1. Initial investigation and referral
Your general practitioner (GP) will assess any symptoms you may notice (for example, a change in the size or shape of your breast or a new lump), conduct a physical examination and arrange tests.
Your GP should also discuss your needs (including physical, psychological, social and information needs) and recommend sources of reliable information and support.
Tests you may have:
- Mammogram: A low-dose x-ray of the breasts. Each breast is pressed between two x-ray plates to spread the breast tissue so that clear pictures can be taken. A mammography can detect changes that are too small to be felt during a physical examination.
- Ultrasound: High-frequency sound waves are used to create an image of the tissues inside the breast.
- Biopsy: Small samples of cells are removed from the breast lump, using a needle, and are examined under a microscope.
Tests should be done within two weeks. If breast cancer or other abnormalities are present, you will be referred to a specialist for further testing within two weeks. Your GP will provide the clinic with information about your medical history, whether there is a history of cancer in your family, and the results of the initial tests.
It can be helpful to bring a family member or friend with you to your appointments.
Some breast cancers are found through mammographic screening. The BreastScreen Australia Program is available free of charge to women from age 40. It is recommended that if you are aged 50–74 you consider undergoing a screening mammogram every two years. Visit breastscreen.org.au
2. Diagnosis and staging
Your specialist may conduct further tests to find out the stage of the cancer (how big it is and whether it has spread to other parts of the body).
You should also meet with a health professional (usually a breast care nurse), who will discuss your needs with you during and after treatment (including physical, psychological, social and information needs) and may refer you to another health professional (for example, a social worker or a physiotherapist) for different aspects of your care.
It can be helpful to contact cancer peer support groups and support groups for carers.
Here is a list of questions to ask your doctor.
To ensure you receive the best care, your specialist will arrange for a team of health professionals to plan your treatment based on your preferences and needs.
The team will be made up of health professionals who have experience managing and supporting women with breast cancer. Your specialist will tell you when the team will be discussing your case.
Your doctor should discuss the different treatment options with you including the likely outcomes, expected timeframes, possible side effects and the risks and benefits. For younger women, your team should also discuss the option of fertility preservation and provide clear information about the risk of early menopause and hormonal changes.
You might want to ask for more time before deciding on your treatment, or ask for a second opinion. Your doctor may also suggest you consider taking part in a clinical trial. If you wish, you can ask for a referral to a fertility service and/or genetic counsellor to help you evaluate your options.
Let your team know about any complementary therapies you are using or thinking about trying. Some therapies may not be appropriate, depending on your medical treatment.
There are a number of ways to treat breast cancer including surgery, radiation therapy and chemotherapy or drug therapy. Usually, more than one type of treatment is recommended to get the best outcome.
Surgery is the most common treatment for early breast cancer. It involves either breast-conserving surgery, where only the cancer and a small amount of healthy tissue is removed, or mastectomy, where the breast is removed. You should be fully informed of your options and offered the option of immediate or delayed reconstructive surgery if undergoing a mastectomy.
Chemotherapy, targeted/biological therapy (for example, trastuzumab) or hormone/endocrine therapy (for example, tamoxifen)
This may benefit some women with breast cancer. Could be given before or after surgery.
This treatment may benefit some women with early breast cancer (after surgery).
For more information about treatment and treatment side effects ask your doctor or visit bcna.org.au.
4. After treatment
After your treatment is completed, your doctor should provide you with a treatment summary that details the care you received including:
- diagnostic tests that were performed and their results
- types of treatment used and when they were performed
- treatment plans from other health professionals
- supportive care services provided to you.
To monitor your health and make sure the cancer has not returned, you may need regular check-ups.
You and your GP should receive a follow-up care plan that tells you about:
- the type of follow-up that is best for you
- types of tests that you may continue to have (it is not usually necessary to have a lot of body scans but annual breast imaging, if appropriate, is important)
- care plans for managing any side effects of treatment should they occur
- how to get specialist medical help quickly if you think the cancer has returned.
Your doctor should:
discuss your needs with you and refer you to appropriate health professionals and/or community organisations, if support is required
provide information on the signs and symptoms to look out for that might mean a return of the cancer
provide information on prevention and healthy living
5. If cancer returns
Sometimes breast cancer can come back after treatment. Everyone is different, and the risk of cancer returning will be influenced by many different things including the type of breast cancer. This is why it is important you have regular check-ups that include a physical examination and breast imaging if appropriate.
6. Living with cancer
Some people experience side effects (for example, tiredness) that continue beyond the end of treatment. Sometimes side effects don’t begin until months after treatment has finished. For more information about side effects ask your doctor.
Advance care plan:
Your doctor may discuss with you the option of developing an advance care plan. An advance care plan is a formal way of setting out your wishes for future medical care. For more information about advance care planning ask your doctor or visit advancecareplanning.org.au.
This type of treatment could be used at different stages to help you with pain relief, to reduce your symptoms or help improve your quality of life. For more information about palliative care ask your doctor or visit palliativecare.org.au.
7. Questions of cost
There can be cost implications at each stage of the cancer care pathway, including costs of treatment, accommodation and travel. There can be substantial out-of-pocket costs if you are having treatment in a private health service, even if you have private health insurance.
You can discuss these costs with your doctor and/or private health insurer for each type of treatment you may have. If you are experiencing financial difficulties due to your cancer treatment you can contact the social worker at your local hospital.
For more information visit costs of treatment.
For more information about accommodation and travel costs visit our support section.
8. Further support
Breast cancer support
For free resources about breast cancer, or to find support available in your area, call Breast Cancer Network Australia on 1800 500 258 or visit bcna.org.au.
You can also speak to specially trained staff at Cancer Council 13 11 20. They can answer your questions about the effects of cancer, explain what will happen during treatment and link you to support groups and other community resources.
If you need an interpreter, call TIS (Translating and Interpreting Service) on 13 14 50.
For support and advice for carers, call the Carers Association on 1800 242 636.
More support options
Australian Cancer Survivorship Centre
Has general and tumour-specific information, primarily focussed on the post-treatment survivorship phase
• Telephone: +61 3 9656 5207
• Website: www.petermac.org/cancersurvivorship
Information on depression, anxiety and related disorders, available treatment and support services
• Telephone: 1300 22 4636
• Website: www.beyondblue.org.au
Look Good, Feel Better
A non-medical, free community service program dedicated to teaching women how to manage the appearance-related side-effects caused by cancer treatment
• Telephone: 1800 650 960 (Monday to Thursday 9.00am to 5.00pm)
• Website: www.lgfb.org.au
Information on cancer prevention, screening, diagnosis, treatment and supportive care for Australians affected by cancer, and their families and carers
• Telephone: 1800 624 973
• Website: www.canceraustralia.gov.au
Breast Cancer Network Australia
Specific information on breast cancer
• Telephone: 1800 500 258
• Website: http://www.bcna.org.au/
Australian organisation for young people living with cancer offers support, information, and resources
• Telephone: 1800 226 833
• Website: www.canteen.org.au
Care Search: Palliative Care Knowledge Network
Information for patients and carers on living with illness, practical advice on how to care, and finding services
• Telephone: (08) 7221 8233
• Website: www.caresearch.com.au
National Health Services Directory
A directory providing information on local hospital and community services
• Website: www.nhsd.com.au
NEMICS A common path: Breast cancer
Videos offering support and advice from people who have been through cancer.
• Visit: www.youtube.com/c/ACommonPathCancersupportandadvice
Clinical versions of the optimal care pathways have been developed for clinicians and general practitioners here.