Breast cancer (female)

Breast cancer (female) - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Breast cancer (female) Breast cancer (female) About breast cancer Symptoms of breast cancer Causes and risk factors of breast cancer Diagnosing breast cancer Treating breast cancer Living with breast cancer Preventing breast cancer About breast cancer Breast cancer is the most common type of cancer in the UK. Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men can alsoget breast cancer . If its treated early enough, breast cancer can be prevented from spreading to other parts of the body. The breasts The breasts are made up of fat, connective tissue and thousands of tiny glands called lobules, which produce milk. When a woman has a baby, the milk is delivered to the nipple through tiny tubes called ducts, which allow her to breastfeed. The body is made up of billions of tiny cells, which usually grow and multiply in an orderly way. New cells are only produced when and where theyre needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably. Read more about the causes of breast cancer Symptoms of breast cancer Breast cancer can have a number of symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue. Most breast lumps arent cancerous, but its always best to have them checked by your doctor. You should also speak to your GP if you notice any of the following: a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Learn more about the symptoms of breast cancer After examining your breasts, your GP may refer you to a specialist breast cancer clinic for further tests.This might include a mammography (breast screening)or a biopsy . Read more about breast screening and how breast cancer is diagnosed Types of breast cancer There are several different types of breast cancer, which can develop in different parts of the breast. Breast cancer is often divided into non-invasive and invasive types. Non-invasive breast cancer Non-invasive breast cancer is also known as cancer or carcinoma in situ. This cancer is found in the ducts of the breast and hasnt developed the ability to spread outside the breast. This form of cancer rarely shows as a lump in the breast that can be felt, and is usually found on a mammogram. The most common type of non-invasive cancer is ductal carcinoma in situ (DCIS). Invasive breast cancer Invasive cancer has the ability to spread outside the breast, although this doesnt necessarily mean it has spread. The most common form of breast cancer is invasive ductal breast cancer, which develops in the cells that line the breast ducts. Invasive ductal breast cancer accounts for about 80% of allbreast cancer cases and is sometimes called no special type. Other types of breast cancer Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Pagets disease of the breast . Its possible for breast cancer to spread to other parts of the body, usually through the lymph nodes (small glands that filter bacteria from the body) or the bloodstream. If this happens, its known as secondary or metastatic breast cancer. Breast cancer screening Theres a good chance of recovery if breast cancer is detected in its early stages. For this reason, its vital that women check their breasts regularly for any changes and always get any changes examined by their GP. Mammographic screening (where X-ray images of the breast are taken) is the best available method of detecting an early breast lesion. However, you should be aware that a mammogram might fail to detect some breast cancers. It might also increase your chances of having extra tests and interventions, including surgery. Women with a higher-than-average risk of developing breast cancer may be offered screening and genetic testing for the condition. As the risk of breast cancer increases with age, all women who are 50to 70 years old are invited for breast cancer screening every 3 years. Women over 70 are also entitled to screening and can arrange an appointment through their GP or local screening unit. The NHS is in the process of extending the programme as a trial, offering screening to some women aged 47to 73. Read more about breast screening and find breast cancer screening services near you Treating breast cancer If cancer is detected at an early stage, it can be treated before it spreads to nearby parts of the body. Breast cancer is treated using a combination of surgery, chemotherapy and radiotherapy . Surgery is usually the first type of treatment youll have, followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. The type of surgery and the treatment you have afterwards will depend on the type of breast cancer you have. Your doctor will discuss the best treatment plan with you. In asmall proportion of women, breast cancer is discovered after its spread to other parts of the body (metastasis). Secondary cancer, also called advanced or metastatic cancer, isnt curable, so the aim of treatment isto achieve remission (symptom relief). Read more about treating breast cancer Preventing breast cancer As the causes of breast cancer arent fully understood, its not possible to know if it can be prevented altogether. If youre at increased risk of developing the condition, some treatments are available to reduce the risk. Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions, there are benefits for women who maintain a healthy weight , exercise regularly and who have a low intake of saturated fat and alcohol . Its been suggested that regular exercise can reduce your risk of breast cancer by as much as a third. If youve been through the menopause, its particularly important that youre not overweight or obese. This is because being overweight or obese causes more oestrogen to be produced, which can increase the risk of breast cancer. Read more about preventing breast cancer Living with breast cancer Being diagnosed with breast cancer can affect daily life in many ways,depending on what stageits at and what treatment youre having. How women cope with their diagnosis and treatment varies from person to person. You can be reassured that there are several forms of support available, if you need it. For example: yourfamily andfriends can be a powerful support system you can communicate with other people in the same situation find out as much as possible about your condition dont try to do too much or overexert yourself make time for yourself Read more about living with breast cancer Symptoms of breast cancer The first symptom of breast cancer most women notice is a lump or an area of thickened tissue in their breast. Mostbreast lumps (90%) arent cancerous, but its always best to have them checked by your doctor. You should speak to your GP if you notice any of the following: a lump or area of thickened tissue in either breast a change in the size or shape of one or both breasts discharge from either of your nipples(which may be streaked with blood) a lump or swelling in either of your armpits dimpling on the skin of your breasts a rash on or around your nipple a change in the appearance of your nipple, such as becoming sunken into your breast Breast pain alone isnt a symptom of breast cancer. Read further information: Breast Cancer Now: Signs and symptoms of breast cancer Cancer Research UK: Breast cancer symptoms Macmillan Cancer Support: Signs and symptoms of breast cancer Breast awareness Its important to be breast aware,so you can pick up any changes as soon as possible. Get to know what is normal for you. For instance, your breasts may look or feel different at different times of your life. This will make it much easier to spotpotential problems. Read further information: Breast Cancer Now: Checking your breasts Breast Cancer Now: Signs and symptoms of breast cancer Causes and risk factors of breast cancer The causes of breast cancer arent fully understood, making it difficult to say why one woman may develop breast cancer and another may not. However, there are risk factors that areknown to affect your likelihood of developing breast cancer. Some of these you cant do anything about, but there are some you can change. Age The risk of developing breast cancer increases with age. The condition is most common among women over 50 who have been through the menopause . About 8 out of 10 cases of breast cancer occur in women over 50. All women who are 50to 70 years of age should be screened for breast cancer every 3 years as part of the NHS Breast Screening Programme. Women over the age of 70 are still eligible to be screened and can arrange this through their GP or local screening unit. Read more about breast screening Family history If you have close relatives who have had breast cancer or ovarian cancer , you may have a higher risk of developing breast cancer. However, because breast cancer is the most common cancer in women, its possible for it to occur in more than one family member by chance. Most cases of breast cancer arent hereditary (they dont run in families), but particular genes, known as BRCA1 and BRCA2, can increase your risk of developing both breast and ovarian cancer. Its possible for these genes to be passed on from a parent to their child. A third gene (TP53) is also associated with an increased risk of breast cancer. If you have, for example, 2 or more close relatives from the same side of your family, such as your mother, sister or daughter, who have had breast cancer under the age of 50, you may be eligible for surveillance for breast cancer or for genetic screening to look for the genes that make developing breast cancer more likely. If youre worried about your family history of breast cancer, discuss it with your GP. Read about predictive genetic tests for cancer risk genes Previous diagnosis of breast cancer If youve previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast again. Previous benign breast lump A benign breast lump doesnt meanyou have breast cancer, but certain types of lump may slightly increase your risk of developing it. Certain benign changes in your breast tissue, such as atypical ductal hyperplasia (cells growing abnormally in ducts), or lobular carcinoma in situ (abnormal cells inside your breast lobes), can make getting breast cancer more likely. Breast density Your breasts are made up of thousands of tiny glands (lobules), which produce milk. This glandular tissue contains a higher concentration of breast cells than other breast tissue, making it denser. Women with dense breast tissue may have a higher risk of developing breast cancer because there are more cells that can become cancerous. Dense breast tissue can also make a breast scan (mammogram) difficult to read, because it makes any lumps or areas of abnormal tissue harder to spot. Younger women tend to have denser breasts. As you get older, the amount of glandular tissue in your breasts decreases and is replaced by fat, so your breasts become less dense. Exposure to oestrogen The female hormone, oestrogen,can sometimes stimulate breast cancer cells and cause them togrow. The ovaries, where your eggs are stored, begin to produce oestrogen when you start puberty , to regulate your periods. Your risk of developing breast cancer may rise slightly with the amount of oestrogenyour body is exposed to. For example, if you started your periods at a young age and experienced themenopause at a late age, youll have been exposed to oestrogen over a longer period of time. In the same way, not having children, or having children later in life, may slightly increase your risk of developing breast cancer because your exposure to oestrogen is uninterrupted by pregnancy. Being overweight or obese If youve experienced the menopause and are overweight or obese , you may be more