?

Although breast cancer is not easily controlled, the spread of breast cancer is sometimes predictable. The cancer cells spread through a customary path, out from the tumor and into the surrounding lymph nodes, before they progress throughout the body.

What is the sentinel node?

The sentinel lymph node (and in some cases there are several grouped together) is the first node “downstream” from the cancer in the lymph circulatory system. If the cancer were to travel away from the breast tumor and into the lymphatic system, this node would be the first one to show evidence of breast cancer.

What Is A Sentinel Node Biopsy?

A sentinel lymph node biopsy is a procedure to examine the lymph node closest to the tumor because this is where the cancer cells have most likely spread. First, the surgeon will want to identify the “sentinel lymph node,” the lymph node (or nodes) closest to the tumor. To be able to identify the sentinel lymph node, the surgeon will inject dye or radioactive substances into the tissue near the tumor. The lymph nodes that are the most susceptible to the cancer’s spread will be marked by the dye or radioactive substance. During surgery, the nearest lymph nodes will be removed and checked for the presence of cancer cells.

A biopsy is nearly always taken of the sentinel node, and the breast surgeon typically removes the sentinel node as well for dissection.

What Is An Axillary Node Dissection?

This procedure is a method for determining if the cancer has spread to more than one of your lymph nodes. Axillary node dissection removes some of the the axillary lymph nodes, which are the lymph nodes located in the underarm. Once removed, they are dissected and examined by the pathologist, looking at all of the tissue and individual nodes very closely under a microscope.

Do The Lymph Nodes Always Need To Be Removed?

Not always, especially when there is no evidence of any cancer in the lymph system. A mastectomy or lumpectomy operation will most often include either a sentinel node biopsy or an axillary node dissection. Both procedures involve a separate incision for lumpectomy patients. Following surgery, the pathologist will test the lymph nodes to determine whether the cancer has spread past the breast. When some evidence of cancer is found in the lymph system, recents standards are as follows:

For patients who are having a lumpectomy and the sentinel node is positive for cancer:

Effective in mid-2012, the standard of care was changed to no longer require women with early-stage breast cancers to have a full dissection and removal of the lymph nodes under the arm when the sentinel node is found to contain cancer. Radiation to the underarm area and upper chest wall is also part of treatment. The exception is for postmenopausal patients who are over age 70 and whose cancer is estrogen receptor-positive. These patients may not need radiation and may undergo hormone therapy instead.

For patients who are having a mastectomy surgery and have a positive sentinel node:

For these women, the standard of care remains the same, calling for the node removal and dissection of the axillary (or underarm) nodes. The additional nodes removed at the time of the breast cancer surgery will be examined by the pathologist in the following days to determine if others beyond the sentinel node contained cancer or not. If cancer cells are found in those lymph nodes, other cancer treatments will be considered.

What Is Lymphedema?

Lymphedema is a chronic condition that is caused by a disruption or damage to the normal drainage pattern in the lymph nodes.  It most often causes swelling of the arm, but it can also affect the breast, chest, and sometimes even the legs. The swelling, caused by an abnormal collection of too much fluid, is called lymphedema.  Removing the axillary lymph nodes increases your risk for developing lymphedema.

The risk of developing lymphedema continues for the rest of your life, so it is imperative that you are aware of these risks.  Often it is best to learn about preventative measures for lymphedema before surgery so you will know the signs and symptoms to look for and can discuss treatment options with your physician.

Some ways to reduce the risk of developing lymphedema following a lymph node surgical removal or radiation to the lymph node area under the arm are:

• Avoid wearing tight rings, watches, or other jewelry on the affected arm
• No needle sticks or blood pressures should be taken on the affected arm
• Whenever a minor injury such as a small cut of the finger or arm occurs, immediately wash the area, apply antibiotic ointment, and cover with a bandage.

After lymph node surgery, if you experience unusual and painful swelling, you should immediately notify your doctor to monitor it. There is no cure for lymphedema, but your doctor can take steps to reduce swelling and maintain that reduction. With proper health care, good nutrition, and exercise, it may be possible for you to reduce the effects of lymphedema.

Medically reviewed June 2023

The post Lymph Node Removal & Lymphedema appeared first on National Breast Cancer Foundation.

Breast Reconstruction Options

There are a few options for breast reconstruction, and which one you use will depend on your age, body type, and treatment plan.

• Breast Implants: The breasts are filled with sacs of saline or silicone gel, or a combination of both. 
• Skin Grafts and Transplant (TRAM Flap, Latissimus Dorsi Flap, Gluteal Flap, or TUG): An alternative solution is to use tissue the surgeon removes from another part of your body. The TRAM flap, which uses tissue and muscle from the belly area, can have lifting restrictions for patients in the future. The Latissimus Dorsi flap takes the muscles from under the shoulder blade. The Gluteal flap takes no muscles, just tissue from the buttocks. A procedure called TUG takes the inner thigh fat and no muscle. Procedures that take no muscle require the expertise of a plastic surgeon who does microvascular surgery.
• DIEP Flap (Deep Inferior Epigastric Perforator Flap): This solution uses the abdominal fat (no muscle) to sculpt the tissue into the shape of your breast, resulting in a full tummy tuck and no lifting restrictions later.
• Additional Cosmetic Details: In addition to reconstructing the breast, the surgeon can add a nipple, change the shape or size of the reconstructed breast, and operate on the opposite breast as well for a better match. Areola and nipple tattooing are also options. The plastic surgeon will be able to discuss with you the benefits and risks of each procedure and help you decide what will make you feel the most natural.

Are There Any Alternatives To Breast Reconstruction Surgery?

One alternative to breast reconstruction is a removable prosthetic breast that is worn in a mastectomy bra equipped with a pocket to keep the prosthesis in place. This will preserve the shape and look of the breast without the surgical procedures. Some women opt for a prosthesis to help balance out their weight and posture, too. Full or partial breast prosthetic forms and mastectomy bras are often times covered by health insurance.

There are also clinical situations in which due to the size of the tumor or other medical diseases and disorders you may not be a candidate for getting reconstruction done at the time of mastectomy. 

If you decide not to undergo a breast reconstruction procedure or are not able to, there are still options to improve the appearance of your chest wall.

Aesthetic flat closure is a surgical procedure that removes or rearranges excess breast skin and fat after a mastectomy to produce a smooth, flat chest wall contour. If needed, revision procedures such as fat grafting can further help with creating the best possible outcome.

