Breast Care
The open access follow-up programme supports you when you have finished your treatment. It helps you to monitor your health and you are in control. This means that you will not have to go to regular hospital appointments that may disrupt your routine and cause anxiety. You can easily contact the breast care team and hospital instead, if you need to.
Follow-up mammograms and bone density scans
If you have had breast cancer, there is a small chance of getting cancer again in the same breast (recurrence) or a new cancer in the other breast, Mammograms (breast X-rays) can help find breast cancer, or early signs of it, before you or your doctor feel anything.
After breast conserving surgery (lumpectomy/wide local excision therapeutic mammoplasty), you will have a mammogram on both breasts. If you have had a mastectomy, the mammogram will be done on your remaining breast. Reconstructed breasts do not need mammograms.
A mammogram may not be suitable in some cases. Other options will be discussed with you if this happens.
50 years or over: After 5 years of yearly follow-ups, you will be invited to the National Breast Screening Programme. They will arrange a mammogram for you every 3 years through your local service. It is important that you attend.
Under 50 years: After 5 years of follow-ups, we recommend annual mammograms until you are invited for screening every 3 years through your local service.
71 years or over: You will not be called for routine screening. However, you can request an appointment if you want to continue to have a mammogram every 3 years. Contact your local NHS Breast Screening Unit or GP to arrange this. Contact numbers can be found at the back of this booklet.
Your mammogram results
Your GP will have your results within 2 weeks after your mammogram. If you cannot access your results within one month, please contact the breast cancer nurses from your hospital. Contact numbers can be found at the end of this booklet.
Sometimes it can be hard to read mammograms accurately after breast cancer treatment. We may ask you to come back for more tests when this happens. We will contact you by telephone or by letter if this is the case
DEXA scans and bone health
When oestrogen levels decrease after menopause, bones can become weaker. Taking medicines such as letrozole, anastrozole, or exemestane may accelerate this. Your consultant will explain the need for regular bone density scans (DEXA scans). DEXA scans look for signs of bone thinning and osteoporosis. Treatment usually involves taking a calcium and vitamin D supplement with or without a bisphosphonate.
Regular exercise such as walking, and eating a diet high in calcium, is important to maintain your bone health. You can find more information on the Breast Cancer Now website or the Macmillan website. Their details can be found at the end of this booklet.
Patients with hormone receptive cancers are given anti-hormone tablets, also known as endocrine therapy. This type of treatment includes medicines such as tamoxifen, letrozole, anastrozole and exemestane. Your doctor will recommend taking these medicines for 5, 7 or 10 years.
Once you have completed 5 years of treatment, we will write to you and your GP to discuss if you should stop, continue, or change medicines. Your treatment summary will show the date you started your anti-hormone medicine and the date you will finish it. Please contact your breast care nurse if you have not been contacted towards the end of the 5 years of treatment.
Sometimes, patients may be advised to change their tablets after 2 to 3 years. For example, if you reach menopause and tamoxifen masks your periods, the breast care team might suggest a different treatment.
Younger patients may be advised to have monthly or 3 monthly injections of goserelin (zoloadex) or Prostap to induce menopause. If this applies to you, your oncologist will discuss the risks and benefits with you and this information will be included in your treatment summary.
You will not have to pay for hormone treatment tablets as you are entitled to free prescriptions. You can get a medical exemption certificate from https://
We are always learning and improving our treatments. If there are any changes in the way we prescribe anti-hormone medicine, we will explain what this means. You may be referred to your GP or breast care nurse to discuss this.
Possible side effects of anti-hormone medicine
Your medicines may cause side effects. We have not listed all the side effects in this booklet. Side effects can vary from person to person and depend on other treatments you are having. Your side effects can be worse if you are also taking other medicines. Please check with a healthcare professional before buying over-the-counter medicines.
If you are taking or have taken tamoxifen in the past, you may experience abnormal gynaecological symptoms. These can be symptoms such as vaginal bleeding, menstrual irregularities, vaginal discharge, pelvic pain, or pressure. You may be referred to a gynaecologist to have these symptoms investigated. You may also have hot flushes. Contact your GP or your breast care nurse if you have concerns.
1 in 10 patients may develop a blood clot called deep vein thrombosis (DVT). This clot could travel to your lungs. Your specialist will discuss your risk and give advice how to reduce this risk. Go to A&E immediately if you experience pain, redness, swelling or warm to touch in either of your calves, or shortness of breath.
Antidepressants such as paroxetine and fluoxetine may cause tamoxifen to be less effective. Please tell your GP if you are prescribed these medicines whilst you are taking tamoxifen.