at risk of developing breast cancer. This is thought to be linked to the amount of oestrogen in your body, because being overweight or obese after the menopause causes more oestrogen to be produced. Being tall If youre taller than average, youre more likely to develop breast cancer than someone whos shorter than average.The reason for this isnt fully understood, but it may be due to interactions between genes, nutrition and hormones. Alcohol Your risk of developing breast cancer can increase with the amount of alcohol you drink . Radiation Certain medical procedures that use radiation, like X-rays and computerised tomography (CT) scans , may slightly increase your risk of developing breast cancer. If you had radiotherapy to your chest area for Hodgkin lymphoma when you were a child, you should have already received a written invitation from the Department of Health for a consultation with a specialist to discuss your increased risk of developing breast cancer. Speak to your GP if you werent contacted, or if you didnt attend a consultation. If you currently need radiotherapy for Hodgkin lymphoma, your specialist should discuss the risk of breast cancer before your treatment begins. Hormone replacement therapy (HRT) Hormone replacement therapy (HRT) is associated with a slightly increased risk of developing breast cancer. Both combined HRT and oestrogen-only HRT can increase your risk of developing breast cancer, although the risk is slightly higher if you take combined HRT. Read further information: Breast Cancer Now: Breast cancer causes Macmillan Cancer Support: Risk factors for breast cancer Diagnosing breast cancer If you have suspected breast cancer, eitherbecause ofyour symptoms or because your mammogram has shown an abnormality, youll be referred to a specialist breast clinic for further tests. What to expect at the breast clinic The tests youll receive at the breast clinic depend on your current symptoms, your age, and the results of the initial examination youll have when you arrive. Many people dont need any further tests after the initial examination. Most of the time you can expect to spend up to 2 hours at the breast clinic. Mammogram and breast ultrasound If you have symptoms and have been referred by your GP, youll meet a specialist wholl examine you to determine if you need further tests. If youre under40 years of age, the specialistmay suggest you only have a breast ultrasound scan. This is because younger women have denser breasts, which means a mammogram isnt as effective as an ultrasoundfor diagnosing breast disease. If you have a mammogram, it will produce an X-ray of your breasts. You may also need an ultrasound scan . Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts, showing any lumps or abnormalities. Your doctor may also suggest a breast ultrasound if they need to know whether a lump in your breast is solid or contains liquid. Read more about breast screening Biopsy A biopsy is where a sample of tissue cells is taken from your breast and tested to see if its cancerous. You may also need a scan and a needle test on lymph nodes in your armpit (axilla) to see whether these are also affected. Biopsies can be taken in different ways, and the type you have will depend on what your doctor knows about your condition.Different methods ofcarrying outa biopsy are discussed below. Needle aspiration may be used to test a sample of your breast cells for cancer or to drain a benign cyst (a small fluid-filled lump). Your doctor will use a small needle to extract a sample of cells, without removing any tissue. Needle biopsy is the most common type of biopsy. A sample of tissue is taken from a lump in your breast using a large needle. Youll have a local anaesthetic , which means youll be awake during the procedure, but your breast will be numb. Your doctor may suggest that you have a guided needle biopsy (usually guided by ultrasound or X-ray, but sometimes MRI is used) to obtain a more precise and reliable diagnosis of cancer and to distinguish it from any non-invasive change, particularly ductal carcinoma in situ (DCIS). Vacuum-assisted biopsy, also known as a mammotome biopsy, is another type of biopsy. During the procedure, a needleis attached to a gentle suction tube, which helps toobtain the sample and clear any bleeding from the area. Read further information: Breast Cancer Now:What happens at a breast clinic appointment? Breast Cancer Now: Your pathology results Macmillan Cancer Support: Breast cancer Further tests for breast cancer If a diagnosis of breast cancer is confirmed, more tests will be needed to determine the stage and grade of the cancer, and to work out the best method of treatment. Ifyourcancer was detected through the NHS Breast Screening Programme, youll have further tests in the screening centre before being referred for treatment. Scans and X-rays Computerised tomography (CT) scans , or chest X-ray and liver ultrasound scans, may be needed to check whether the cancer has spread to your lungs or liver. An MRI scan of the breast may be needed to clarify or to assess the extent of the condition within the breast. If your doctor thinks that the cancer could have spread to your bones, you may need a bone scan. Before having a bone scan, a substance containing a small amount of radiation, known as an isotope, will be injected into a vein in your arm. This will be absorbed into your bone if its been affected by cancer. The affected areas of bone will show up as highlighted areas on the bone scan, which is carried out using a special camera. Tests to determine specific types of treatment Youll also need tests that show whether the cancer will respond to specific types of treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how best to treat it. The types of test you could be offered are discussed below. In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. If this is the case, the cancer may be treated by stopping the effects of the hormones, or by lowering the level of these hormones in your body. This is known as hormone therapy. Duringa hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone. If the hormone is able to attach to the cancer cells (using a hormone receptor), theyre known as hormone receptor positive. While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein calledhuman epidermal growth factor receptor 2 (HER2). These types of cancer can be diagnosed using a HER2 test, and treated with medication to block the effects of HER2. This is known as biological or targeted therapy. Stage and grade of breast cancer Stage of breast cancer When your breast cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread. Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer: stage 1  the tumour measures less than 2cm, the lymph nodes in the armpit arent affected, and there are no signs that the cancer has spread elsewhere in the body stage 2  the tumour measures 2 to 5cm or the lymph nodes in the armpit are affected, or both, and there are no signs that the cancer has spread elsewhere in the body stage 3  the tumour measures2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, the lymph nodes in the armpit are affected butthere are no signs that the cancer has spread elsewhere in the body stage 4  the tumour is of any size and the cancer has spread to other parts of the body (metastasis) This is a simplified guide. Each stage is divided into further categories: A, B and C. If youre not sure what stage you have, ask your doctor. TNM staging system The TNM staging system may also be used to describe breast cancer, as it can provide accurate information about the diagnosis. T describes the size of the tumour, N describes whether cancer has spread to the lymph nodes, and M gives an indication of whether the cancer has spread to other parts of the body. Grade of breast cancer The grade describes the appearance of the cancer cells. low grade (G1)  the cells, although abnormal, appear to be growing slowly medium grade (G2)  the cells look more abnormal than low-grade cells high grade (G3)  the cells look even more abnormal and are more likely to grow quickly Read further information: Cancer Research UK: TNM breast cancer staging Cancer Research UK: Stages and grades of breast cancer Treating breast cancer Surgery is usually the first type of treatment for breast cancer. The type of surgery you undergo will depend on the type of breast cancer you have. Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment youll have will depend onyour type of breast cancer. Your doctor will discuss the most suitable treatmentplan with you. Chemotherapy or hormone therapy will sometimes be the first treatment. Secondary breast cancer Most breast cancers are discovered in the conditions early stages. However, a small proportion of women discover that they have breast cancer after its spread to other parts of the body (known as metastasis). If this is the case, the type of treatment you have may be different. Secondary cancer, also called advanced or metastatic cancer, isnt curable and treatment aims to achieve remission (where the cancer shrinks or disappears, and you feel normal and able to enjoy life to the full). Read further information aboutsecondary breast cancer Surgery There are 2 main types of breast cancer surgery. They are: surgery to remove the cancerous lump (tumour), known as breast-conserving surgery surgery to remove the whole breast, which is called a mastectomy In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a bulge to replace the breast that was removed. Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer. Breast-conserving surgery Breast-conserving surgery ranges from a lumpectomy or wide local excision, wherejust the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, whereup to a quarter of the breast is removed. If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on the: type of cancer you have size of the tumour and where it is in your breast amount of surrounding tissue that needs to be removed size of your breasts Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If theres no cancer present in the healthy tissue, theres less chance that the cancer will reoccur. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast. After having breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells. Mastectomy A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy. If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm). Reconstruction Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. Read further information aboutbreast reconstruction Lymph node surgery To find out if the cancer has spread, a procedure called a sentinel lymph node biopsymay be carried out. The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. Theyre part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so theyre identified using a combination of a radioisotope and a blue dye. The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread. If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm. Radiotherapy Radiotherapy uses controlled doses of radiation to kill cancer cells. Its usually given after surgery and chemotherapy to kill any remaining cancer cells. If you need radiotherapy, your treatment will begin about a month after your surgery or chemotherapy, to give your body a chance to recover. Youll probably have radiotherapy sessions 3 to 5 days a week, for 3 to 6 weeks. Each session will only last a few minutes. The type of radiotherapy you have will depend on your cancer and surgery type. Some women may not need to have radiotherapy at all. The types available are: breast radiotherapy  after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue chest