With aesthetic flat closure, you can choose to have other forms of reconstruction later (as long as you’re medically cleared).

Coping With Change, Making Your Plan

After a mastectomy, you have several choices that can help you become comfortable with the changes in your body. They are all options with benefits to each approach. What is best for you and your body may not be what is best for another woman.

If you think you will opt for a breast reconstruction, you should speak with your medical team before you have the lumpectomy or mastectomy, even if you plan to wait until later to have your breast reconstruction.

Whether you undergo breast reconstruction, wear a prosthetic breast, or choose to simply embrace the changes you have experienced by allowing the breast removal to remain obvious, you should feel free to make whatever decision is right for you. The goal is to prevent the discomfort of unwanted change, while enabling you to accept what has occurred and continue on with your life.

Medically reviewed June 2023

The post Breast Reconstruction appeared first on National Breast Cancer Foundation.

What Is Targeted Therapy?

In addition to chemotherapy and hormone therapy, there are newer, more effective treatments that can attack specific breast cancer cells without harming normal cells. Currently, these biologic targeted methods are commonly used in combination with traditional chemotherapy. However, targeted drugs often have less severe side effects than standard chemotherapy drugs.

How do breast cancer biologic targeted therapies work?

Breast cancer biologic targeted therapy uses drugs that block the growth of breast cancer cells in specific ways. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells.  For example, Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2.

Monoclonal Antibodies: Binding Agents For Cancer Cells

One type of biologic targeted therapy currently being studied is monoclonal antibodies. These laboratory-manufactured proteins bind with certain cancers.

Herceptin: Targeting HER2-Positive Receptors

Monoclonal antibody drugs such as Herceptin (also known as Trastuzumab) target HER2-positive tumors. If cancer cells are positive for the HER2/neu receptors that means there is an overabundance of receptors on the cancer cell for the growth-stimulating HER2 protein.

The tumor acts almost like a magnet for growth hormones, and when the tumor cells connect with growth hormone cells, the cancer can quickly grow and multiply. Herceptin helps shrink these HER2-positive tumors by finding the cells, binding with them, and blocking the action of the receptor.

This type of drug is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills.

Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Herceptin also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs.

How Are Herceptin And Other Biologic Targeted Therapies Administered And What Are The Likely Side Effects?

The drug Herceptin is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills.

Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Herceptin also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs.

Lapatinib: blocking abnormal proteins that signal cancer cells to multiply

This tablet, taken by mouth, helps stop or slow the spread of cancer cells. Lapatinib is given with chemotherapy or after other methods have not worked to slow the cancer.

Lapatinib is for HER2 positive breast cancers and is commonly used for metastatic breast cancer that has spread to the brain since it crosses the blood-brain barrier.

Side effects can include nausea, vomiting, diarrhea, tiredness, mouth sores, and rashes. It can also cause red, painful hands and feet. Before treatment, your doctor will check your heart and liver. During treatment, your doctor will watch for signs of heart, lung, or liver problems.

As with all medical treatments, if you experience unusual changes in your health during targeted therapy, notify your doctor immediately.

Bevacizumab: Reducing the cancer cells’ blood supply

Another targeted therapy, Bevacizumab, also known as Avastin, prevents tumors from making new blood vessels that could feed the tumor, essentially cutting off the cancer cells from all nutrients.

Options For Metastatic (Stage 4) Breast Cancer Patients

Immunotherapy

Immunotherapy is a relatively new form of treatment for women with metastatic breast cancer. It uses the patient’s immune system to fight the cancer. There are many types of immunotherapy drugs, including pembrolizumab (Keytruda) and atezolizumab (Tecentriq).

PARP Inhibitors

PARP (poly-ADP ribose polymerase) inhibitors are targeted drugs that are given to women with Stage 4 metastatic breast cancer who carry a breast cancer gene mutation. Currently, the PARP inhibitors olaparib (Lynparza) and talazoparib (Talzenne) are FDA-approved for the treatment of HER2- metastatic breast cancer in those who have a BRCA1 or BRCA2 inherited gene mutation.

CDK4/6 Inhibitors

CDK4/6 inhibitors are used to treat ER+, HER2- Stage 4 metastatic breast cancer that has spread (metastasized) to other areas of the body. This treatment is also used in some patients with regionally advanced breast cancer (Stage 3). They are given in combination with an aromatase inhibitor as an initial endocrine-based therapy. This new drug category and treatment combination has given many women with metastatic breast cancer increased life expectancy.

There are additional biologic targeted drugs being developed. Discuss biologic targeted treatment options with your healthcare professional for more details.

Medically reviewed June 2023

Material on this page courtesy of the National Cancer Institute

The post Targeted Therapy appeared first on National Breast Cancer Foundation.

Taking Care Of Yourself During Treatment And Beyond

It’s important for you to take good care of yourself before, during, and after cancer treatment. If you’re a caretaker, this is equally important as the demands of care taking can take a toll on your physical and mental health.

Taking care of yourself includes:

• Eating well by making healthy food choices
• Staying as active as you can
• Finding an exercise routine, such as walking, that works for you
• Understanding your thoughts, emotions, and reactions
• Taking time for yourself
• Prioritizing your mental health
• Exploring meditation & mindfulness

Jump to:
– Physical Activity
– Yoga
– How Yoga for Cancer Patients is Different
– Meditation
– How to Begin Meditation
– Free Meditation Resources
– Nutrition
– Free Nutrition Resources
– Mindfulness
– Free Mindfulness Resources

Physical Activity

It is okay to continue exercise during breast cancer treatment as long as your doctor okays your physical activity. Many women find that they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start.

Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know.

Yoga

Yoga is a system of physical postures and breathing techniques to promote physical and emotional well-being. Research has shown that yoga can reduce the side effects of cancer and its treatments ^[1]. It is recommended to get between 150-320 minutes of exercise per week to speed recovery or defend against cancer occurrence and recurrence ^[2].

Not all yoga is the same and for cancer survivors the needs are different. Oncology based programs are required to provide safe and effective support.

