Booklets

Advanced Cancer/Matepukupuku Maukaha

Bowel Cancer/Mate Whēkau Pukupuku

Chemotherapy/Hahau

Eating Well/Kia Pai te Kai

Got Water?/He Wai?

Lung Cancer/Matepukupuku Pūkahukahu

Melanoma/Tonapuku

Prostate Cancer/Matepukupuku Repe Ure

Radiation Treatment/Haumanu Iraruke

Secondary Breast Cancer/Matepukupuku Tuarua ā–Ū

Sexuality and Cancer/Hōkakatanga me te Matepukupuku

Understanding Grief/Te Mate Pāmamae

What Do I Tell the Children?/He Aha He Kōrero Maku Ki Āku Tamariki?

Brochures

Being Active When You Have Cancer

Talking to a Friend With Cancer

When Someone Has Cancer

When You Have Cancer

How common is breast cancer?

Breast cancer is the most common cancer in New Zealand women. Approximately 2300 women are diagnosed each year. Breast cancer can occur at any age but is most common in women between the ages of 50–70 years.

Although it is very unusual, men can develop breast cancer (approximately 1% of all breast cancer).

Pēhea te hōrapa o te matepukupuku o nga ū?

Ko te matepukupuku o ngā ū te matepukupuku nui rawa ka pā ki ngā wāhine o Aotearoa. Āwhiwhiwhi e 2300 ngā wahine ka tohungia ia tau mō tēnei mate. Ka pā te mate nei ki te wahine ahakoa he aha te pakeke; heoi, ka kaha rawa te tipu i ngā wāhine e 50–70 tau te pakeke.

Ruarua noa ngā tāne ka pāngia i te matepukupuku o ngā ū (āwhiwhiwhi 1% o ngā matepukupuku o ngā ū).

What causes breast cancer?

The causes of breast cancer are not clear, so there is no certain way to prevent it. There are some clues, or risk factors, about who is more likely to develop the disease. The most important are:

• age – a woman’s chances of developing breast cancer increase as she gets older

• previous breast cancer

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• atypical hyperplasia can be seen in breast biopsy

• a family history of breast cancer.

Women with a family history of breast cancer may have an increased risk of getting breast cancer. The risk can be mild, moderate, or high and depends on the number of relatives affected, whether they are first or second degree relatives, and the age of the relative(s) when their breast cancer was found. However, even among women with a high risk, most will not develop breast cancer. Those with a very strong family history of breast cancer who are shown to have inherited one of the abnormal genes associated with breast cancer have an increased risk. Most women who develop breast cancer have no family history of the disease.

Nā te aha te matepukupuku o ngā ū?

Kāore i te mārama ngā takenga o te matepukupuku o ngā ū, nā reira, kāore he tikanga kaupare pai rawa atu. Heoi, kei te mārama ētahi o ngā āhuatanga me ngā tūponotanga mō te tipu o te mate nei, arā:

• te pakeketanga – ka pakeke haere te wahine, ka nui atu te tūponotanga ka tipu te matepukupuku o ngā ū

• te pānga o te matepukupuku o ngā ū i mua

• ka tohu he unuhanga o ngā ū ki ētahi rerekētanga, pērā i te atypical hyperplasia

• kua pā kē te matepukupuku o ngā ū ki te whānau.

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Mehemea kua pā kē te matepukupuku o ngā ū ki te whānau, ka nui atu te tūponotanga tērā ka pā anō te mate ki tētahi o ngā wāhine o taua whānau. Kei runga te tūpono pā mai o te matepukupuku o ngā ū i te tokomaha o te whānau kua pāngia kētia i te mate, te pā tata o ngā uri kua pāngia i te mate, tae atu ki te pakeke o aua whanaunga i te wā tuatahi ka hurahia te mate.

Kāore te matepukupuku o ngā ū e pā ki te nuinga o ngā wāhine, ahakoa pēhea te nui o te tūponotanga o te pānga o te mate. He nui te tūponotanga ki ngā whānau kua pāngia kahangia e te matepukupuku o ngā ū, i ahu mai i ngā pūtau hē. Kāore i pā te matepukupuku o ngā ū ki ngā whānau o te nuinga o ngā wāhine kua pāngia ki te matepukupuku o ngā ū.

Symptoms

Breasts undergo changes throughout a woman’s life, particularly the normal changes experienced during the menstrual cycle.

Some breast changes may be early signs of breast cancer, including:

• a lump or lumpiness

• thickening of the tissue

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• nipple changes; for example a blood stained discharge from one nipple, an inverted nipple (unless the nipple has always been turned in) and a rash on a nipple

• skin dimpling

• a change in shape

• a painful area

• a rash or red marks which appear only on the breast.

Although these changes do not necessarily mean you have breast cancer, any breast change should be checked by a doctor.

If you have a change in your breast, you may have several tests. Your general practitioner may arrange these tests or you may be referred directly to a breast specialist.

Ngā tohumate

Ka panoni ngā ū puta noa i te koiora o te wahine, tae atu ki ngā panonitanga i te wā ka heke ōna toto.

Tērā pea ka tohu ngā panonitanga ki ngā ū ki te tipu haere o te matepukupuku o ngā ū pērā i:

• te pupuketanga ki te tinana

• te mātotoru haere o ngā ū

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• te panoni o ngā kōmata, hei tauira, te rere o te toto i tētahi o ngā ū; he kōmata kua huri kōaro (i kō atu i ngā kōmata he pērā te āhua mai anō)

• te komekome o te kiri

• te rerekē o te āhua

• te mamae tētahi wāhi

• te whero o ngā ū anake.

Ehara i te mea he tohu ēnei kua pāngia koe i te matepukupuku o ngā ū; heoi, haere kia tirohia e te tākuta.

Mehemea kua rerekē te āhua o ō ū, tērā pea ka whakahaerehia ētahi whakamātautau. Mā tō rata ake ēnei whakamātautau hei whakarite, mā te mātanga ū rānei.

Physical examination

The doctor will take your medical history and examine your breasts.

Diagnostic imaging

A mammogram is a breast X-ray. It will give your doctor more information about any lump or other change noticed. Occasionally, a lump that can be felt is not seen on a mammogram. Such a lump should not be ignored. Other tests will need to be done.

An ultrasound is a test using high frequency sound waves to help detect lumps or other changes.

