Early and locally advanced breast cancer: diagnosis and management

Early and locally advanced breast cancer: the care you should expect

Breast cancer is the most common cancer in the UK. Over 60,000 people are diagnosed with breast cancer each year. Breast cancer is much more common in women, but over 300 men in the UK are diagnosed every year.

Breast cancer is called ‘early’ if it is in the breast, or in the breast and the lymph nodes in the armpit, and it has not spread to other parts of the body. If the cancer is in a large part of the breast and in several lymph nodes or other tissues nearby, it is called ‘locally advanced’.

There are several different types of breast cancer, and the right treatment is different for each person. We want this guideline to make a difference to people by making sure that:

• if your care team thinks you may have breast cancer, they confirm it quickly and learn all they can about it to help them offer you the best treatment
• you know what treatments are available, and you get good, balanced information and help to work out what you would prefer
• if you’re having a mastectomy (surgery to remove your breast), your care team talks with you about the option of breast reconstruction at the time of your cancer surgery if this is suitable for you
• you have help to cope with the effects of breast cancer treatment, and advice about how a healthy lifestyle can reduce the risk of the cancer returning
• your care team talks with you about the pros and cons of different medicines to help stop the cancer coming back, if they might be suitable for you, for example:
  • carrying on longer with tamoxifen, if you’re already taking it and you have not been through the menopause
  • swapping to an aromatase inhibitor, if you’ve been through the menopause and you have already taken tamoxifen
  • taking a bone medicine called a bisphosphate if you’ve been through the menopause.

Making decisions together

Decisions about treatment and care are best when they are made together. Your health professionals should give you clear information – including about the pros and cons of surgery for you – and talk with you about your options. They should listen carefully to your views and concerns.

To help you make decisions, think about:

• What matters most to you – what do you want to get out of any treatment?
• What are you most worried about – are there risks or downsides to the treatment that worry you more than others?
• How will the treatment affect your day to day life?
• What happens if you don’t want to have treatment?

If you can’t understand the information you are given, tell your health professional.

Read more about making decisions about your care.

Where can I find out more?

NHS Choices has more information about breast cancer in women and men.

The NHS Choices Live Well hub includes details of apps and websites covering over 100 healthy living topics.

The organisations below can also give you more advice and support:

• Breast Cancer Care, 0808 800 6000, including advice if you are considering breast reconstruction
• Breast Cancer Now, 0333 207 0300
• Cancer Research UK, 0808 800 4040
• Macmillan Cancer Support, 0808 808 0000

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people who have been affected by early and locally advanced breast cancer and staff who treat and support them. All the decisions are based on the best research available.

ISBN: 978-1-4731-3009-8