How Yoga for Cancer Patients is Different

Specialized Training is Required

A specialized yoga teacher training about cancer helps teachers identify and work with the lifelong side effects triggered by cancer and its treatments. Yoga teachers need the essential facts about both cancer and yoga because understanding, not just compassion, is essential. Compassion might, for example, lead a teacher to provide only gentle or restorative poses for a cancer survivor. But yoga is not just a relaxation technique; movement is necessary to stimulate the cardiovascular and lymphatic systems that assist in recovery and in creating long-term stability.

Recent research suggests that the physical exercise provided by yoga improves immune function ^[3], reduces inflammation ^[4], and enhances the efficacy of chemotherapy and radiation ^[5]. Still, there are limits, especially right after surgery, or if a survivor is physically limited. Only training and supervised experience can inform a yoga teacher about safe and effective methods of adapting yoga for cancer survivors.

Safety Comes First

Healing begins with feeling safe. Safety for a cancer survivor, whether physical or psychological, can be different than for a typical student. The effects of some cancer treatments go beyond hair loss and fatigue to create serious long-term fragilities requiring special attention.

Emotional safety is important as well. Survivors bring their fears to class, such as the fear of developing lymphedema (fluid retention and swelling caused by a compromised lymphatic system), which may be as strong as the fear of cancer. Students need to hear that the teacher understands their fears and will know how to provide modifications of poses or sequences they teach. A student touched by cancer might be struggling to understand the new limitations of her body and will be looking for reassurance and informed advice.

Understanding Risk Factors

Like cancer, yoga is not “one size fits all.” Each survivor’s specific cancer, treatments, side effects, and body are different, and yoga teachers must adapt to their needs. The difference in teaching yoga to cancer survivors is that the risks are higher and a teacher should know what they are to best care for their students.

A short list of risk factors includes:

• Fragile bones that increase the risk of fracture
• Abdominal obstructions and sensitivities
• Weak or missing muscles
• Peripheral neuropathy (nerve pain in the hands or feet) affecting balance
• A compromised immune system, increasing the risk of infection

When offering a class for cancer survivors, a teacher is saying, “I am responsible. I know what yoga is best for you and I will protect you from possible discomfort and injury, and calm your doubts or fears with knowledge and facts.” Survivors expect teachers to understand three general topics:

1. The effects of cancer treatments on the body
2. The poses that have the most benefits
3. The poses that can be harmful

Meditation

Meditation is a way to untangle our thoughts and the emotions associated with them. When we’re stressed or distracted, we’re focused on our reaction to something—an event, or a frustration, for example. Meditation teaches us to separate ourselves from our reaction and simply observe it, without attaching emotion. This awareness allows us to remain in the present moment, understand our thought patterns, and learn more about our emotions and ourselves.

Stress is a leading trigger of many health conditions, and current research shows that meditation can help with stress management, anxiety, sleep disorders, and chronic pain ^[6]. Meditation has been shown to increase the brain’s capacity for attention span, focus, and creativity. Recent studies have also shown that meditation can increase our compassion toward others ^[7].

How to Begin Meditation

Our partner, Meditation Studio, has shared tips on how to begin meditation as well as free resources linked below.

All you need to start your meditation practice is comfort and dedication. Find a comfortable place to sit, and be willing to commit to your practice at the same time each day. Do your best to stay committed and remember, if you skip a day, simply start again. 

Begin slowly with just a few minutes a day, and increase the length of your practice over time. We all have busy schedules, but making time on the front end will help you manage your time more effectively in the long run. Practicing first thing in the morning can be helpful as it’s a nice way to start the day—fresh and clear, carrying your intention and your awareness through the rest of the day.

For beginners, it’s important not to sit too long. Meditations can range from two-, five-, ten-, and 15-minutes, all of which are suitable for beginners who want to start a daily practice. Committing to shorter daily meditations is better than doing a longer meditation once a week.

Think about meditation like exercise: start slowly and build up your endurance. Ten minutes a day is a great starting point, and with time, you might like to extend your meditation to 25 minutes or longer.

A common misconception about meditation is that you have to “stop thinking.” Because of the way our brains work, we are hard-wired to think—and the more we try to stop our thoughts, the more they pop up.

When your mind feels flooded, have patience with yourself, bring your attention back to your breath, and allow yourself to simply observe your train of thought. Over time—and with practice—your sense of ease and calm will increase.

Free Resources

Meditation Series

Meditation Studio is offering NBCF supporters free access to the Cancer Comfort Meditation Series.

This series includes:

• Managing Chronic Pain
• Breath as Ally
• Letting Others In
• Cultivating Self Compassion
• Facing Denial and Disappointment
• Facing Death and Grief
• Insomnia
• Building Strength and Resilience

Click here to listen to the free Cancer Comfort Meditation Series.

(back to top)

Finding Hope That Heals

Our latest eBook guides patients and caregivers to strengthen hopes that help and let go of those that may harm.

Tell us where we can send your free copy of the eBook, Finding Hope That Heals.

Nutrition

Eating well may actually help you feel better and have more energy. It’s important to do your best to eat the right amount of calories to maintain a healthy weight. Adequate protein can help to keep up your strength, too.

Sometimes, especially during or soon after treatment, you may not feel like eating. Some treatments can leave you feeling tired and uncomfortable. Or you may find that some foods don’t taste as good as they used to.

In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well. On the other hand, some women treated for breast cancer may have a problem with weight gain.

Your doctor, a registered dietitian, or another healthcare provider can suggest ways to help you meet your nutrition needs and remain as close to a healthy weight as you can.

(back to top)

Free Resources

Nutrition Care for Breast Cancer Patients eBook

Nutrition is an important, but sometimes overlooked, part of breast cancer treatment. Our new eBook Nutrition Care for Breast Cancer Patients will teach those in treatment and their caregivers about creating nutritious meals that are easy to prepare, safe to eat, and may help manage side effects from treatment.

Tell us where we can send your free eBook:

Healthy Recipes for Cancer Patients

Get our free cookbook featuring 10 healthy recipes from breakfast through dinner—plus healthy snack ideas, tips for food safety, simple options that make healthy cooking and nutrition more accessible, and pro tips from registered dietitian Annie Cavalier, MS, RDN, LD.

Where can we send your free cookbook?

(back to top)

Mindfulness

Mindfulness is the ability to be fully present and aware of your thoughts, feelings, and surrounding environment in a gentle, nurturing way. Mindfulness involves accepting your feelings and thoughts without judgment and understanding what you are sensing in the present moment rather than living in the past or imagining the future.

