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Introduction

Breast cancer is currently the second most common cancer in women in Ireland. Each year, it affects approximately 3,000 women and 20 men in this country. All of the body’s organs and tissues are made up of building blocks called cells. In healthy tissue, cells replace or repair themselves when they get injured or are worn out. Breast cancer occurs when cells do not behave as normal and continue to grow. The exact cause of breast cancer is, however, unknown. Certain risk factors can increase your chance of developing breast cancer, including:

  • Gender: Breast cancer is 100 times more common in women than men.
  • Age: Breast cancer is rare under age 30 and occurs most often over age 50.
  • Previous breast disease: Your risk is increased if you were previously diagnosed with breast cancer or atypical ductal hyperplasia (ADH).
  • Previous radiotherapy: Radiation to the chest area in the past increases the risk of developing breast cancer.
  • Hormones: Starting your periods early, having your first baby at an older age, having a late menopause, taking HRT (hormone replacement therapy) and using the contraceptive pill can increase your risk of breast cancer.
  • Family history: A very small number of breast cancers are caused by an inherited faulty gene. Your risk may be higher if a number of close relatives have had breast cancer or other cancers such as ovarian and bowel, as well as breast cancer, or if a close relative under the age of 50 has had breast cancer.
  • Lifestyle: Other factors that might increase your risk of breast cancer include being physically inactive, being overweight, smoking, having a high alcohol intake and eating a diet high in fat and low in fibre and fresh fruit and vegetables.

St James’s Hospital is one of the eight national breast centers treating both benign and malignant breast disease. Approximately 11,871 patients were seen at its clinic in 2019, of whom 357 were newly diagnosed with breast cancer. The treatment options for breast cancer include surgery, chemotherapy, hormone therapy, radiotherapy and other drug treatments. Your treatment plan will depend on the type of breast cancer you have, and each patient’s care pathway will be individually tailored to their needs.

Hormone therapies are medications that are used to destroy cancer cells or slow the progression of cancer cell growth. It might be given before or after surgery. It can help to make the cancer smaller before surgery (neoadjuvant) or can help reduce the risk of recurrence when given after surgery (adjuvant). It can also be given to treat breast cancer that has spread or come back. You might receive hormone therapy if your breast cancer is hormone-receptor positive.

  • There are many different forms of breast cancer, and these are usually divided into two types: Ductal carcinoma in situ (DCIS) and invasive breast cancer.

    • DCIS is the earliest form of breast cancer. It is pre-cancerous, intraductal, or non-invasive, which means that cancer cells have formed inside the milk ducts but have not spread. Most people have no symptoms and are usually diagnosed from a mammogram.
    • Invasive breast cancer: If your cancer has moved beyond the milk ducts and spread to the surrounding breast tissue, it is called invasive. There are several different types of invasive breast bancer, but the two most common are invasive ductal carcinoma (80%) and invasive lobular carcinoma.
    • Invasive ductal carcinoma: This is the most common type of breast cancer. It starts to develop in the milk ducts and then invades the surrounding breast tissue.
    • Invasive lobular carcinoma: This type of cancer starts in the cells of the lobules where milk is stored. It is less common than invasive ductal carcinoma, affecting approximately one in ten women. Sometimes it is found in both breasts at the same time.
  • The aim of treatment is to stop any spread of cancer and, if possible, to remove all the cancer from your body. In deciding the most suitable treatment, your doctor will consider:

    • the size of the breast cancer,
    • the type of breast cancer,
    • whether the breast cancer has spread to the lymph nodes under your arm or any other part of your body.

    Treatment plans in the hospital are discussed by the consultant breast surgeons, consultant breast radiologists, consultant pathologists, consultant medical oncologist, consultant radiation oncologist and breast care nurse specialists at the multidisciplinary team meeting. The main treatments for breast cancer are:

    • Surgery
    • Chemotherapy
    • Radiotherapy
    • Hormone therapy
    • Biological therapies.

    These therapies may be used individually or in combination to treat breast cancer. Surgery is referred to as local treatment, radiation as loco-regional treatment and chemotherapy and hormone therapy as systemic treatment. You will be given the treatment that is right for you.

    Surgery

    There are two types of breast surgery:

    • Breast-conserving surgery: Involves the removal of part of the breast. Radiotherapy will be required afterwards.
    • Mastectomy: Refers to the removal of the breast.

    There are two types of axillary surgery, referring to surgery of the armpit carried out to determine the course of treatment based on whether the cancer has spread.

    • Sentinel lymph node biopsy. If the ultrasound of your armpit shows no enlarged lymph nodes, this test is performed to definitely check whether cancer cells have reached the lymph nodes. The sentinel lymph node/s (1-3) are surgically removed and examined instead of removing all of the nodes. The benefits of this test are that you spend less time in hospital, experience less discomfort and are at a reduced risk of lymphoedema (swelling of the arm).
    • Axillary clearance. If the lymph nodes from your armpit are tested and show cancer cells, some or all of them will be removed. Afterwards, you will need to do special exercises, as shown by the specialist breast physiotherapist.