Aromatase inhibitors such as letrozole, anastrozole and exemestane can sometimes cause joint stiffness and pain. They can also cause vaginal dryness which may be uncomfortable and affect your sex life. These medicines can also weaken your bones and increase the risk of bones breaking (osteoporosis).
Please contact your breast care nurse or GP if you are experiencing medicine side effects that are affecting your quality of life. They can offer further support and advice. They may consider changing your medicines.
It is important to know how your breasts usually look and feel. This is so that you can recognise any changes.
After breast cancer treatment, it can take some time (up to 2 years) for changes to settle and for you to become familiar with your treated breast. However, you know better than anyone how your breasts look and feel. If you notice a change, contact your breast care nurse on the phone numbers in this booklet, or see your GP.
There is no right or wrong way to examine your breasts. Try to get used to the way your breasts look and feel. You can do this around once a month, in the bath or shower while using soap or body lotion. You do not need to change your everyday routine. You can find leaflets and websites listed at the end of this booklet.
Contact your nurse or GP if you notice:
• any new lumps in the breast area, under the arm, on the neck or collar bone
• bleeding from the nipple
• change in the shape or outline of the breast
• swelling of the arm or breast (also known as lymphoedema)
• puckering of skin – can look/feel like orange peel (peau d’orange)
• inverted nipple (turned inward)
Signs and symptoms
You may be concerned that any new pain is related to cancer. Included below is a summary of symptoms that you should report to your surgical breast care nurse or GP if you have them. It is important to remember that if you have any of these symptoms it does not mean that your cancer has returned. They may be caused by other common conditions.
Contact your nurse or GP if you have:
• breathlessness not associated with a cold or chest infection
• persistent and new pain anywhere in the body that lasts for more than 2 weeks
• any other new symptom that last for more than two weeks
• sudden pins and needles, loss of sensation, or weakness in your arms or legs
• unexplained weight loss and loss of appetite
• a constant feeling of being sick (nausea)
• discomfort or swelling under your ribs or across your tummy area (abdomen)
• persistent dry cough
• severe headaches that are usually worse in the morning
• changes in vision or speech
• yellowing of the white of your eyes or skin (jaundice)
• dizziness and balance issues
A recurrence or a new cancer can be scary. But it is important to remember that it can usually be treated.
Survival rates for breast cancer are improving and modern treatments are highly successful.
The risk of breast cancer returning reduces over time.
The risk of recurrence for hormone receptor positive breast cancer continues for 20 to 25 years or more. However, it reduces over time.
For triple negative and HER two positive cancers the risk decreases faster. The risk becomes very low after 5 years.
It is important that you are aware of what to look for and what to do if you become concerned.
Breast cancer can return:
• in the treated breast (local recurrence)
• in the nearby area under your arm, above your collarbone, or neck area (regional recurrence)
• sometimes in the other breast
• elsewhere in the body such as the bones, lungs, liver, or brain (distant recurrence) also known as metastatic breast cancer or secondary breast cancer
If you have had a mastectomy and decided against reconstruction but change your mind later, please contact your breast care nurse. They can refer you back to clinic to discuss this.
If you had radiotherapy, we would advise you to wait at least a year for surgery However, on an individual basis you may be offered surgery after 6 months. In some cases, surgery can be offered to correct unequal breast sizes, and the breast care nurse can also refer you back to clinic if you wish to discuss this.
It is natural for breasts (treated and untreated) to change over time. Please contact your breast care nurse if you require information about your prosthesis, including replacement.
Everyone will have different feelings about completing their treatment. Some people feel relieved; others may be concerned about what can happen in the future. There may be anxiety about losing contact with the hospital where they had treatment and worry about the cancer returning. This is very normal, and these anxieties can lessen with time.
Realising there is a problem and getting help is the most important thing you can do.
While it is normal to feel low at times, you may find the way you are feeling is interfering with your enjoyment of life. Speak to your breast care nurse if you are finding it difficult. They will be able to discuss your concerns.
A referral for counselling can be helpful. It may also help to contact a local or national support organisation such as Breast Cancer Now, Macmillan Cancer Support, Breast Cancer Haven or Penny Brohn. You may consider signing up to the Moving Forward Course or HOPE Course.
The contact details can be found in this booklet.
What can you do to help yourself?
• Eat a healthy, well-balanced diet
• Exercise regularly
• Avoid large amounts of alcohol
• Maintain a healthy weight
• Look after mental wellbeing
• Stop smoking
Hope Course
Cancer patients can share their experiences, gain confidence, and build resilience following treatment. The course runs locally and is a 3 hour session once a week for 6 weeks. Please see next pages in this booklet for details.
Moving Forward Course
This is a Breast Cancer Now Charity course. It is held locally for breast cancer patients only. The course consists of 2, 3-hour sessions that take place once a week for 2 weeks. Please see next pages in this booklet for details.