There is a powerful connection between mental health and physical health, a true mind and body connection. During treatment and beyond, it can be important to gain techniques to build, sustain, and maintain a strong mindset.

Roadmap to Mindfulness

A Mindfulness Roadmap is beneficial to help sustain, reflect, and shift your mindset. A common goal of mindfulness for patients and survivors is to adopt a growth mindset where your diagnosis doesn’t define you. 

Dr. Carol Dweck has conducted over 30 years of research on the potential of growing and shifting our mindset. Her research discovered that we can retrain our brains to grow and develop stronger brain cells. Her research spanned children, adolescents, and adults and found that although we cannot change our IQ or personality traits, by shifting to a growth mindset, we can increase our emotional intelligence (self-awareness, social awareness, self-management, and relationship management).

Building a Growth Mindset

There are tangible mindset tools that anyone can implement and put to practice to develop a new mindset and lifestyle habits for managing through a cancer diagnosis. 

• Address self-limiting beliefs
• Replace Automatic Negative Thoughts (ANTs)
• Focus on the present
• Practice self-reflection by journaling
• Use guided imagery
• Build principles of resilience

Self-Limiting Beliefs

The first step in building and sustaining a growth mindset is to recognize how self-limiting beliefs and negative thought patterns can affect the way we think, feel and behave. 

Self-limiting beliefs are thoughts about yourself that keep you from living your best and most authentic self. They are not your reality and are caused by negative thought beliefs and patterns that are brought on in different ways. These can be caused from past beliefs and behaviors that were told or taught to you as a young child or teenager by parents, authority figures or friends (and often may not be intentionally done).

As you eliminate self-limiting beliefs and blocks, you begin to evolve your true belief, value and moral system. This involves how you perceive yourself (your reality), how you perceive those around you, and how you perceive yourself in the world.  

We all have self-limiting beliefs and they can be eliminated at any age. If we do not address our self-limiting beliefs, they will inhibit our ability to grow and can limit what our role is in our community and the world around us. Eliminating self-limiting beliefs has a positive impact on your self-esteem but most importantly, your self-worth.

Automatic Negative Thoughts (ANTs)

As we develop a positive mindset, it’s important to rid our brain from automatic negative thoughts (ANTs). ANTs are automatic negative thought patterns about something we tell ourselves, something others tell us, or thoughts that are not true or may be self-limiting. 

ANTs can come from all angles including what others tell us, what we hear on the news or read, and what we are telling ourselves. This can put our negative thoughts in a looping pattern in our brain. When we rid ourselves of ANTs we are retraining our brain (like retraining a muscle) to shift negative thoughts to positive thoughts and to what is true and real.

Begin to think about what negative internal talk that you want to change. Start with: What are you telling yourself? Why are you telling yourself this?

Focusing on the Present

Focusing on the present keeps your mind in a good state and allows you to experience gratitude for what you have. 

If you find yourself thinking about the past or worrying too much about the future, then bring yourself back to the present and ask yourself what you are grateful for.

Having a “gratitude journal” will help you capture good thoughts and gratitude in the moment.

Ask yourself what three things you are thankful for, then say them and write them down every day or weekly. They can be big or small. At night ask yourself, what went right today and celebrate your successes for the day.

Journaling and Self-Reflection

One of the most impactful and powerful ways to get to know yourself is through journaling. Journaling helps you connect to your inner self and find wisdom to help figure out who you are, what you want, and what you need.

Journal prompts to help with self-discovery and self-reflection:

1. How would you describe yourself in three words?
2. How would others describe you in three words?
3. What are your best qualities?
4. What are the five most meaningful lessons you have learned this year?
5. What are some of your favorite memories with family and friends?
6. Your favorite way to spend the day and night is?
7. The two life events that I will never forget are…Describe them in detail and what makes them so memorable.
8. What 10 things make you smile the most?
9. When you are feeling physical or mental discomfort, what things can you do to make yourself feel better?   
10.  Write down compassionate and kind ways you have supported yourself and others.  

Guided Imagery

Guided imagery is visualizing yourself being in a certain environment that relaxes you. Your guided imagery could be any activity or place you enjoy and resonate with that reduces your anxiety and stress.

When you are in a stressful place, whether it be professional or personal, use guided imagery and visualization to take you to a relaxing place.  

Principles of Resilience

A resilient person works through challenges by using personal resources, strengths, and other positive capacities like hope, optimism, and self-efficacy. 

The Principles of Resilience are:

• Positive self-image
• Problem-solving skills
• Self-regulation
• Adaptability
• Faith (understanding the meaning of one’s purpose)
• Positive outlook
• Skills and talents that are valued by self and community
• General acceptance by others

When applying the Principles of Resilience, start by implementing and practicing one or two principles at a time. For example, start by taking a self-image inventory. Make a list of your positive qualities, then lean on these strengths when dealing with challenges. If you are struggling to identify positive qualities on your own, reach out to a friend or loved one and ask them to help. 

Next, focus on self-regulation by reflecting on your thoughts and feelings during a situation, specifically how you can control and manage them. It is important not to focus on what happens to you, but how you react to situations you’re faced with.

Once you feel the first two principles have become lifestyle habits, begin to work on one or two other Principles of Resilience. 

(back to top)

Medically reviewed June 2023

Free Resource

10 Prompts to Mindfulness

This free guide will give you 10 short prompts for reflection to help incorporate gratitude, reflection, compassion, and self-love into your daily routine.

Tell us where we can send your free guide:

(back to top)

Material on this page courtesy of the National Cancer Institute, Meditation Studio, and Mental Wellness Unleashed.

Sources:

[1] Yoga for the Management of Cancer Treatment-Related Toxicities
[2] American Cancer Society, U.S. Department of Health and Human Services
[3] Regular Yoga Practice Improves Antioxidant Status, Immune Function, and Stress Hormone Releases in Young Healthy People: A Randomized, Double-Blind, Controlled Pilot Study
[4] Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial
[5] Yoga Helps Maintain Quality of Life, May Lessen Side Effects in Men Undergoing Prostate Cancer Treatment
[6] Brief, Daily Meditation Enhances Attention, Memory, Mood, and Emotional Regulation in Non-Experienced Meditators
[7] Concentrative Meditation Influences Creativity by Increasing Cognitive Flexibility

The post Physical Activity, Wellness & Nutrition appeared first on National Breast Cancer Foundation.