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An MRI scan is a scan that uses magnetic resonance to detect abnormalities in the breast. This type of scan is sometimes used in lobular carcinomas to make sure there is not more than one cancer present, and it can check the other breast as well. It can also be used to check the breast if a mammogram is negative but the specialist is concerned about the lump or changes in the breast.

Fine needle aspiration

A fine needle aspiration can be done in your specialist’s rooms, in a hospital outpatient department, or at a laboratory by a pathologist. A very narrow needle is used to take some cells from the lump. These cells are then sent to a laboratory for examination. A fine needle aspiration may cause a little discomfort but is not usually any more painful than a blood test. Results from this test may be available immediately or take some time, depending upon where it is done.

Biopsy

Often a biopsy will be necessary. A biopsy is the removal of a sample of a lump or the entire lump for examination under a microscope.

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Unuhanga (Biopsy)

He wā anō ka unu. Ko te tikanga o te unu ka tangohia he wāhanga, te katoa rānei o te pupuketanga kia āta mātaitia.

Further tests

If the lump is a cancer, hormone tests will be done using immuno-histochemistry (IHC) on the sample that was removed. These tests show whether the cancer cells have special ‘markers’ on them called hormone receptors (oestrogen/progesterone). If these markers are present, the cancer is described as ‘hormone receptor positive’, and the cancer is more likely to respond to hormone treatment if this is needed later.

Staging breast cancer

Staging is a process of assessing the extent of a tumour. Other tests may also be necessary if cancer is diagnosed. These include blood tests and a chest X-ray.

In some situations a bone scan and a liver scan may be done.

The complete results from the biopsy and any further tests will help to determine the best treatment for you.

With this information your doctors will know if you have an early breast cancer, locally advanced breast cancer, or metastatic (secondary) breast cancer.

Tātari te matepukupuku o ngā ū kia kite kua pēhea te hōrapa

Mā ngā putanga o te unuhanga me ētahi atu whakamātautau e tohu ko tēhea te huarahi whakaoranga ka tika mōu.

Whāia, ka mārama ō rata mehemea kua pāngia koe i te matepukupuku tōmua o ngā ū rānei, te matepukupuku o ngā ū rānei, te matepukupuku tuarua o ngā ū (metastatic) rānei.

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The following table sets out the breast cancer stages.

Stages of breast cancer

Specialists would treat Stages 1 and 2 and early Stage 3 in the same way: an operation, or operation plus radiation, then possibly, systemic therapy, i.e. chemotherapy, hormone therapy, or monoclonal therapy, according to the individual woman’s cancer.

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TNM is an international staging system.

T = tumour (numbered 1 – 4 to indicate the size and extent of the tumour).

N = node (whether or not lymph nodes are affected by cancer).

M = metastases (the spread of cancer from the breast to other parts of the body).

Grading breast cancer

The pathologist (the doctor who looks at cancers in the laboratory) ‘grades’ the cancer according to the way the cancer cells look and behave. The grades are numbered from 1 to 3.

The cells of a Grade 1 breast cancer look more like normal breast cells whereas the cells of a Grade 3 breast cancer look very abnormal, indicating a faster growing cancer.

Before any treatment begins, make sure that you have discussed the choices with your doctor. Your doctor may advise that one method of treatment is better than another. The treatment choices you are offered will be based on all the information the doctor has about your cancer. These include:

• the size of the cancer

• the grade of the tumour (how the cancer looks under the microscope. Aggressive cancers have a special appearance that tells doctors they are more likely to spread.)

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• the number of lymph nodes under your arm that contain cancer cells

• whether the cancer was growing into the blood or lymphatic vessels. (This is described as lymphatic vascular invasion [LVI].)

• whether the cancer cells have hormone receptors (oestrogen/progesterone) on them

• whether there were cancer cells present at the edges of the tissue removed (also called positive margins)

• HER2 receptor status (see page 18).

Breast cancer is treated by several different methods: surgery, radiation treatment, chemotherapy, and hormone treatment.

You may find it useful to have your husband, partner, or a friend with you when you talk to the doctor. You may also find it helpful to make a list of questions before your visit (refer to the list of questions at the end of this booklet and take notes during your discussion).

Make sure you understand the reasons for your doctor’s advice. Ask for a second opinion if you want one.

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Whakaoranga

Ehara i te mea kotahi anake te tikanga whakaoranga: hāparapara, haumanu iraruke, hahau, taiaki.

Ka whakataungia ko tēhea te whakaoranga tika, mēnā kotahi te momo whakaoranga, e rua rānei, neke atu rānei i runga i te:

• matepukupuku ake: te momo, te taumata, te korahi, mehemea kua hōrapa (kei tēhea taumata te mate)

• wahine ake: tona pakeke, tona hauora whānui, āna ake whiringa.

He painga pea kia whai tō tāne, tō hoa rangatira rānei, tētahi o ō hoa rānei i a koe kia kōrero ki te rata. Tērā pea ka whakaaro koe mō ētahi pātai i mua i tō haerenga (titiro ki ngā pātai kei te paunga o te puka nei; tango tuhituhinga i te wā o te kōrero me te rata).

Kia mārama koe ki te roanga atu o ngā kōrero a tō tākuta. Ki te hiahia koe, me tono ki tētahi atu rata he aha ōna whakaaro.

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The treatment team

From the time that you are first diagnosed with breast cancer you will be cared for by one or more of a team of health professionals including:

• your family doctor, who will often be the first person you see

• a breast surgeon who specialises in breast diseases, and sometimes a (plastic) reconstructive surgeon

• a pathologist, a doctor who diagnoses disease by studying cells and tissues under a microscope

• a radiation oncologist, a doctor who specialises in the use of radiation in the treatment of cancer

• a medical oncologist, a doctor who specialises in the use of drug treatments for cancer

• a radiation therapist, who prepares you and gives you your radiation treatment

• oncology nurses and breast care nurses, who will help you through all stages of your cancer experience

• dietitians, who will recommend the most suitable foods to eat

• social workers, physiotherapists, and occupational therapists, who will advise you on the support services available, and help you get back to normal activities.

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Ideally, your hospital should have all available means of diagnosis and treatment, although this will not be the case in some areas.

Surgery

The first treatment for breast cancer is usually surgery. This includes surgery on the breast and, for most women, on the glands in the armpit (the axillary lymph nodes). Examination of the cancer and the lymph glands by the pathologist will indicate whether further treatment should be considered after the surgery.

