Breast cancer recurrence
When given a diagnosis of breast cancer, views on how to stop it coming back aren't what women think about.
How to fight it off in the first place is the issue. However, the risks of it recurring should also be emphasised as early as possible.
If women know what to look out for, and the importance of keeping up with their treatments, they'll be in a much better position to prevent it recurring.
Talk about recurrence
A study by Macmillan Cancer Support in 2012 suggested that over 1 in 5 breast cancer patients experience recurrence. Sometimes in the initial stages that issue isn't addressed.
"It isn't talked about enough. People are often terrified of a recurrence and healthcare professionals are sometimes anxious to bring up the subject as they don't want to upset their patient so it becomes the elephant in the room," says Grete Brauten-Smith, clinical nurse specialist at Breast Cancer Care.
She adds: "Women who go on to have a recurrence often tell us they wish someone had told them what to look out for, and what the signs and symptoms are."
When you are diagnosed and a treatment plan is put into place your oncologist will have carefully assessed the type of cancer you have. They will be aware of the recurrence risk of your type of cancer and will have tailored your treatment plan with that in mind.
For some women even after surgery it can be many years of sticking to a hormone therapy programme with potential side effects.
The programme of therapy and possible side effects is different for each person. "There's growing evidence that for some women taking hormone therapy for 10 years rather than 5 further reduces the risk of breast cancer coming back," says Grete.
"We hear from many women who suffer with side-effects which impact on their quality of life. So it's very much about weighing up the risk versus the benefits. It is vital women are aware of these side effects and how best to manage them so they can make an informed decision about taking any drug," adds Grete.
Side-effects can be gruelling and impact on quality of life. Women should be made aware that not following the recommended treatment plan may have an effect on recurrence.
The type of hormone therapy you have depends on your age, whether you are pre- or post- menopause as well as the grade and stage of your cancer.
Tamoxifen is usually prescribed to pre-menopausal women, while women after the menopause may be treated with aromatase inhibitors.
The side-effects of tamoxifen include hot flushes, night sweats, low sex drive, headaches and mood swings. Aromatase inhibitors may also cause joint aches and pain, and muscle pain.
If women experience any of these side-effects to a severe or debilitating extent they should talk to their health professional to see if there are any ways to alleviate the symptoms.
"Some younger women go on a 'tamoxifen holiday' and stop taking tamoxifen for a while because they would like to try for a baby - it is not advisable to get pregnant while on tamoxifen as it may harm the developing baby," says Grete. "Researchers are still gathering evidence to see what impact this 'holiday' may have on risk of recurrence."