wall radiotherapy  after a mastectomy, radiotherapy is applied to the chest wall breast boost  some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed; however, the boost may affect the appearance of the breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of the breast tissue (fibrosis) radiotherapy to the lymph nodes  where radiotherapy is aimed at the armpit (axilla) and the surrounding area to kill any cancer that may be present in the lymph nodes The side effects of radiotherapy include: irritation and darkening of the skin on your breast, which may lead to sore, red, weepy skin fatigue (extreme tiredness) lymphoedema(excess fluid build-up in your arm caused by blockage of the lymph nodes under your arm) Read further information aboutradiotherapy for breast cancer Chemotherapy Chemotherapy involves using anti-cancer (cytotoxic) medication to kill the cancer cells. Its usually used after surgery to destroy any cancer cells that havent been removed. This is called adjuvant chemotherapy. In some cases, you may have chemotherapy before surgery, which is often used to shrink a large tumour. This is called neo-adjuvant chemotherapy. Several different medications are used for chemotherapy and three are often given at once. The choice of medication and the combination will depend on the type of breast cancer you have and how much its spread. Chemotherapy is usually given as an outpatient treatment, which meansyou wont have to stay in hospital overnight. The medications are usually given through a drip straight into the blood through a vein. In some cases, you may be given tablets that you can take at home. You may have chemotherapy sessions once every 2 to 3 weeks, over a period of 4 to 8 months, to give your body a rest in between treatments. The main side effects of chemotherapy are caused by their influence on normal, healthy cells, such as immune cells. Side effects include: infections loss of appetite nausea and vomiting tiredness hair loss sore mouth Many side effects can be prevented or controlled with medicines that your doctor can prescribe. Chemotherapy medication can also stop the production of oestrogen in your body, which is known to encourage the growth of some breast cancers. If you havent experienced the menopause, your periods maystop while youre undergoing chemotherapy treatment. After youve finished the course of chemotherapy, your ovaries should start producing oestrogen again. However, this doesnt always happen and you may enter an early menopause . This is more likely in women over 40 years old, becausetheyre closer to menopausal age. Your doctor will discuss with you the impact that any treatment will have on your fertility. Chemotherapy for secondary breast cancer If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy wont cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life. Read further information aboutchemotherapy for breast cancer Hormone treatment Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body. These types of cancer are known as hormone-receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects. The type of hormone therapy youll have will depend on the stage and grade of your cancer, which hormone its sensitive to, your age, whether youve experiencedthe menopause and what other type of treatment youre having. Youll probably have hormone therapy after surgery and chemotherapy, but its sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you from having surgery, chemotherapy or radiotherapy. In most cases, youll need to take hormone therapy for up to five years afterhaving surgery. If your breast cancer isnt sensitive to hormones, hormone therapy will have no effect. Tamoxifen Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. Its taken every day as a tablet or liquid. It can cause several side effects, including: tiredness changes to your periods nausea and vomiting hot flushes aching joints headaches weight gain Aromatase inhibitors If youveexperienced the menopause, you may be offered an aromatase inhibitor. This type of medication works by blocking aromatase, a substance that helps produce oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries. Three aromatase inhibitors may be offered. These areanastrozole, exemestane and letrozole. These are taken as a tablet once a day. Side effects include: hot flushes and sweats lack of interest in sex (loss of libido) nausea and vomiting tiredness aching joints and bone pain headaches skin rashes Ovarian ablation or suppression In women who haventexperienced the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries working and producing oestrogen. Ablation can be carried out using surgery or radiotherapy. Itstops the ovaries working permanently and means youll experience the menopause early. Ovarian suppression involves using a medication called goserelin, which is a luteinising hormone-releasing hormone agonist (LHRHa). Your periods will stop while youre taking it, although they should start again once your treatment is complete. If youreapproaching the menopause (around the age of 50), your periods may not start again after you stop taking goserelin. Goserelin is taken as an injection once a month and can cause menopausal side effects, including: hot flushes and sweats mood swings trouble sleeping Read further information abouthormone therapy Biological therapy (targeted therapy) Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 (HER2). These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and by helping your immune system to fight off cancer cells. If you have high levels of the HER2 protein and are able to have biological therapy, youll probably be prescribed a medicine called trastuzumab. Trastuzumab, also known by the brand name Herceptin,is usually used after chemotherapy. Trastuzumab Trastuzumab is a type of biologial therapy