You’ll need regular check-ups after treatment for breast cancer. Check-ups help ensure that any changes in your health are noted and treated if needed. If you have any new health problems between checkups, you should contact your doctor.

What Happens At Breast Cancer Follow-Up Appointments?

Your doctor will check how you are feeling. Likely if you had surgery, chemotherapy, and radiation, your treatment team will rotate seeing you every few months at first and then your appointments become more spaced out as time goes by.

In addition to checking overall health, check-ups help detect health problems that can result from cancer treatment, such as lingering side effects or even new side effects.

Check-ups usually include an exam of the neck, underarm, chest, and breast areas. Since a new breast cancer may develop, you should continue to have regular mammograms. You probably won’t need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.

After active cancer treatment ends, many women and men will continue to be on hormone therapy of some kind. It is important to make your doctor aware of any side effects of hormone therapy you may be experiencing, especially if those side effects disrupt your quality of life. If side effects are not addressed and managed, it may lead to a patient not taking their hormone therapy as prescribed, which means it isn’t working its best or at all to prevent a breast cancer recurrence.

During follow-up appointments, you should ask your doctors what the probability is of developing a local recurrence within the breast tissue or a distant recurrence in another organ, based on the stage of the breast cancer and the treatments you’ve had.

Fear of Recurrence

It is very common and normal to worry about your cancer coming back. However, try to not allow your mind to fixate on this. Your life was saved so that you can enjoy your life going forward and fulfill the life goals you set out to do before you were diagnosed. This can also be a time to give gratitude to those who helped you through this journey.

Facing breast cancer is a life-altering experience for most breast cancer survivors. You may look at the world differently, having been in touch with your own mortality. Try using this newfound knowledge and experience to set new life goals, perhaps helping others who become diagnosed after you.

Interested in more information about recurrence? Check out our two free eBooks:

• What You Need to Know About Breast Cancer Recurrence: The idea that breast cancer can recur is daunting. Expand your knowledge on what recurrence is and why proper follow-up care is crucial.
• Most Asked Questions About Breast Cancer Recurrence: Find answers to a wide range of questions about breast cancer recurrence, answered by two-time survivor and medical expert, Lillie Shockney

What Kinds Of Problems Need To Be Reported To My Physician During The Breast Cancer Follow-Up Phase?

You should report any changes in the treated area or in your other breast to your doctor right away.

Also, make your doctor aware of any new aches or pains that last more than 3 weeks that don’t have a reason to occur. For example, if you’ve been lifting something heavy, you may have simply hurt your back rather than experiencing a recurrence. If you have a new ache or pain elsewhere, think about what activities you have done recently that might be the cause. If you can’t think of any reasons for these new symptoms, call your doctor.

In addition to follow-up appointments with your breast oncologist, it is important to routinely see your primary care physician to address any non-cancer related health issues you may experience. You should also stay up to date on routine vaccinations and other screenings, such as colonoscopies, skin cancer checks, well-woman exams and Pap tests, cholesterol screenings, and any other tests or screenings your physician recommends.

Medically reviewed June 2023

The post Follow-Up Care appeared first on National Breast Cancer Foundation.

Your Doctor Patient Relationship

From the time you are diagnosed with breast cancer, you will work with a team of cancer specialists that may include:

• A medical oncologist
• A surgical oncologist
• A radiation oncologist
• A care-manager/caseworker/nurse navigator or patient navigator

Your healthcare team may also include an oncology nurse and a registered dietitian. 

Can You Ask Questions And Get Answers You Can Understand?

Finding the right team, one that consists of professionals with whom you are comfortable, makes a big difference in how your treatment will progress. Your physicians should be knowledgeable, of course, but they should also welcome questions and be able to explain your treatment options to you in a way you can understand.

Do you understand your treatment goals and why particular treatments are recommended?

Once you’ve identified your team, your doctors can describe your treatment choices, the expected results, and the possible side effects you may experience.

Are Your Concerns Treated With Respect?

Don’t be afraid to ask questions; raising your concerns—even those that you may think will be viewed as trivial—with your oncology team will help you better understand your options and provide your doctors with insight into what is important to you. Today, there are many treatment options available to you. Work with your team to find the right combination for you.

Do you feel comfortable sharing with your medical team about what you have learned regarding your condition?

Do your research. Speak with support groups and breast cancer survivors. The more information you gather about your treatment options from reputable sources, the better decisions you’ll make. You can also ask your care team what resources they can give you to help you better understand your diagnosis and treatment.

Do You Know The Parts Of Your Treatment Plan That Are Up To You?

Remember that while your doctors can make recommendations and provide options, the final decisions regarding your treatment are yours. With good research from reputable sources, you can have confidence in the path you take. By embracing your part, you’ll give yourself the best odds for a long and healthy life.

When Is A Second Opinion A Good Idea?

Having a second opinion can help you be certain of your optimal treatment plan and healthcare partnering decisions. You will have less anxiety if you can cultivate a sense of trust and care with your doctor. In addition to quality care and good treatment decisions, your peace of mind is an important part of the equation.

Here some ideas that may be important to consider regarding second opinions:

• Most breast cancer doctors are very comfortable with their patients seeking a second opinion.
• Many health insurance companies will pay for a second opinion if you or your doctor requests it, and some companies require a second opinion.
• If you get a second opinion, the doctor may agree with your first doctor’s diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you’ll have more information and perhaps a greater sense of control. You may also feel more confident about the decisions you make, knowing that you’ve looked carefully at your options.
• It is important to be sure that treatments you receive are in keeping with the NCCN treatment guidelines. So consider printing off the NCCN Guidelines for Patients document. It contains the guidelines for treatment based on stage of the disease and prognostic factors of the tumor that are considered the gold standard nationally.
• It may take some time and effort to gather your medical records and see another doctor. Usually it’s not a problem if it takes you several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this possible delay with your doctor. Some women with breast cancer need treatment right away.
• There are many ways to find a breast cancer doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Medically reviewed June 2023

The post Choosing Your Doctor appeared first on National Breast Cancer Foundation.

Before selecting your treatment plan, you should first understand the difference between standard treatment and clinical trials.

• Breast cancer standard treatments are methods that experts agree are appropriate, accepted, and widely used. These standard procedures have proven useful in fighting breast cancer in the past.
• A breast cancer clinical trial, on the other hand, is an approved research study that some doctors believe has a strong potential to improve standard treatments. When clinical trials demonstrate better results than the standard, that new treatment becomes the standard. Remember, all our current standards were clinical trials at one time.