The aim of surgery is to remove all of the cancer. The type of surgery depends on a number of factors including the size of the cancer, the size of the breast, the position of the cancer in the breast, and the patient’s choice. Surgery may be by removing the cancer and a rim of breast tissue around it (wide local excision) or by removing the whole breast (mastectomy). At the same time some of the lymph glands in the armpit are also removed.

Hāparapara

Hei te nuinga o te wā, ko te hāparapara te huarahi whakaora tōmua mō te matepukupuku o ngā ū. Ka pā te hāparapara ki te ū, ka mutu, mō te nuinga o ngā wāhine, ka pā ki ngā repe i te kēkē hoki (tīpona waitinana kēkē). Waihoki, whai muri i te tātari a te pathologist i te matepukupuku me ngā repe waitinana, ka wānangatia mēnā ka haere tonu ngā mahi whakaora.

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Mastectomy

Mastectomy is the removal of the whole breast including some of the skin and the nipple. The chest muscles are not removed. Some lymph glands in the armpit are also removed during the operation.

Usually the lymph nodes are removed through the same incision during this operation. This is called axillary node clearance (or dissection).

Diagram:

Lymph node areas adjacent to breast area

Transcriber's Note: Six lymph node areas around the breast area are labelled on the diagram. The lymph node and the approximate location are described below.
A. Pectoralis major muscle – located behind the nipple area of the breast
B. Axillary lymph nodes: level I – located at the bottom of the armpit
C. Axillary lymph nodes: level II – located at the top of the armpit
D. Axillary lymph nodes: level III – located at the top of the breast near the collar bone
E. Supraclavicular lymph nodes – located above the collar bone near the centre of the neck.
F. Internal mammary lymph nodes – located near the sternum in the centre of the chest.
End of Note.
End of Diagram.

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Mastectomy is less disfiguring than the radical mastectomy of the past. The new type of mastectomy performed today allows for easier breast reconstruction. After mastectomy, most women will have a horizontal scar across their chest. Breast reconstruction can be performed for women undergoing mastectomy. This can be done at the same time as mastectomy (immediate reconstruction) or after all the treatments for the cancer are completed as a separate operation (delayed reconstruction).

Diagram:
Transcriber's Note: Two-step diagram.
Step 1: Picture of a woman with the lymph nodes under her armpit labelled "removal of lymph nodes", and her breast labelled "removal of breast".
Step 2: The woman's breast and nipple are gone, and a horizontal scar exists in its place. The scar is labelled "scar after mastectomy".
End of Note.
End of Diagram.

Breast-conserving treatment

For many women it is now possible to have smaller operations, such as partial mastectomy (or wide local excision). A breast-conserving operation involves removing the breast lump with some surrounding normal breast tissue to ensure a good clearance. Surgery is then followed by radiation treatment to the remaining part of the breast – this is usually six to eight weeks after surgery.

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This makes sure that any cancer cells that may still be present in the breast are treated and significantly reduces the risk of cancer recurring in the remaining breast tissue.

Diagram:

Breast-conserving treatment

Transcriber's Note: Two-step diagram.
Step 1: Picture of a woman with the lymph nodes under her armpit labelled "removal of lymph nodes", and her breast labelled "removal of breast tissue".
Step 2: The woman's breast and nipple remain much the same. There is a horizontal scar at the top of the breast and a scar in the armpit. The scars are labelled "scars after conserving surgery".
End of Note.
End of Diagram.

Lymph glands are also removed for examination in these smaller operations and this is often through a separate incision (cut) in the armpit.

Breast-conserving operations have been routinely performed now for many years. Studies show that both mastectomy and breast-conserving operations with radiation treatment are equally effective in the treatment of early breast cancer. However, breast-conserving surgery is not suitable for every woman with breast cancer.

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Sentinel node biopsy

Many New Zealand patients were involved in a study that the Australian and New Zealand College of Surgeons undertook to find out the accuracy of sentinel node sampling in detecting the spread of breast cancer, and the procedure’s safety. During this study, many New Zealand breast surgeons became skilled in the technique.

A sentinel node biopsy locates the first lymph node(s) that drains from the area where the breast cancer developed.

This node(s) is detected after injecting a blue dye and a radioactive tracer into the breast tissue where the cancer was found. The node(s) is then removed surgically so that the tissue can be examined. It is thought that removing this node(s) alone may avoid larger operations in the armpit and reduce the chance of arm swelling (lymphoedema) and other potential side effects, such as shoulder stiffness and nerve pain/numbness in the upper arm.

If the sentinel node is involved, under the same anaesthetic, the surgeon will proceed to remove the nodes below the pectoral minor muscle, usually 10-20 nodes. The higher lymph nodes in the armpit are not removed.

Extending the operation, to what was standard treatment before sentinel node biopsy, has a risk of lymphoedema of less than 5%.

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Unu tīpona sentinel

Mā te poka i te tīpona sentinel e tohu ko tēhea te tīpona waitinana tuatahi ka rere i te wāhi tīmata ai te matepukupuku o ngā ū.

Ka kitea tēnei tīpona mā te wero i te tae kikorangi me tētahi mātai iraruke ki te wāhi o te ū i kitea ai te matepukupuku. Ka tapahia te tīpona kia taea taua wāhi o te ū te tātari. Ko te whakapae, ka tangohia te tīpona kia kore ai e pokaina te kēkē, kia iti iho hoki te pupuhitanga (lymphoedema), kia kore ai e pā mai ētahi atu putanga kētanga pērā i te pā o te mamae ki te pakihiwi, te kōpā i te taha runga o te ringa.

Drainage after breast surgery

After your operation you will have one or two tubes (drains) coming from the area of your operation into small bags. These drain fluid, which if not drained can cause discomfort, delay wound healing, and may cause an infection. They are usually left in place for a few days. Some women are discharged with their drains in place. If this happens, your nurse will show you how to care for them at home and your doctor will make an appointment for you to have them removed at a later date. Removing the drains is quick and causes only mild discomfort. It can be done at the doctor’s rooms or at the outpatients’ clinic.

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Advantages and disadvantages of the surgical methods

While many women may want a breast-conserving operation, the choice between a mastectomy and a breast-conserving operation depends upon the size of the breast cancer and the size of the breast.

It is helpful to weigh up the advantages and disadvantages of each method for yourself.

The main advantage of the smaller operation is that the breast is saved. However, a disadvantage is that further treatment with radiation treatment is almost always needed. This can take up to six weeks. In the future, some patients with small tumours may be candidates for partial breast irradiation given on only one to five days. This treatment is still under investigation but may become a more common practice in the future. Following radiation treatment, the breast may feel different.