    Chemotherapy

    Chemotherapy is the use of drugs to treat cancer. Chemotherapy may be given before or after surgery. It can help to make the cancer smaller before surgery (neoadjuvant) or can help reduce the risk of recurrence when given after surgery (adjuvant). It can also be used to treat breast cancer that has spread or come back. The drugs can be used as a single agent or in combination with each other. The drugs used in chemotherapy travel through the bloodstream to almost every part of the body, and they are often given in cycles of two to three weeks with a rest period in between. They may be given as an injection, an intravenous drip or in tablet form. The side-effects may include:

    • Nausea and vomiting
    • Infection
    • Anaemia
    • Sore mouth
    • Hair loss
    • Constipation and diarrhoea
    • Fatigue
    • Skin and nail changes.

    Hormone Therapy

    Hormone therapies are medications that are used to destroy cancer cells or slow the progression of cancer cell growth. It might be given before or after surgery. It can help to make the cancer smaller before surgery (neoadjuvant) or can help reduce the risk of recurrence when given after surgery (adjuvant). It can also be given to treat breast cancer that has spread or come back. You might receive hormone therapy if your breast cancer is hormone-receptor-positive.

    Radiotherapy

    Radiotherapy uses high-energy X-rays to kill cancer cells. The aim is to kill the cancer cells while causing as little damage as possible to normal cells.  Radiotherapy is given after breast surgery, especially breast-conserving surgery, or after chemotherapy as adjuvant treatment. This is done to reduce the risk of the cancer coming back. It can also be given to help shrink a large tumour. If the cancer has spread and is causing pain or pressure, a small dose of radiotherapy can relieve pressure by reducing the cancer size. The side-effects may include:

    • Skin changes.
    • Tiredness (fatigue).

    Biological Therapies

    Biological therapies are also known as targeted therapies. Most targeted therapies work like the antibodies made by your immune system, using the body’s immune system to fight cancer and other diseases. These drugs target specific features of cancer cells. Unlike chemotherapy, targeted therapies do not harm healthy cells. Targeted therapies used in the treatment of breast cancer include:

    • Trastuzumab (Herceptin)
    • Lapatinib (Tykerb)
    • Bevacizumab (Avastin).
  • Consultant Breast Surgeons

    Advanced Nurse Practioner (ANP)

    • Ms Yvonne Hanhauser

    Clinical Nurse Specialist in Breast Care

    • Ms Alison O Driscoll
    • Ms Elaine Richardson

    Clinical Nurse Manager II in Breast Care

    • Ms Fiona Lynch (job sharing)
    • Ms Olivia Merrigan (job sharing)
    • Ms Niamh Byrne

    Clinical Nurse Specialist in Breast Family Risk

    • Ms Carol Spillane

    Clinical ANP in Breast Radiology:

    • Ms Maeve Stenson

    Clinical Nurse Specialist in Breast Radiology

    • Ms Rebecca O Loughlin

     Consultant Radiologists

    Consultant Radiation Oncologists 

    Clinical Nurse Specialist in Radiation Oncology

    • Ms Ann O Hara
  • The following are contact details for breast cancer support services:

    Irish Cancer Society

    43/45 Northumberland Road
    Dublin 4.

    Phone: (01) 231 0500 
    Fax: (01) 231 0555
    Email: info@irishcancer.ie
    Website: www.cancer.ie

    National Cancer Helpline

    Phone: 1800 200 700
    Email: helpline@irishcancer.ie

    Marie Keating Foundation

    Unit 9
    Millbank Business Park
    Lucan
    Co. Dublin.

    Phone: (01) 628 3726
    Fax: (01) 628 3759
    Email: info@mariekeating.ie
    Website: www.mariekeating.ie

  • "I was actually in very good health; I lead a very active life, I walk, play golf, swim and I'd even took up set dancing, so this was completely out of the blue."

  • "To say that I was shocked was a complete understatement, I never ever thought from the lifestyle that I lived that I would get breast cancer."

  • Mr Alazawi’s secretary (01) 428 4121

    Mr Boyle’s secretary (01) 416 2530

    Ms Connolly’s secretary (01) 428 4123 

    AnneMarie Geoghegan - Breast Family Risk secretary (01) 428 4190

    Celina Windrum - Routine Review Clinic (afternoon clinics) Secretary (01) 428 4120

    Breast care Nursing (01) 410 3857

    Carol Spillane - CNS Breast Family Risk (01) 428 4034

    Breast Imaging Appointment Queries (01) 410 3420