If a breast cancer clinical trial is an option for you, your doctor will explain the possible trade-offs with the trial treatment versus standard treatment. Together with your medical team, you will need to decide what treatment method is the best for you and your health.

Breast Cancer Standard Treatments By Stage

Your treatment options depend on the stage of your disease and these factors:

• The size of the tumor in relation to the size of your breast
• The results of specific pathology tests (hormone receptors, HER2 receptors, grade of the cells, proliferation rate of the cells)
• Whether you have gone through menopause
• Your general health
• Your age
• Your family history or other risk factors associated with a predisposition for developing breast or ovarian cancer

Below are brief descriptions of common treatments for each stage. Other treatments may be appropriate for some women. Research studies (clinical trials) can be an option at all stages of breast cancer.

Stage 0 (DCIS)

Most women with ductal carcinoma in situ (DCIS), also known as non-invasive breast cancer, have breast-conserving surgery, also known as lumpectomy followed by radiation therapy. For some women over the age of 70 who have an early diagnosed breast cancer and the tumor is hormone receptor positive, they may be a candidate to forego radiation therapy.  Though Stage 0 breast cancer is the very earliest that breast cancer can be diagnosed, there are situations in which there is a lot of DCIS within the breast tissue. In some situations, it may be necessary to have a mastectomy performed. Some women also may choose to have a mastectomy. Women with DCIS may receive Tamoxifen to reduce the risk of developing invasive breast cancer in the future.
 

Stages 1, 2, 3A, and Some 3C

Women with Stage 1, Stage 2, Stage 3A, or operable Stage 3C breast cancer may have a combination of treatments. (Operable means the cancer can be treated with surgery.)

Some may have breast-conserving surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Some may decide to have a mastectomy. With either approach, women (especially those with Stage II or IIIA breast cancer) often have lymph nodes under the arm removed.

Whether or not radiation therapy is used after mastectomy depends on the extent of the cancer. If cancer cells are found in 1 to 3 lymph nodes under the arm or if the tumor in the breast is large, the doctor sometimes suggests radiation therapy after mastectomy. If cancer cells are found in more than 3 lymph nodes under the arm and/or the tumor was very close to the chest wall, the doctor usually will suggest radiation therapy after mastectomy.

The choice between breast-conserving surgery (followed by radiation therapy) and mastectomy depends on many factors:

• The size of the tumor in relationship to the size of the breast
• The location of the tumor within the breast
• Whether multiple tumors are found within the breast, known as multicentric (which requires mastectomy)
• Whether the patient carries a breast cancer gene
• Certain features of the cancer itself
• How the woman feels about surgery changing her breast appearance
• How the woman feels about radiation therapy
• The woman’s ability to travel to a radiation treatment center
• The patient’s age
• The patient’s health conditions

It is important to note that some women decide to do bilateral mastectomies for peace of mind. Although women without a known genetic cause for their breast cancer have a relatively low rate of developing breast cancer in the opposite healthy breast, still there is a trend currently for women to opt for bilateral mastectomies with immediate reconstruction.

Breast reconstruction is a covered benefit by health insurance companies and is required to be covered by a federal law passed in 1998 for women diagnosed with breast cancer. It is not considered cosmetic surgery but instead part of a woman’s treatment to restore her silhouette and psychological well being.

Some women have chemotherapy before surgery. This is called neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often are advised to choose this treatment.

After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to lower the chance of breast cancer returning. Radiation treatment is local therapy that can kill any remaining cancer cells in and near the breast. Women may also have hormone therapy, chemotherapy, targeted therapy, or a combination. These systemic therapies can destroy cancer cells that remain anywhere in the body. They can prevent or delay the cancer from coming back in the breast or elsewhere.
 

Stage 3B and Some Stage 3C

Women with Stage 3B (including inflammatory breast cancer) or inoperable Stage 3C breast cancer have chemotherapy first and then may be offered other treatments. (Inoperable means the cancer can’t be treated with surgery without first shrinking the tumor.) They may also have targeted therapy.

If the chemotherapy or targeted therapy shrinks the tumor, then surgery may be possible:

• Mastectomy: The surgeon removes the breast. In most cases, the lymph nodes under the arm are removed, known as an axillary node dissection. After a mastectomy, a woman may receive radiation therapy to the chest and underarm area.
• Breast-conserving surgery: In rare cases, the surgeon removes the cancer but not the breast. The lymph nodes under the arm are usually removed. After surgery, a woman may receive radiation therapy to the breast and underarm area.  This may be possible for someone with stage III breast cancer if they received neoadjuvant chemotherapy and the tumor was successfully shrunk to be smaller as a result. Women with inflammatory breast cancer are never a candidate for breast conserving surgery, even though chemotherapy is given first. This is because the breast cancer began within the underlying skin of the breast; therefore, all of that skin must be surgically removed.

After surgery, the doctor will likely recommend chemotherapy, targeted therapy, hormone therapy, or a combination. This therapy may help prevent the disease from coming back in the breast or elsewhere.

Stage 4 and Recurrent

Women with Stage 4 breast cancer will be treated based on where the cancer returned. If the cancer returned in the chest area or within the breast tissue that remained after surgery, the doctor may suggest surgery, radiation therapy, chemotherapy, hormone therapy, or a combination.

Women with Stage 4 breast cancer or recurrent cancer that has spread to the bones, liver, or other areas usually have hormone therapy, chemotherapy, targeted therapy, or a combination. Radiation therapy may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.

Many women need supportive care along with anti-cancer treatments. Anti-cancer treatments are given to slow the progress of the disease, and whenever possible to control the cancer, treating it as a chronic illness. Supportive care helps manage pain, other symptoms of cancer, or the side effects of treatment (such as nausea). This care can help a woman feel better physically and emotionally. Supportive care does not aim to extend life. Some women with advanced cancer decide to have only supportive care. Today more and more research is taking place regarding Stage 4 breast cancer, which is increasing the treatment options for patients diagnosed with metastatic breast cancer. It is not unusual, particularly for women whose tumors are estrogen receptor positive, to live a decade or more while maintaining quality of life.

Metastatic Trial Search

Find metastatic breast cancer trials that are right for you. Simply provide your breast cancer type, sites with current evidence of disease, gender, birth year, and zip code to get started. Learn more.