Small-breasted women may also find that the smaller operation still leaves them with a big change in their breast shape and a potentially poor cosmetic result.

An advantage of mastectomy is that radiation treatment may not be needed. However, in some cases if the tumour is large, close to the underlying muscle or if there are many involved lymph nodes, radiation treatment is still recommended to reduce the risk of cancer recurring.

The main disadvantage of mastectomy is the loss of the breast.

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Reconstruction is possible and can be carried out at the time of the mastectomy or in the future. In some small-breasted women mastectomy and reconstruction will give a better cosmetic result than breast-conserving surgery.

Radiation treatment

This is the use of radiation (rays of energy called photons or little particles called electrons) to destroy cancer cells, usually using a machine called a Linear Accelerator. You will see a radiation oncologist who will discuss this treatment with you.

Treatment is carefully planned to reduce any effect on normal cells. This usually requires a visit for simulation or a planning CT scan to work out the position you will lie in for treatment and to plan your treatment on a computer.

Treatment is given four to five days a week over about four to five weeks. It is painless and only takes a few minutes for each treatment.

An extra radiation ‘boost dose’ may be given to the area where the breast cancer was located, taking the overall treatment time up to five to six weeks.

Partial breast irradiation is currently being investigated as an alternative to whole breast irradiation in certain patients.

Sometimes radiation is given after mastectomy and axillary surgery to reduce the likelihood of developing recurrence in/over the chest wall or in the axillary or supraclavicular (above the collar bone) lymph nodes. This decision is usually made once the results of the surgery are available and the risks for recurrence in these sites have been assessed.

Radiation may also be used for the treatment of recurrence or cancers that cannot be removed, either in the area of the breast or in other parts of the breast. The aim is to try to control the disease or reduce symptoms. This usually requires fewer visits.

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Haumanu iraruke

Ko tā tēnei, he nanao ki te iraruke (he hihi pūngao kīia ai he photon) hei patu i ngā pūtau matepukupuku, mā te whakamahi i tētahi mīhini kīia ai he Linear Accelerator. Ka kōrero tētahi kaimātai matepukupuku iraruke ki a koe mō tēnei huarahi.

Ka āta whakatakotoria te huarahi whakaoranga, kei kaha rawa te pānga o te iraruke ki ngā pūtau noa. Me haere koe kia whakangungu i tēnei tikanga, kia tātaria koe mā te CT, kia kitea ko tēhea te takotoranga pai mōu, kia takoto te mahere whakaora ki runga rorohiko.

Ka haere ngā mahi whakaora mō ngā rā e whā e rima i te wiki, mō ngā wiki e whā e rima. Kāore e rongohia te mamae, ka mutu, kāore e pau ētahi meneti kua mutu te whakaoranga kotahi.

Ka whakamahia anōtia te iraruke mō ngā matepukupuku ka hoki mai, mō ngā matepukupuku hoki e kore e tareka te tango, ki tō rohe, ki tawhiti rānei. Ko te whāinga, kia tāmia te mate, kia pēhia rānei te mamae. Kāore e rahi ngā noho mō tēnei whakaoranga.

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Chemotherapy

This is the treatment of cancer by drugs. The aim is to destroy cancer cells while having the least possible effect on normal cells. The drugs are usually given intravenously via a drip and, therefore, circulate around the body. Chemotherapy is a systemic treatment (treating the whole body) compared with surgery and radiation treatment, which are local treatments to a specific area in the body (breast, chestwall, axilla, etc).

There are different regimens or combinations of drugs used in breast cancer. Most will contain an anthracycline drug, for example, doxorubicin (Adriamycin). If there is a greater risk of spread and, therefore, greater benefit from chemotherapy, taxanes, for example docetaxel (Taxotere), may be used.

Treatment is often in cycles at three-weekly intervals, and may last for six cycles (nearly six months). A medical oncologist will discuss all aspects of the treatment with you.

Chemotherapy is offered to some women with early breast cancer as an additional treatment to surgery, radiation treatment, or both. This is called adjuvant chemotherapy. Adjuvant chemotherapy aims to destroy cancer cells that remain in the body but which cannot be detected. The purpose of this treatment is to reduce the chance of the breast cancer coming back (known as a recurrence).

Radiation treatment, if it is necessary, comes after chemotherapy, starting about four weeks after the last cycle of chemotherapy. Hormone therapy, if recommended, comes after the radiation treatment.

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The women who are most likely to benefit from chemotherapy are those in whom the lymph glands in the armpit do have cancer cells. There is also a benefit from chemotherapy in women who do not have spread into armpit glands, but have more aggressive cancers (Grade 3 and oestrogen receptor negative). Women who are HER2 positive will benefit greatly from chemotherapy.

Women with large tumours or a type of cancer called inflammatory breast cancer may be offered chemotherapy pre-surgery. This is called neo-adjuvant chemotherapy.

Hahau

He patu i te matepukupuku mā te rongoā te tikanga o tēnei huarahi whakaoranga, tae atu ki te tiaki i ngā pūtau noa. Ka kuhuna te rongoā mā te ia auraki kia huri āmio i te tinana. He rerekē te whakaoranga hahau ki te whakaoranga haumanu iraruke; kapi katoa ai te tinana i te hahau, hāunga te haumanu iraruke, ka arotahi ki tētahi wāhi ake o te tinana (uma, poho, kēkē, aha atu). He maha ngā whenumitanga o ngā rongoā i te matepukupuku o ngā ū. He anthracycline kei roto i te nuinga o ngā rongoa. Ki te nui atu te tūponotanga o te hora o te mate, he nui atu te painga ka hua i ngā whakaoranga hahau, ka āhei te nanao ki ngā momo taxanes.

E toru wiki te roa o ngā rāuna whakaoranga, ā, e ono pea ngā rāuna (tata ki te ono marama). Ka kōrero te kaimātai matepukupuku i ngā āhuatanga katoa o tēnei huarahi whakaornga.

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Monoclonal antibodies

Monoclonal antibodies are drugs that recognise and bind to specific proteins (receptors) that are found in particular cancer cells or in the blood stream.

Trastuzumab (Herceptin) is given intravenously once every week or three weeks, and is usually well tolerated.

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It may cause some impairment of heart pumping function, especially when used with a chemotherapy drug which affects the heart. A heart echo test will be done every 12 weeks to check this. (For more information see page 18.)

Monoclonal antibodies

Ko ēnei rongoā ko ngā monoclonal antibodies, ka mōhio kia piri ki ngā pūmua ka kitea i ētahi pūtau matepukupuku, i te ia toto rānei.

