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Introduction

St James's Hospital Breast Care Unit is one of eight designated breast cancer centres in Ireland. We provide a high quality service for patients with all forms of breast disease. We see approximately 11,000 patients per year and diagnose approximately 350 breast cancers.
The unit is staffed by a specialist breast care team that includes:

  • Specialist Breast Surgeons
  • Specialist Breast Radiologists
  • Advanced Nurse Practitioner – Breast Cancer
  • Clinical Nurse Specialists - Breast Cancer
  • Clinical Nurse Specialist - Family Risk
  • Specialist Mammography Radiographers
  • Advanced Nurse Practitioner - Breast Radiology
  • Clinical Nurse Specialist - Breast Radiology
  • Specialist Breast Pathologists
  • Medical Oncologists
  • Radiation Oncologists
  • Administration staff
  • Data Manager
  • Breast cancer starts when cells in the breast begin to divide and grow in an abnormal way. Breast cancer is not one single disease and there are several types. It can be diagnosed at different stages and can grow at different rates. Breast cancer can be non-invasive (also called ‘in situ’) or invasive.

    Non-invasive Breast Cancer

    Ductal carcinoma in situ (DCIS) is an early type of breast cancer. The cancer cells are inside the milk ducts (known as ‘in situ’) and have not yet developed the ability to spread, either through the breast or to another part of the body

    If DCIS is not treated, the cells may develop the ability to spread and become an invasive breast cancer.

    Invasive Breast cancer

    Most breast cancers are invasive. This is when the cancer cells have started to spread to the surrounding breast tissue. It can be diagnosed at different stages; this means people may have different treatments. There are several different types of invasive breast cancer, but the two most common are invasive ductal carcinoma and invasive lobular carcinoma

    Invasive ductal carcinoma: This is the most common type of breast cancer (80%). 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

    Lymph nodes status

    The breasts contain a network of lymph vessels that drain into the lymph nodes (glands) under the arm (axilla). If you have invasive breast cancer, your consultant will check if any of the lymph nodes under the arm contain cancer cells. This helps them to decide whether you will benefit from any additional treatment after surgery.

    Further Reading:

    Understanding Breast Cancer by The Irish Cancer Society

  • The aim of treatment is to remove the cancer and reduce the risk of it returning in the breast or spreading to other parts of the body. Treatment decisions are made by following local and national guidelines developed by breast cancer experts and others involved in caring for people with breast cancer. All cases are discussed at the breast multi-disciplinary team meeting to ensure each patient receives the most appropriate treatment.

    There are lots of ways breast cancer can be treated. In order to decide the most appropriate treatment for your cancer, your team will assess:  

    • 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

    The main treatments for breast cancer are:

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

    Surgery aims to remove the cancer in the breast and any affected lymph nodes under the arm. This is called local control. Surgery and radiotherapy are treatments for local control.

    Treatment also aims to destroy any cancer cells that may have already spread from the breast into the body through the bloodstream or the lymphatic system, and to reduce the risk of cancer affecting other parts of the body in the future. This is called systemic treatment. Chemotherapy, hormone therapy and targeted therapy are all types of systemic treatment

  • There are different types of surgery for breast cancer, your team will explain why they think a particular operation is best for you and what the risks and benefits of each are.

     

    Breast-Conserving Surgery: This is where the cancer is removed with a margin (border) of normal, healthy breast tissue. The aim is to keep as much of your breast as possible while ensuring the cancer has been completely removed. This can also be referred to as a “lumpectomy” or “wide local excision”.

    Mastectomy: A simple mastectomy is the removal of all the breast tissue including the skin and nipple area.

    Breast Reconstruction: Breast reconstruction is the creation of a new breast shape or mound using surgery. There are many different types of breast reconstruction using a breast implant or moving some tissue from another part of the patient's body, or a combination of both of these. Reconstruction can be done at the same time (immediate) as the mastectomy or at a later date (delayed). Your team will go through the options and explain why they think a particular operation is best for you and what the risks and benefits of each are.

    Surgery to the lymph nodes

    On the same side as your breast cancer you will either have some (sentinel lymph node biopsy) or all (axillary clearance) of the lymph nodes removed during surgery. This assists your team in deciding on what further treatment is required to treat your cancer. Your team will explain why they recommend a particular operation for you and what the risks and benefits are.

    After surgery it is important to follow the specialist exercises, lifting and driving restrictions given by your team. These are used to reduce the risk of lymphoedema (long term swelling of the arm / breast) and maintain shoulder mobility.

    Please watch this video on lymphoedema for more information:

    https://www.loom.com/share/f8179706f6fe4b2e83de368dc142baaf

    Advice and Exercises Following Breast Surgery by Marie Keating:

    https://www.mariekeating.ie/wp-content/uploads/2018/05/Advice-and-Exercises-Following-Breast-Surgery.pdf

  • Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. The aim is to reduce the risk of the cancer coming back, by destroying any cancer cells that may have spread from the breast to other parts of your body. There are different types of chemotherapy drugs and it can be administered in a number of ways such as an injection, an intravenous drip or in tablet form.