Medically reviewed June 2023

The post Standard Treatment vs. Clinical Trials appeared first on National Breast Cancer Foundation.

Medically reviewed June 2023

The post Metastatic Breast Cancer Trial Search appeared first on National Breast Cancer Foundation.

What Is Chemotherapy?

Chemotherapy is a treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells.

• Cytotoxic drugs (meaning “toxic to cells”) are usually given orally or through a vein (intravenously or “through the bloodstream”).
• Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body.

Who Needs Breast Cancer Chemotherapy?

Chemotherapy is offered to most patients based on several factors including:

• Tumor type
• Tumor grade
• Tumor size
• Type of receptors and status
• Number of lymph nodes involved and degree of involvement
• The risk for cancer to spread elsewhere in the body

Your medical team will work to select the right blend of chemotherapy drugs to suppress each stage of the cancer cells’ growth.

How Is Breast Cancer Chemotherapy Administered?

Chemotherapy is commonly prescribed along with other treatment methods such as hormonal and targeted therapies. It can also be used to shrink a tumor before surgery for easier and safer removal, referred to as neoadjuvant chemotherapy. Most chemotherapy treatments are administered intravenously, or through an IV.

If you receive chemotherapy, your doctor will administer it in short courses with several weeks in between to allow your normal cells to recover. This treatment period can be a challenging time emotionally and physically. It is important for you to develop a support team of family or friends that can help comfort and encourage you in this time.

What Are The Side Effects Of Chemotherapy?

Although chemotherapy kills the fast-growing cancer cells, the drugs can also unfortunately harm normal cells that divide rapidly.

• You may have a reduction in red blood cells. When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your healthcare team will check for low levels of blood cells. If your levels are low, your healthcare team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
• You may have a reduction in white blood cells. A reduction in white blood cells can increase your risk of getting an infection. This is why it’s important to stay away from people who have a cold or flu, eat healthy meals, get your rest, and take your temperature each day. A rise in body temperature is usually the first sign of your white blood cells being very low, known as neutropenia. There are medications your medical oncologist can prescribe to get your white blood cells to start increasing in number again.
• Chemotherapy may affect the cells that produce hair.  Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
• You may have changes from a different balance of cells lining your intestinal tract. Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your healthcare team can prescribe medicines and suggest other ways to help with these problems.
• Chemotherapy may affect the nerve cells. Some drugs used for breast cancer can cause tingling or numbness in the hands or feet. This type of side effect is called peripheral neuropathy. This usually goes away after treatment is over.

Are there any lasting side effects of chemotherapy?

Sometimes people do experience problems that may not go away. For example, some of the drugs used for breast cancer may weaken the heart. Your doctor may check your heart before, during, and after treatment. A rare side effect of chemotherapy is that occasionally, years after treatment, a few women have developed leukemia (cancer of the blood cells).

Some chemotherapy drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or they may stop. You may become infertile (unable to become pregnant).

Child-Bearing in the Future After Completing Chemotherapy Treatments

If you are of childbearing age and plan to have children in the future, you should talk with your doctor about family planning and fertility preservation before treatment begins. Chemotherapy can effect the ovaries, preventing normal ovarian function in the future. Additionally, many chemotherapy drugs given during the first trimester are known to cause birth defects.

Although chemotherapy is often a very personally challenging time in life, there are thousands of people today who are very thankful for its life-saving and life-extending potential.

Medically reviewed June 2023

The post Chemotherapy appeared first on National Breast Cancer Foundation.

What Is Radiation Therapy And How Does It Work?

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated with the radiation. Breast cancer radiation therapy may be used to destroy any remaining mutated cells that remain in the breast or armpit area after surgery.

Note: There are special situations in which radiation is used for women with metastatic breast cancer experiencing painful bone metastasis. This section however focused on the use of radiation for adjuvant therapy (treatment given after the main treatment to lower the chance of breast cancer returning).

Who should expect to be prescribed radiation therapy and what is involved?
Some people with Stage 0 (DCIS) and most people with Stage 1 invasive cancer and higher, who have had a lumpectomy, can expect radiation therapy to be a part of their treatment regimen. The exception to this is women age 70 or older who had a small tumor, no positive lymph nodes, and whose cancer cells were estrogen receptor positive. These women may be given hormone therapy, rather than radiation, to prevent a local recurrence of their breast cancer.

What Are The Different Kinds of Radiation Therapy?

Most radiation therapy is administered by a radiation oncologist at a radiation center and usually begins three to four weeks after surgery. The radiation is used to destroy undetectable cancer cells and reduce the risk of cancer recurring in the affected breast.

There are two main kinds of radiation therapy that may be considered, and some people have both.

• External Beam Breast Cancer Radiation (Traditional cancer-killing rays delivered by a large machine)
• Internal Breast Cancer Radiation (Newer treatments that inject radioactive cancer-killing treatments only in the affected area)

Keep in mind that the course of treatment you decide is something you should discuss with your radiation oncologist in order to ensure that it is as effective as possible.

External Beam Breast Cancer Radiation

External beam radiation (also known as traditional or whole breast radiation therapy) uses external beam radiation, like that of a regular x-ray, but the beam is highly focused and targets the cancerous area for two to three minutes. This form of treatment usually involves multiple appointments in an outpatient radiation center — as many as five days a week for five or six weeks. Certain situations may require a slightly higher dose of radiation over a shorter course of treatment, usually three to four weeks (called accelerated radiation.)

External breast cancer radiation used to be the most common type used for breast cancer. However in more recent years internal radiation clinical trials have enabled more women to opt for this method if their cancer was caught early enough.  Internal radiation typically offers fewer noticeable side effects.

Internal Breast Cancer Radiation

Internal radiation is a form of partial breast radiation. During the treatment, the physician or surgeon inserts a radioactive liquid using needles, wires, or a catheter in order to target the area where the cancer originally began to grow and tissue closest to the tumor site to kill any possible remaining cancer cells. Internal radiation is rarely used today, with many doctors opting for short-term radiation therapy instead.

Brachytherapy (Internal Radiation) Delivered Via Implantable Device

The doctor places a device inside the breast at the time of the surgery or shortly thereafter which carries targeted radiation to the tissue where the cancer originally grew (also known as the tumor bed). This type of radiation may take only one treatment delivered in the operating room or may take 5-7 days given on an outpatient basis in the radiation therapy department.