Hormone treatments

Many breast cancers appear to be influenced by the female hormones, oestrogen and progesterone.

Pre-menopausal women may be offered tamoxifen, a hormone treatment taken as a tablet. They may also have menopause induced to stop their own production of hormones. This can be done by four-weekly injections with goserelin (Zoladex) or by surgical removal (laparoscopic oophorectomy) of the ovaries. Once you stop taking goserelin your periods will usually return.

Post-menopausal women may be offered oral hormone treatments – either tamoxifen or aromatase inhibitors anastrozole (Arimidex) or letrozole (Femara), which reduce the production of hormones in the body (other than from the ovaries).

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Whakaoranga taiaki

Te āhua nei he pānga tō ngā taiaki wahine, oestrogen me te progesterone ki runga i te maha o ngā momo matepukupuku.

Ka tāpaea te tamoxifen – he whakaoranga taiaki ka kainga pēnei i te pire – mā ngā wāhine kei te rere tonu ō rātou toto. Tērā pea ka katia te rere o te toto kia kore ai te tinana e hanga taiaki. Ka tareka tēnei mā ngā werohanga o te Zoladex (goserelin) ia whā wiki, mā te pokanga (laparoscopic oophorectomy) o ngā kiato kākano. Hei te nuinga o te wā, mutu ana tō kai i te goserelin ka rere anō ō toto.

Ka tāpaea ngā rongoā taiaki ā-waha – tamoxifen, aromatase (ka pēhi), te anastrozole (Arimidex), letrozole (Femara) – ka tāmi i te hanga a te tinana i te taiaki ki ētahi atu pito o te tinana (i tua atu i ngā kiato kākano).

Talking with doctors

You may want to see your doctor a few times before making a final decision on treatment. It is often difficult to take everything in, and you may need to ask the same questions more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it.

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Before you see the doctor, it may help to write down your questions. There is a list of questions at the end of this booklet, which may help you. Taking notes during the session can also help. You may find it helpful to take a family member or friend with you, to take part in the discussion, take notes, or simply listen. Some people find it is helpful to tape record the discussion.

Te kōrero me tō rata

Tērā ka hiahia kōrero koe ki tō rata i mua i te whakatau ko hea te huarahi whakaora pai mōu. Me uaua ka tarea e koe ngā kōrero katoa, hei ētahi wā me tuarua, tuatoru ō pātai. Kei a koe te tika kia rapu he aha ngā putanga o tētahi whakaoranga mōu ake, ā, kei a koe te tika ki te kaupare i te whakaoranga ahakoa he aha taua momo whakaoranga.

Talking with others

Once you have discussed treatment options with your doctor, you may want to talk them over with someone else, such as family or friends; specialist nurses; your family doctor; the Cancer Society; the hospital social worker or chaplain; your own religious or spiritual adviser; or another person who has had an experience of breast cancer.

Talking it over can help you to sort out what course of action is right for you.

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Te kōrero ki ētahi atu

Ina oti ō whitiwhitinga kōrero me tō rata, tērā ka pīrangi kōrero koe ki ētahi atu pērā i tō whānau, ō hoa, ngā tapuhi, te rata o tō whānau, te Kāhui Matepukupuku te minita te kaimahi hapori rānei i te hōhipera, tōu ake minita, pirihi, pīhopa, aha atu, tētahi atu wahine rānei kua pāngia i te matepukupuku o ngā ū.

A second opinion

You may want to ask for a second opinion from another specialist. Your specialist or general practitioner can refer you to another specialist and you can ask for your records to be sent to the second doctor.

You may be interested in looking for information about breast cancer on the internet. While there are very good websites, you need to be aware that some websites provide wrong or biased information.

We recommend that you begin with the Cancer Society’s site (www.cancernz.org.nz) and use our links to other good cancer websites.

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Taking part in a clinical trial

Research into the causes of breast cancer and into ways to prevent, detect, and treat it is continuing. Your doctor may suggest that you consider taking part in a clinical trial.

Clinical trials are a vital part of the search to find better treatments for cancer, and are conducted to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. However, the decision to take part in a clinical trial is always yours.

If you are asked to take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for your treatment. Before deciding whether or not to join the trial, you may wish to ask your doctor:

• Which treatments are being tested and why?

• What tests are involved?

• What are the possible risks or side effects?

• How long will the trial last?

• Will I need to go into hospital for treatment?

• What will I do if any problems occur?

• If the treatment I receive on the trial is successful for my cancer, is there a possibility of carrying on with the treatment after the trial?

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You will be chosen at random to receive one treatment or the trial treatment, but either treatment will be appropriate for your condition. In clinical trials, people’s health and progress are carefully monitored.

If you join a clinical trial, you have the right to withdraw at any time. Doing so will not jeopardise your treatment.

Te whai wāhi ki te whakamātautau haumanu

Kei te haere tonu ngā rangahau mō te pūtake o te matepukupuku o ngā ū, tae atu ki ngā kauparetanga, ngā tūhuratanga, ngā whakaoranga hoki. Tērā pea ka tohutohu tō rata kia kuhu koe ki tētahi whakamātautau haumanu.

He waiwai ngā whakamātautau haumanu i te rapunga oranga i te matepukupuku. Whakahaerehia ai ngā whakamātautau haumanu ki te whakamātautau i ngā whakaoranga hōu me ngā whakaoranga kua whakapanoni ki te aha, ki te rapu mēnā he pai atu ēnei momo whakaoranga i ngā whakaoranga kei te mahia i ēnei rā. Ka hia tāngata puta i te ao kua whai wāhi ki ngā whakamātautau haumanu, me te aha, kua pai atu ngā whakaoranga i te matepukupuku. Heoi, kei a koe te tikanga kia kuhu ki tētahi whakamātautau haumanu kāore rānei.

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Arm care

Following your surgery, it may take some time to regain the full use of your arm. Your physiotherapist or breast care nurse will give you instructions for exercises.

You may be concerned that your arm will swell after your lymph glands have been removed. This is much less common today because of the better methods of surgery and radiation

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treatment. However, a few women will still develop problems with arm swelling (called lymphoedema). To reduce the risk of this happening, you should try to avoid injury or infection to your arm or hand.

Some simple measures will help:

• Wear gardening gloves when gardening, an oven glove when handling hot dishes, and use a thimble for sewing. If you’re out in the sun, protect your arm from sunburn by wearing a long-sleeved shirt. Use a good sunscreen (SPF30+) on uncovered areas.

