The Breast Care new patient clinic is for women and men who have been referred by their GP and includes patients with breast pain, lumps and/or bumps, breast changes or discharge. Patients are usually over the age of 16 years of age, although we also see children.
Use the section below to help you find answers to some of the common practical questions that you may have. Simply click on the blue panel and it will expand to give more information on the relevant section.
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Your letter will invite you to the Day Surgery Unit which you will find on Level 2 of the hospital, please follow the signage. Speak to the staff at the reception when you arrive with your letter. You may also be treated at the Haemotology/Oncology Ward though most patients will have chemotherapy treatment or radiology treatment at the Edinburgh Western General Hospital.
What happens next
At your first appointment, if appropriate, you would usually have a mammogram, potentially alongside an ultrasound scan and possibly a biopsy, all performed on the same day at the breast clinic- this can mean being at the clinic for up to three or four hours.
You will then be seen by a breast doctor and offered an appointment which will be around 1-2 weeks later for your results. If further tests, for example an MRI scan, are required, they cannot be done on the same day and you would need to return at a later date.
After this, you will be invited to the breast consultant follow up clinic to receive results of needle tests, biopsies and/or surgery you’ve had. You will be seen by a Breast care consultant and your results will be discussed with you and a further plan of treatment recommended, if required.
You should also have the opportunity to discuss the results and treatment plan with a clinical nurse specialist (CNS) The CNS can provide written information and make additional appointments for you to discuss things further on a separate day, once you have had time to digest the information, and thought of questions you may wish to ask.
Your first appointment
Your first appointment will come to you from our Medical Records team and will give you a date and a time and information on which hospital you will be seen at. At your first appointment to see the specialist doctor, you will be asked about what is concerning you about the signs and symptoms you are experiencing. This appointment is a chance for you to ask any questions you may have so it is helpful to bring them written down and also to bring someone with you to help support you.
Asking your healthcare professional the right questions will help you decide the tests and treatments that are right for you. We therefore encourage you to ask the BRAN questions at your appointment.
What are the Benefits?
What are the Risks?
What are the Alternatives?
What if I do Nothing?
Make sure that your contact details are up to date with the team so that we can contact you if we need to rearrange or to allow us to offer you cancellation appointments if available.
New patients' appointments can take a few hours.
Treatment and Investigations
Treatments for breast cancer can include surgery, chemotherapy, and radiotherapy and hormone therapy.
Surgery is usually the first treatment for people with breast cancer. The two main types of breast surgery are Breast-conserving surgery – the cancer is removed along with a border (margin) of normal breast tissue around it.
Mastectomy – removal of all the breast tissue including the nipple area.
The type of surgery recommended for you depends on the type and size of the cancer, where it is in the breast and whether more than one area of the breast is affected. It will also depend on the size of your breast. Your treatment team will explain why they think a particular operation is best for you.
Breast cancer cells can sometimes spread to the lymph nodes under the arm. Anyone with invasive breast cancer will have the lymph nodes under the arm assessed. The outcome of this will help your treatment team recommend which treatments are best for you.
Radiotherapy uses high-energy x-rays to destroy cancer cells. It’s given to destroy any cancer cells that may have been left in the breast and surrounding area after surgery. You may hear this called adjuvant radiotherapy.
Radiotherapy is given after surgery to reduce the risk of breast cancer coming back. If you’re having chemotherapy after surgery, radiotherapy is usually given after the chemotherapy. If you don’t need chemotherapy, radiotherapy will usually start four to eight weeks after surgery. Your specialist or breast care nurse will explain when you will start radiotherapy.
Radiotherapy is usually given daily over one to three weeks. It will be given Monday to Friday with a break at weekends. Most hospitals do not give radiotherapy on bank holidays. You may have radiotherapy for longer if you need an extra boost.
Chemotherapy is a treatment that destroys cancer cells using anti-cancer drugs. It works by interfering with the cancer cells’ ability to divide and grow. Different chemotherapy drugs work in different ways. This is why a combination of drugs is often used.
Chemotherapy may be used after surgery for primary breast cancer to reduce the risk of cancer returning or spreading. This is called adjuvant chemotherapy. You may be given chemotherapy in combination with other treatments. Chemotherapy affects cells throughout the body and can cause side effects.
Chemotherapy may be used before surgery to slow the growth of rapidly growing breast cancer. Or it might be given to shrink a larger breast cancer before surgery (this may mean breast-conserving surgery is an option, rather than a mastectomy).
Chemotherapy can be given in several ways. For breast cancer the drugs are most commonly given intravenously (into a vein) or orally (by mouth).
Oncotype DX is a test that predicts how likely breast cancer is to spread to somewhere else in the body (secondary breast cancer) within 10 years of diagnosis.
Your specialist may recommend the Oncotype DX test if the benefit of chemotherapy for you is less clear. The test is done on a small amount of breast cancer tissue already removed (for example during a core biopsy or surgery). The tissue is sent to a laboratory in the USA, where the test is carried out. The test looks at groups of genes found in breast cancer.
Best Supportive Care
Sometimes we do not think that chemotherapy or radiotherapy will help you. Best Supportive Care focuses on quality of life and aims to help you live as well and as comfortable as possible, rather than curing the cancer. Best Supportive Care can:
- Help with symptoms such as breathlessness, pain, sickness or problems eating
- Help you and the people you care about come to terms with the diagnosis and what it means
- Help you talk about the future and plan ahead. This can be hard to do but can help you feel more prepared and in control
- Support you to manage at home
Best Supportive Care is usually provided by a combination of people, including: GPs and District Nurses, Cancer Specialist Nurses and Specialist Palliative Care.
Your care team
The breast clinical nurse specialists (CNSs) are nurses who specialise in breast cancer. Clinical nurse specialists work as part of the multi-disciplinary team, alongside healthcare professionals. They provide information about your diagnosis, treatment options, specialist support and information to you, your family and those who care for you, throughout your cancer treatment and follow up care.
Our breast cancer navigator works as part of the cancer care team alongside registered practitioners to help improve care for people with cancer, helping patients to self-manage their recovery and return to leading a healthy life. The breast cancer navigator is trained and experienced in supporting people with a cancer diagnosis.
The breast cancer navigator can offer practical and emotional support, signposting, and information about lifestyle changes, such as diet, physical activity, benefits referrals and local support available.
What can you do to prepare
This is where you will find information about how you can get ready for treatment.
Some treatments for breast cancer require you to be reviewed by a dentist prior to starting treatment.
- Think about arranging transport, time off work or childcare for the day of your appointments.
- Make sure you know where you are going.
- Bring a pen and paper to take notes.
- Try to bring a friend or family member with you.
- Allow extra time in case it takes longer than expected.
- Make sure your mobile phone is charged.
- Don’t be afraid to ask the BRAN questions.
What are the Benefits?
What are the Risks?
What are the Alternatives?
What if I do Nothing?
Services useful to you
We work closely with external services that offer additional support to help with your cancer journey, these include the following organisations:
Cancer Telephone Helpline: 0800 9177711
Provide feedback via Care Opinion
The most effective way to feedback about your patient experience is to use the Care Opinion website. Care Opinion allows you to truthfully share your experience with us and with others. This site is moderated and your comments will be both seen and reviewed.
If you require this information in a community language or alternative format e.g. Braille, audio, large print, BSL, Easy Read please contact the Equality and Human Rights Team at: email: fife.EqualityandHumanRights@nhs.scot or phone 01592 729130. For people with a hearing or verbal impairment you can also contact the team via the NHS Fife SMS text service number on 07805800005.
You can also find health related information on many topics in an Easy Read format on nhsinform.scot.