In nearly all cases, the appropriate method is determined by the radiation oncologist based on the location and size of the tumor.

What Are The Side Effects Of Radiation?

Radiation therapy can have side effects, and these vary from person to person.

The most common side-effects are:

• Sunburn-type skin irritation of the targeted area (which may range from mild to intense)
• Red, dry, tender, or itchy skin
• Breast heaviness
• Discoloration, redness, or a bruised appearance
• General fatigue

What should I do about side effects from breast cancer radiation?
If you experience difficulty from side effects, you should discuss them with your doctor, who may be able to suggest ways you can treat side effects and help yourself feel more comfortable. These problems usually go away over a short period of time, but there may be a lasting change in the color of your skin.

Here are some good general tips for dealing with the most common side effects of radiation:

• Bras and tight clothes may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time.
• Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area.
• You need to be aware that more intense treatment methods will tax your body. During radiation therapy, it is essential to take good care of yourself by getting extra rest and making good nutrition a priority.
• Although resting is important, doctors usually advise patients to try to stay active too, unless it leads to pain or other problems. Routine exercise, such as walking for 30 minutes a day, has been proven to reduce the degree of fatigue patients experience from radiation therapy.
• You may wish to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy to the chest may harm the lung or heart. Also, it can change the size of your breast and the way it looks. If any of these problems occur, your oncology team can tell you how to manage them.

Medically reviewed June 2023

The post Radiation Therapy appeared first on National Breast Cancer Foundation.

How Can Hormones Affect The Growth Of Breast Cancer?

Hormones like estrogen and progesterone are chemicals produced by glands in the body. Normally, these hormones help regulate body cycles, like menstruation. However, sometimes these same hormones can cause cancer to grow.

The pathologist will perform tests on the breast cancer cells to determine if they have receptors that feed on estrogen or progesterone, stimulating their growth. If the cancer cells have these receptors, your doctor may recommend hormone therapy drugs, such as blockers or inhibitors. Both types of drugs help to destroy cancer cells by cutting off their supply of hormones.

What Do Hormone Blockers Do To Treat Breast Cancer?

One of the most common hormone therapy drug is Tamoxifen. It blocks the estrogen-shaped openings in the cells, preventing estrogen-fueled cancers from growing.

Tamoxifen can be taken as a pill on a daily basis, up to five years after surgery. It is for postmenopausal women and has been in use for more than 60 years.

What are hormone inhibitors and how do they work?

Hormone inhibitors also target breast cancer cells with hormone receptors, but unlike hormone blockers, they work by reducing the body’s hormone production. When breast cancer cells are cut off from the ‘food supply’ (in this case, estrogen) the tumor begins to starve and die.

Generally, the benefits of using hormone therapy and chemotherapy together have a much greater combined effect than using either alone. If your breast cancer is positive for hormone receptors, your doctor may recommend both therapies.

When Are Hormone Blockers Used?

Hormone inhibitors and blocker options may depend on a person’s stage of life.

• Hormone inhibitors are only used in postmenopausal women. They can be given to premenopausal women if steps are taken by the treatment team to put the ovaries to sleep by blocking the ovaries from producing estrogen or progesterone.
• Hormonal therapy may also be called anti-hormone treatment.  Think of it as the opposite of hormone replacement therapy (HRT). If pathology tests show that the tumor in your breast has hormone receptors (referred to in the pathology report as being Estrogen receptor positive and/or progestersone receptor positive) , then hormonal therapy may be recommended for you after the completion of your acute treatment (surgery, chemo, and radiation) . (See pathology Tests with Breast Tissue.)
• Hormonal therapy keeps breast cancer cells from receiving or using the natural female hormones in your body (estrogen and progesterone)  which they need to grow. Hormonal therapy also blocks the ability of health breast cells to receive hormones that could stimulate breast cancer cells to regrow again in the form of recurrence of the breast cancer within the breast or elsewhere in the body.

Options Before Menopause

If you have not gone through menopause, the options include:

• Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast or growing elsewhere in your body in the future. It’s in pill form and must be taken every day usually for 5 years.
  In general, the side effects of Tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts.
• LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain. This is sometimes called chemical menopause. This enables the patient to take hormone inhibitor drugs more commonly given to post-menopausal women.
• Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body’s main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn’t benefit from this kind of surgery because her ovaries produce little to no estrogen.) When the ovaries are removed, menopause occurs right away. This is known as surgical menopause and can enable the patient to take hormone inhibitor drugs. The side effects are often more severe than those caused by natural menopause but taper off with time. Your oncology team can suggest ways to cope with these side effects.

It is important to note that if a patient receives LH-RH agonist treatment or has her ovaries surgically removed, she will likely be placed on an aromatase inhibitor instead of Tamoxifen, but both remain options.

Options After Menopause

If you have gone through menopause, the options include:

• Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol. This is also a pill taken daily.
• Tamoxifen: Hormone therapy is given for at least 5 years. Women who have gone through menopause receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years.

Research has been conducted and more is underway to determine if there is a benefit in taking hormonal therapy for longer than 5 years. Some research studies have demonstrated that there may be benefits in switching from one hormonal therapy agent to another during the 5 year period. Your oncologist will discuss with you the most appropriate hormonal therapy regimen based on your breast cancer pathology and age. It is very important to take these pills every day as without adhering to the daily schedule and dosage as planned, you may not reap the benefit of these drugs. Overall, hormonal therapy can reduce risk of recurrence by 50%.

These drugs can be expensive. If you need financial help in paying for these medications contact the medical oncology nurse practitioner or social worker to receive assistance how to get the prescription at a discount.

Based on the side effects listed above, sexual dysfunction can occur. If you are experiencing a drop in libido, vaginal dryness resulting in pain during intercourse, make your oncologist aware as there may be some options for decreasing these side effects.

Options For Advanced-Stage Breast Cancer Patients

Women with metastatic breast cancer or regionally advanced breast cancer (Stage 3) that carries a high risk of progressing to Stage 4 breast cancer may be given a CDK4/6 inhibitor along with endocrine therapy, a form of hormone therapy. A CDK4/6 inhibitor is a drug given to women with advanced cancer that is ER+ and HER2-.

Medically reviewed June 2023

The post Hormone Therapy appeared first on National Breast Cancer Foundation.