• Get help with heavy jobs like moving furniture or carrying heavy luggage, handbags, and avoid using heavy backpacks for any length of time.

• It is suggested that it may be beneficial to wear a support sleeve when flying.

• If it can be avoided, don’t have your blood pressure or blood taken from that arm. Avoid having an intravenous drip in that arm and ask that any injections, including acupuncture or anaesthetics, be given elsewhere.

• If you have a cut, clean it well and use an antiseptic dressing. See your doctor quickly if you think it is infected.

• Be aware of swelling in the arms at any point in the future. Contact your doctor if this occurs.

Lymphoedema therapists and physiotherapists can also advise about the need to wear a support sleeve if swelling occurs.

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Te tiaki i tō ringa

Whai muri i te hāparapara ka roa te wā kātahi anō ka hoki mai te kaha ki tō ringa. Ka āwhina koe e te kairomiromi, e te tapuhi tiaki ū rānei ki ngā korikori tinana.

Tērā pea kei te āwangawanga koe kei pupuhi tō ringa i te tangohanga o ngā repe waitinana. Kāore e tino pā mai tēnei mate i ēnei rā, nā te pai o ngā hāparapara me te haumanu iraruke. Heoi, ka pā tonu tēnei mate pupuhi ki ngā ringa o ētahi wāhine tokoiti noa (kīia ai he lymphoedema). Me āta tiaki tō ringa kia kore ai tēnei mate e pā ki tō ringa.

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Breast forms

If you have had a mastectomy it’s important to know about a breast form (prosthesis). A breast form can give a good cosmetic appearance as well as helping your balance and posture.

Many women choose to use a breast form although some women prefer not to. Breast forms are also available for women who have had lesser surgery (partial mastectomy). Immediately after surgery, temporary prostheses are available from your local Cancer Society or breast care nurse.

About six weeks post-operatively, you may choose to wear a permanent prosthesis.

You are entitled to a benefit for a permanent breast form. Ask your surgeon or breast care nurse for a medical certificate of entitlement.

Hanga ū

Mehemea kua oti te poka ū i a koe, he mea nui kia mōhio koe mō te hanga ū (kīia ai he prosthesis). He āwhina i te hanga ū kia pai ai tō āhua, kia pai ai hoki tō tū.

Ka taea te tono i tētahi penihana mō tētahi hanga ū tūturu. Me tono ki tō rata, ki tō tapuhi tiaki ū rānei mō tētahi tiwhikete e āhei ana koe te tono.

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Reconstruction

After a mastectomy your breast can be reconstructed either immediately or at a later date. A surgeon’s decision about which method of reconstruction to recommend is based on many different factors. Reconstruction should be discussed fully with your specialist and you may be referred to a plastic (or reconstructive) surgeon. Many women do not wish to have a reconstruction. Speaking with a breast care nurse or with a woman who has had a reconstruction may be helpful. Information is available from your local Cancer Society or call the Cancer Information Helpline 0800 CANCER (226 237).

Possibility of recurrence

Sometimes, breast cancer can come back (known as a recurrence).

Most recurrences appear within five years after the initial treatment. Regular check-ups are necessary during this period. You should also regularly examine your remaining breast and mastectomy area and report any unusual breast symptoms or general symptoms to your doctor. You will need a yearly mammogram.

Treatment of recurrent breast cancer may be by surgery, radiation treatment, chemotherapy, hormone treatment (refer to pages 41 to 43) or Herceptin (refer to page 18) or combinations of these. It aims to control the disease.

Successful treatment of recurrent breast cancer will allow many women to continue leading normal lives.

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A specific book Secondary Breast Cancer/Matepukupuku Tuarua ā-Ū is available from your local Cancer Society, or by phoning the Cancer Information Helpline 0800 CANCER (226 237).

Emotional support

Women react in different ways when they learn they have breast cancer. Feelings can be muddled and change quickly. This is quite normal and there is no right or wrong way to feel.

Some women may have particular concerns – they may be worried about the change in their appearance after surgery and how it will affect their lives and relationships. Younger women may be worried about fertility, pregnancy, and breast feeding following treatment (this should be discussed with your specialist). Other women may feel that they are not getting enough personal support to help them deal with their illness.

It may be helpful to talk about your feelings with your partner, family members, friends or with a breast care nurse, your local Cancer Society, counsellor, social worker, psychologist, or your religious/spiritual adviser. Talking to other women with breast cancer may also help.

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Sometimes you may find your friends and family do not know what to say to you: they may have difficulty with their feelings as well. Some people may feel so uncomfortable they avoid you. They may expect you to lead the way and tell them what you need.

You may prefer to ask a close family member or friend to talk to other people for you.

Anyone you tell needs time to take it in and to come back with his or her questions and fears – just like you. You can help them to adjust, just as they can help you. But remember that while you are having treatment your needs should come first. If you do not feel like talking, or you cannot cope with any more visitors, say so. If there are practical things they can do to help – let them know. Some friends are better at doing something practical to help than they are at sitting and talking. Everyone is different, and some may find it so difficult that they stop visiting for a while.

Breast cancer and its modern treatment is a huge life journey.

At the beginning there is the enormity of coping with a cancer diagnosis and the initial uncertainty about what care plan is best for you. This is because your oncologist cannot advise you specifically about your best choices until the pathologist has reported on your lump or breast tissue, the lymph glands, and receptors.

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Your oncologist bases recommendations on the size of the cancer; how abnormal it is (its grade); whether it has been completely removed; whether the lymph nodes have cancer in them or not (and if so how many lymph nodes were involved); and whether the cancer had oestrogen (ER) and progesterone (PR) receptors and whether the HER2 receptor is positive.

That visit to discuss the pathology report is a huge step and you need to always attend with support people. Many women cope well with the first part of chemotherapy, but the ‘relentlessness’ of the programme means that by the end of chemotherapy, many women are ‘tired’ of the journey.

Interestingly, it is often after the initial (and hopefully) only treatment is finished that the full impact of the breast cancer diagnosis, and its treatment, ‘hits home’. Many women feel vulnerable at this time. The family and friends may have ‘moved on’, but you as a woman, ‘are forever changed’.

There may be an impact on relationships, sexuality, and the ability to work.

This ‘vulnerable phase’ may last 6-12 months. The first mammogram is often ‘a hurdle’ as is the anniversary date of the diagnosis, etc.