    Chemotherapy can be given before (neo-adjuvant) or after (adjuvant) surgery or some patients will have a combination of both.

    Neo-Adjuvant Chemotherapy: to help to make the cancer smaller before surgery and help reduce the risk of the cancer coming back.

    Adjuvant Chemotherapy: to help reduce the risk of the cancer coming back.  

    Chemotherapy is often given in cycles of two to three weeks with a rest period in between. Chemotherapy is given as an outpatient in the dedicated Oncology Day ward.

    Chemotherapy drugs can cause side effects; these will vary from person to person. Your team will prescribe other drugs to help you cope with them.

    Further information:

    https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/chemotherapy

  • Some breast cancers are hormone receptor positive / sensitive; this means the hormones oestrogen and progesterone help the breast cancer to grow. There are a number of different medications (Hormone therapies) that can help to block / stop the effect of hormones on cancer cells.  

    Women can have hormone receptor positive breast cancer even after the menopause.

    Hormone therapy is usually given for a number of years after breast cancer surgery to help reduce the risk of the cancer coming back.

    Some women may be recommended to take hormone therapy before surgery (neo-adjuvant) to help to reduce the size of the cancer before surgery.

  • Radiotherapy uses high-energy X-rays to destroy cancer cells. The aim is to destroy the cancer cells while causing as little harm as possible to normal cells.  Radiotherapy is given after breast surgery or after chemotherapy as adjuvant treatment. Radiotherapy is given to reduce the risk of the cancer coming back in the breast after breast conserving surgery or on the chest wall after a mastectomy.

    Radiotherapy can also be used to help manage symptoms if surgery is not an option. Your team will go through the options and explain the risks and benefits and reasons for radiotherapy for your cancer.

    Radiotherapy is given by St Luke’s Radiation Oncology Network (SLRON). The network includes St Luke’s Hospital, Rathgar (SLH), St Luke’s Radiation Oncology Centre at St James’s Hospital (SLROC SJH) and St Luke’s Radiation Oncology Centre at Beaumont Hospital. Most of St James’s Hospital's patients receive treatment in St Luke’s Hospital or in the centre onsite.

    Further Reading:

    Understanding Radiotherapy by The Irish Cancer Society

  • Biological therapies are also known as targeted therapies.

    Targeted therapies are a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that cause cancer to grow. Unlike chemotherapy, targeted therapies do not harm healthy cells.  

    The type of targeted therapy you are given will depend on the biological features of your breast cancer. The most widely used targeted therapies are for people with HER2 positive breast cancer. Your team will discuss whether your cancer will benefit from this type of treatment.

  • Consultant Breast Surgeons

    Consultant Radiation Oncologists 

    Medical Oncologists

    • Ciara O'Hanlon Brown
    • Lore Komanyane Kabo

    Breast Care Nursing Team

    Advanced Nurse Practioner (ANP)

    • Ms Yvonne Hanhauser

    Clinical Nurse Specialists

    • Ms Alison O Driscoll
    • Ms Elaine Richardson
    • Ms Carol Spillane
    • Ms Fiona Lynch
    • Ms Olivia Merrigan
    • Ms Niamh Byrne

    Oncology cANP

    • Ms Antonia Tierney

    You may also meet other members of our team, including senior and junior doctors, physiotherapists, social workers and occupational therapists who will help you get back to your normal activities and lifestyle.

  •  

    The following are contact details for some of the cancer support services available. Please check the Irish Cancer Society website for services in your county

     

    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

    ARC Cancer Support

    65 Eccles Street, Dublin 7 D07TD35
    559 South Circular Road, Dublin 8
    Lowell House, 23 Herbert Ave, Dublin 4

    Phone: (01) 215 0250
    Email:  info@arccancersupport.ie
    Website: https://www.arccancersupport.ie/ 

    Cuisle Cancer Support

    Block Road, Portlaoise, Co. Laois
    The Waterways, Sallins, Co. Kildare 

    Phone: 0578681492
    Email: info@cuislecancersupport.ie
    Website: www.cuislecancersupport.com

    Dochas Offaly

    Teach Dóchas, Offaly Street, Tullamore, Co. Offaly
    Dóchas Outreach Centre, Market Square, Birr, Co. Offaly

    Phone: (057) 93 28268 (Tullamore), (087) 2777728 (Birr)
    Email: info@dochasoffaly.ie 
    Website: www.dochasoffaly.com 

    Gary Kelly Cancer Support Centre

    George’s Street, Co. Louth

    Phone: 0419805100
    Email: info@gkcancersupport.com
    Website: gkcancersupport.com

    • Prof Connolly’s secretary (01) 428 4123
    • Mr. Boyle’s secretary (01) 416 2530
    • Alazawi’s secretary: (01) 428 4121
    • Medical Oncology Secretary: (01) 416 2149
    • Medical Oncology Day Ward: (01) 410 3970
    • Radiation Oncology: (01) 406 5000
    • Breast Care Nursing: (01) 410 3857
    • Carol Spillane - CNS Breast Family Risk (01) 428 4034
    • Breast Imaging Appointment Queries (01) 410 3420
  • "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."