Our commitment to you
You will not lose contact with our service because you have been transferred to self-management initiated follow up. If you have any specific issues or problems you wish to discuss, use the relevant contact details at the back of this booklet for the hospital where you were treated.
RIGHT BREAST GRADE: 1 2 3
LEFT BREAST GRADE: 1 2 3
BOTH BREASTS (BILATERAL) GRADE: 1 2 3
SIZE (mm) __________
TYPE: DUCTAL, LOBULAR
OTHER (state)______________________________________
DCIS: low intermediate high
Lymph nodes (number involved)______________________
OESTROGEN RECEPTOR POSITIVE OR NEGATIVE
PROGESTERONE RECEPTOR POSITIVE OR NEGATIVE
TRIPLE NEGATIVE
HER2 POSITIVE or NEGATIVE
Type of surgery WIDE LOCAL EXCISION
MASTECTOMY
THERAPEUTIC MAMMOPLASTY
RECONSTRUCTION
DATE OF SURGERY: ________________________
CHEMO BEFORE SURGERY
(neo adjuvant)
AFTER SURGERY
(adjuvant)
DATE OF 2ND SURGERY
OTDX TEST YES / NO
SCORE _______________
DATES OF CHEMOTHERAPY:
REGIME:
Start: ________________ Completed: ________________
DATES OF RADIOTHERAPY
Start: ________________ Completed: ________________
Hormone Treatment
YOU HAVE BEEN PRESCRIBED _______________________
You should stop taking this: _________ month _________ year
Your next Mammogram is due: __________________________
and should be done in _______ (month) for the next 5 years
Date of baseline bone density scan_______________________
This should be repeated two yearly whilst taking_____________
Your next MUGA scan / echocardiogram is due: _____________
Needs to be three to four monthly whilst on Trastuzumab/ Phesgo/ Kadcyla. On completion of these treatments the same cardiac test needs to be repeated six monthly for two years.
Useful Contacts
Surgical Breast Care Nurses: 024 7686 5181
Oncology Breast Care Nurse: 0247686 5778
Living with and Beyond
Cancer Specialist Nurse: 0734 105 5424
Breast Care Secretaries: 024 7686 5116
Monday to Friday, 9am to 5pm
If we cannot answer your call, please leave a voicemail message. Remember to leave your name and telephone number. Messages are checked during the day.
Mammogram appointments
If you need to change your follow up mammogram appointment,
please call 02476 865458
Other support
Cancer Information Support at GEH: 02476 153201
Walk and Talk Support Group: A friendly group where people meet, have a walk in the Riversley Park in Nuneaton and go for a drink afterwards if they wish. They meet every Tuesday at 1.30pm.
For more information, call 0787 659 0687
The Oasis Centre: Based at the hospital, it offers people therapies such as aromatherapy, massage, and relaxation free of charge.
For more information or to book a place, call 02476 86 5046
Breast Cancer Now support https://
HOPE Course: to book contact Cancer Information Support at GEH:
02476 153201
Penny Brohn, Living Well with Cancer - they provide support and practical advice:
0303 300 0118
Useful contacts
Helen Clark Suite: 01926 495321 ext. 8412
Breast Care Nurse Service: 01926 495321 ext. 4503
(Monday to Friday, 8.30am-4.30pm)
If we cannot answer your call, please leave a voicemail message. Remember to leave your name and phone number. Messages are checked during the day.
Mammogram appointments
If you need to change your follow up mammogram appointment,
please call 01926 600007 and select option 8 – Monday/Wednesday/Friday
Other support
Macmillan Cancer Information Support Centre at Warwick Hospital, Aylesford Unit: 01926 495321 ext. 8214
Stratford Hospital, Rigby Unit: 01789 205831 ext. 5871
Breast Cancer Now support https://
HOPE Course: to book contact Cancer Information Support: 01926 495321
Penny Brohn, Living Well with Cancer - they provide support and practical advice:
0303 300 0118
Bounce Back Breast Cancer Support Groups
The Well Healing Centre, 20 Augusta Place, Leamington Spa, CV32 5EL
Meetings: First Wednesday of month at 7pm to 8.45pm
No meetings in January and August
The Lifeways Centre, 30 Albany Road, Stratford upon Avon, CV37 6PG
Meetings: Second Wednesday of month at 6pm to 8pm
No meetings January and August
Contact: info@bouncebackgroup.co.uk
Jan: 01926 770628 – Su: 01926 423633 – Mobile: 07904 914817
George Eliot Hospital is a smoke free environment. For help and advice to stop smoking you can call the national helpline on 0300 123 1044 or visit https://
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