Your oncology team understands the impact of this journey and can help more if you are open and tell them of your emotional and coping concerns. For details of additional support services available phone the Cancer Information Helpline 0800 CANCER (226 237).

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Ngā tautoko o te ngākau

He rerekē te urupare a tēnā wahine a tēnā wahine ki te pānga o te matepukupuku o ngā ū. Ka hurihuri ngā whakaaro, piki, heke. Ehara i te mea kei te hē ēnei hurihuringa, kāore e tareka te kī kei te tika tēnei, kei te hē tēnā.

Kāore e kore he āwangawanga ake ā ētahi wāhine mō te rerekē o ā rātou āhua whai muri i te hāparapara, tae atu ki te pānga ki ō rātou koiora me ō rātou hononga. Tērā pea ka āwangawanga ngā wāhine tamariki whai muri i te hāparapara mō ō rātou whare tangata, te hapūtanga, me te whāngai i te tamaiti ki te waiū (me kōrero koe ki tō rata matepukupuku). Tērā pea kei te whakapae ētahi atu wāhine kāore rātou i te whiwhi āwhina e tika ana e puta ai rātou i ō rātou mate.

He painga pea kia kōrero koe ki tō hoa tata, tō whānau, ō hoa, te tapuhi tiaki ū, he kaitakawaenga, he tauwhiro, te kaimātai hinengaro, tae atu ki tō kaiāwhina i te taha wairua.

Tērā pea kāore ō hoa, tō whānau rānei i te mārama me pēhea te kōrero ki a koe, he pōuri nō rātou. Ko ētahi tāngata, nā te kaha mataku, ka karokaro haere i a koe. Kei te tatari pea rātou mōu ki te ārahi i a rātou, ki te whāki atu he aha ō hiahia.

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Tērā pea ka hiahia koe ko tētahi o tō whānau, ko tētahi hoa rānei e tū hei kaikōrero mōu.

Ahakoa ko wai te tangata ka kōrero koe, me tuku he wā mōna ki te whakaaro mō tēnei take; tērā pea ka hoki mai a ia me āna pātai, āna māharahara, pērā i a koe nā. Kia maumahara i te wā o tō whakaoranga me aro koe ki a koe anō i te tuatahi. Ki te kore koe pīrangi kōrero ki ētahi tāngata, kāore koe e pīrangi ki ētahi manuhiri, kōrerotia. Mēnā ka taea he āwhina i ētahi atu tāngata – kōrerotia. He pai atu ētahi hoa ki ngā mahi, tērā ki te noho ki te kōrero me koe. He rerekē tēnā tangata, tēnā tangata; nā te kaha wehi, kāore ētahi tāngata e puta ake kia kite i a koe mō tētahi wā.

Pāronga a Te Kāhui Matepukupuku o Aotearoa me ngā ratonga tautoko

He ratonga te Cancer Information Service nā te Kāhui Matepukupuku; ka taea te noho me te kōrero i ō āwangawanga ki ētahi tapuhi matatau ki tō mate. Waea atu ki te Rōpū Matepukupuku i tō rohe ka kōrero ki ngā kaimahi, waea rānei ki Waeaāwhina Pārongo Matepukupuku 0800 CANCER (236 237).

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Kei ngā Te Kāhui Matepukupuku i ngā rohe ngā ratonga āwhina mō te hunga kua pāngia i te matepukupuku o ngā ū me ō rātou whānau. Ko ētahi o ēnei āwhina ko:

• ngā kaitaraiwa hei hari i a koe ki ngā mahi whakaoranga

• ngā wāhi noho

• ngā rōpū tautoko me ngā rōpū ako

• e tūtaki ki ētahi atu wāhine kua pāngia i te matepukupuku o ngā ū

• te awheawhe Look Good...Feel Better. Whakapā ki te Kāhui Matepukupuku tata ki a koe mō tēnei kaupapa.

He rerekē ngā ratonga i tēnā rohe, i tēnā rohe, nā reira pātai ki te pokapū i tō rohe he aha ā rātou ratonga.

Talking with your children

How much you tell children will obviously depend on how old they are. Young children need to know that your illness is not their fault. They also need to know that you may have to go into hospital. Slightly older children can probably understand a simple explanation of what is wrong. Adolescent children can obviously understand much more. All children need to know what will happen to them while you are in hospital, who will look after them, and how their daily life will be affected.

Sometimes children rebel or become quiet. Keep an eye on them or get someone else to and get help if you need it; for example, from the school counsellor or a hospital social worker.

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For a copy of the booklet What Do I Tell The Children?/ He Aha He Kōrero Māku Ki Āku Tamariki? contact your local Cancer Society by phoning the Cancer Information Helpline 0800 CANCER (226 237) or download it from our website at www.cancernz.org.nz.

Cancer Society volunteer, information, and support services

Local Cancer Societies provide confidential information and support.

The Cancer Information Helpline is a Cancer Society service where you can talk about your concerns and needs with specially trained nurses. Call your local Cancer Society and speak to support services staff or phone the Cancer Information Helpline 0800 CANCER (226 237).

Local Cancer Society centres offer a range of support services for people with breast cancer and their families. These may include:

• volunteer drivers providing transport to treatment

• accommodation

• support and education groups

• contact with other women who have had breast cancer

• the Look Good...Feel Better workshop. Contact your local Cancer Society about attending this workshop.

The range of services offered differs in each region so contact your local centre to find out what is available in your area.

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Cancer support groups

Cancer support groups offer mutual support and information to people with cancer and their families. It can help to talk to others who have gone through the same experience. Support groups can also offer many practical suggestions and ways of coping. Ask your hospital or local Cancer Society for information on cancer support groups in your area.

Breast care nurses

A breast care nurse may be available in your hospital to provide specialist support and guidance.

Financial assistance

Help may be available for transport and accommodation costs if you are required to travel some distance to your medical and treatment appointments. Your treatment centre or local Cancer Society can advise you about what sort of help is available.

Financial help may be available through your local Work and Income office. Work and Income has pamphlets and information about financial assistance for people who are unable to work. Short-term financial help is available through the Sickness Benefit and longer-term help is provided through the Invalids Benefit. Extra help may be available; for example, accommodation supplements and assistance with medical bills.

More information is available on the Ministry of Social Development’s website, www.msd.govt.nz or by phoning 0800 559 009.

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Home care

Nursing care is available at home through district nursing or your local hospital – your doctor or hospital can arrange this.

