9780199558698

Table of Contents


	List of Abbreviations	xi
1	Breasts and Breast Cancer	1
	Breast Disease	2
	TheBreast—Some Basic Facts	2
	So What is Cancer?	6
	Medical Jargon	7
2	Who is at Risk?	9
	Family History	10
	Benign Breast Disease	11
	Hormones	12
	Alcohol and Diet	12
	Exercise	12
	Geography	12
	Other Risk Factors	13
	What can Decrease the Risk of Developing Breast Cancer?	14
	How to Assess Personal risk	15
3	What to Look For?	17
	Breast Awareness	17
	Breast Self-Examination	18
	When is Breast Self-Examination not Enough?	19
4	Screening for Breast Cancer in the Population	21
	Mammography	22
	Mammogram Screening	23
	The Downside of Screening	24
	Financial Considerations	25
5	Diagnosis of Breast Disease	27
	Diagnosis	27
	Clinical Examination	28
	Breast Tests—Imaging	28
	Breast Test—Biopsies	30
	Diagnosis of the Spread of Cancer	31
6	Breast Cancer Under the Microscope: How Pathology Relates to the Course of the Disease	33
	What is Breast Cancer?	33
	The Pathology of Breast Cancer	34
	Other Pathological Features of Breast Cancer	36
	How Pathology is Related to the Treatment Recommended	38
	How Pathology is Related to the Course of the Cancer	39
	Distant Staging	39
	Advances in Pathology	39
	How Long has the Cancer been Present?	39
7	The Team Approach	41
	General Practitioner	42
	Radiologists and Breast Screening	43
	Surgeons	43
	Breast Nurses	44
	Medical Oncologist	45
	Radiation Oncologist	45
	Physiotherapist	45
	Occupational Therapist	45
	Psychologist	46
	Social Worker	46
	Research Assistant	46
	‘The Rest’	46
	Multidisciplinary Meetings	47
8	Surgery for Breast Cancer	49
	Breast-Conserving Surgery	50
	Hookwire Localization of Breast Cancer	51
	Mastectomy	52
	Axillary Staging	55
	Axillary Clearance	55
	Sentinel Lymph Node Biopsy	56
	The Operation—What to Expect	56
	Breast Reconstruction	57
	When to Avoid Surgery	62
	Removal of the Ovaries	62
9	Radiotherapy	65
	Breast-Conserving Therapy	65
	What is Radiotherapy?	66
	Side-Effects of Radiotherapy	68
	New Types of Radiotherapy	69
10	Chemotherapy	71
	What is Chemotherapy?	71
	Assessing Who should have Chemotherapy	71
	Options for Treatment	72
	Timing of Chemotherapy	72
	Having Chemotherapy	73
	New Treatments	75
11	Hormones and Breast Cancer	77
	Oestrogen	77
	Hormone Replacement Therapy	79
	Oral Contraceptive Pill	79
	Pregnancy	80
	Breastfeeding	80
	Hormonal Therapy for Breast Cancer	80
	How Hormonal Therapies Work	81
	Side-Effects of Hormonal Therapies	82
	Tamoxifen	82
	Ovarian Suppression and Ablation	83
	Aromatase Inhibitors	84
	Prevention of Breast Cancer	85
12	New Drug Treatments	87
	Targeted Drugs	87
	New Chemotherapy Drugs	89
	New Hormonal Drugs	89
	Clinical Trials	90
	The Next Decade…	91
13	Advanced and Recurrent Breast Cancer	93
	Breast Cancer that Presents at an Advanced Stage	93
	Locally Advanced Breast Cancer	95
	Recurrent Breast Cancer	96
	Prognosis of Advanced Breast Cancer	96
	Controlling Disease in the Breast, on the Chest Wall and in the Axilla	97
	Controlling Metastatic Breast Cancer	97
	Drugs for Advanced Disease	97
	Other Treatments for Advanced Disease	98
	Psychosocial Issues and Advanced Breast Cancer	99
	Palliative Care	99
14	Coping with Breast Cancer	101
	How Breast Cancer can Affect a Woman and Her Family	101
	Psychological Issues	102
	Body Image and Sexuality	103
	Support Available	103
	Different Cultures and Breast Cancer	106
	Practical Needs	106
	Grief	106
	Complementary Therapy	107
15	Special Circumstances	109
	Breast Cancer and Pregnancy	109
	Fertility After Breast Cancer	111
	Breast Cancer in Men	112
	Second Cancers	113
	Breast Cancer in Very Young Women	113
	Breast Cancer in the Elderly	116
16	Surviving After Breast Cancer	117
	Lymphoedema	118
	Menopausal Symptoms	119
	Bone Health	121
	Fatigue	121
	Joint Pains	122
	Psychological Issues	122
	Existential Issues	123
	A Survivorship Plan	123
	Acknowledgements and Conclusion	124
Appendix	Template for Breast Cancer Survivorship Plan	127
	Glossary	131
	Index	139