You may be entitled to assistance with household tasks during your treatment. For information on the availability of this assistance, contact your hospital social worker or the District Nursing Service at your local hospital.

Interpreting services

New Zealand’s Health and Disability Code states that everyone has the right to have an interpreter present during a medical consultation. Family or friends may assist if you and your doctor do not speak the same language, but you can also ask your doctor to provide an interpreter if using family members is inappropriate or not possible.

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Diet and food safety

A balanced nutritious diet will help to keep you as well as possible and cope with any side effects of treatment. The Cancer Society’s booklet called Eating Well/Kia Pai te Kai gives useful eating advice and recipes. Phone your local Cancer Society office for a copy of this booklet, call the Cancer Information Helpline 0800 CANCER (226 237), or download the booklet from our website at www.cancernz.org.nz. The hospital will also have a dietitian who can help.

Food safety is of special concern to cancer patients, especially during treatment, which may suppress immune function.

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To make food as safe as possible it is recommended that patients follow the guidelines below:

• Wash your hands thoroughly before eating.

• Keep all aspects of food preparation clean, including washing hands before preparing food and washing fruit and vegetables.

• Handle raw meat, fish, poultry, and eggs with care, and clean thoroughly any surfaces that have been in contact with these foods.

• Keep raw meats separate from cooked food.

• Cook meat, poultry, and fish thoroughly, and use pasteurised milk and juices.

• Refrigerate food promptly to minimise bacterial growth.

• When eating in restaurants, avoid foods that may have bacterial contamination, such as salad bars, sushi and raw or undercooked meats, fish, poultry, and eggs.

• If there is any concern about the purity of your water, for example, if you have well or tank water, have it checked for bacterial content.

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Te kai tika me te haumaru kai

Mā te kai tika me te kai pai hei āwhina i a koe ki te noho ora me te ārai i ngā pānga kino ka whai i ngā maimoatanga. Kei roto i te pukapuka Eating Well / Kia Pai te Kai a Te Kāhui Matepukupuku o Aotearoa, ētahi tohutohu whai kiko mō te kai, me ētahi tohutaka. Waea atu ki tō Rōpū Matepukupuku ā-Rohe mō tētahi kape o te pukapuka nei, me waea atu rānei ki a Waeaāwhina Pārongo Matepukupuku 0800 CANCER (236 237) mō tētahi kape, me tikiake i tō mātou paetukutuku www.cancernz.org.nz. Kei te hōhipera tētahi tohunga mō te kai pai, hei āwhina anō.

He mea nui te haumaru o ngā kai mō ngā tūroro kei te pāngia i te matepukupuku, tae atu ki te wā o tō rātou whakaoranga. Ki te hē ngā kai, tērā pea ka tāmia ngā kauparetanga o te tinana.

Exercise

Many people find regular exercise helps recovery. Research has indicated that people who remain active cope better with their treatment. The problem is that while too much exercise is tiring, too little exercise can also make you tired. Therefore, it is important to find your own level. Discuss with your doctor or nurse what is best for you.

New research shows exercise may provide more benefit to the immune system than any other therapy.

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For more information on the benefits of regular physical activity for people with cancer, telephone the Cancer Information Helpline 0800 CANCER (226 237) or contact your local Cancer Society to receive a copy of our pamphlet Being Active When You Have Cancer.

Kori tinana

He oranga i te korikori tinana mō te tokomaha o ngā tāngata kua pāngia i te matepukupuku. E ai ki ngā rangahau, ki te rite tō korikori tinana ka pai atu koe i te wā o te whakaoranga. Ko te raruraru kē, ahakoa ka pau tō hau ki te kaha rawa tō kori tinana, ka pau rā tō hau ki te iti rawa ō korikoringa. Nā reira, he mea nui kia mōhio koe he aha te korahi o te kori tinana e pai ana mōu. Kōrero ki tō rata, ki tō nēhi rānei mō te huarahi pai rawa mōu ake.

Relaxation techniques

Some people find relaxation or meditation helps them to feel better. The hospital social worker, nurse, or Cancer Society will know whether the hospital runs any relaxation programmes, or may be able to advise you on local community programmes.

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Complementary and alternative therapies

Complementary therapy is a term used to describe any treatment or therapy that is not part of the conventional treatment of a disease. It includes things like:

• acupuncture

• relaxation therapy/meditation

• yoga

• positive imagery

• spiritual healing/cultural healing

• art

• aromatherapy/massage.

Complementary methods are not given to cure disease, but they may help control symptoms and improve wellbeing.

Alternative therapy is a term used to describe any treatment or therapy that may be offered as an alternative to conventional treatments. It includes things like:

• homeopathy

• naturopathy

• Chinese herbs.

Alternative treatments are sometimes promoted as cancer cures.

However, they are unproven, as they may not have been scientifically tested, or, if tested they were found to be ineffective. They can also be expensive.

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It is important to let your doctor know if you are taking any complementary or alternative therapies because some treatments may be harmful if they are taken at the same time as conventional treatments.

Ngā haumanu tāpae me ētahi atu huarahi haumanu

Me whāki ki tō rata mēnā kei te nanao koe ki ētahi atu whakaoranga, kei pā mai he mate ki te kawea ngātahitia ēnei mahi me ngā mahi whakaora mai tō rata.

Seeking advice from health professionals

If you feel uncomfortable or unsure about your treatment, it is important that you discuss any concerns with those involved in your care, including your general practitioner.

Books

Dr. Susan Love’s Breast Book – Susan M. Love. MD. 4th ed. Da Capo Press, Cambridge, USA. 2005.

Couples Confronting Cancer: Keeping your relationship strong – Joy L. Fincannon and Katherine V. Buss. American Cancer Society, USA. 2002.

Websites

Cancer Society of New Zealand www.cancernz.org.nz

Breasthealth (AUS) www.breasthealth.com.au

Breast Cancer Care (UK) www.breastcancercare.org.uk

Cancer Backup (UK) www.cancerbackup.org.uk

The suggested websites, not including the Society’s, are not maintained by the Cancer Society of New Zealand. We only suggest sites we believe offer credible and responsible information, but we cannot guarantee that the information on such websites is correct, up-to-date, or evidence-based medical information.

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We suggest you discuss any information you find with your cancer care health professionals.

This booklet, Breast Cancer/Te Matepukupuku o ngā Ū, is part of a series titled Understanding Cancer, which is published by the Cancer Society. These booklets and booklets from the Living with Cancer series can be viewed and downloaded from our website, www.cancernz.org.nz.

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