Menopausal symptoms and breast cancer - This factsheet is for women who are experiencing menopausal symptoms after breast cancer treatment.

 
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Menopausal
symptoms and
breast cancer

This factsheet is for women who
are experiencing menopausal
symptoms after breast cancer
treatment.
Introduction                              Some of the more common
                                          menopausal symptoms include hot
The menopause is a natural and            flushes, night sweats, palpitations,
inevitable event for all women. The       mood changes, joint aches and pains
average age at which a natural            and vaginal dryness. You may put on
menopause occurs in women in the UK       weight, with the weight being more
is 51 years, with symptoms usually        concentrated around the waist. More
spanning a period of several years.       rarely, some women experience a
However, the treatment some women         crawling sensation under the skin,
receive for breast cancer can cause an    usually on the chest and stomach. You
earlier menopause and/or significant      may find that you become anxious and
menopausal symptoms.                      irritable or have problems with memory
                                          or concentration. The changes you
Some breast cancers (known as
                                          notice in your body may be gradual but
oestrogen receptor positive or ER
                                          for some women changes like hot
positive breast cancers) are stimulated
                                          flushes can start suddenly.
to grow by the hormone oestrogen.
Many breast cancer treatments are         This factsheet covers a range of
therefore designed to reduce oestrogen    treatment options, including
levels or block the action of             complementary therapies and
oestrogen, which can cause                specifically prescribed drugs to help
menopausal symptoms. Menopausal           you cope with these symptoms. The
symptoms can arise as a result of         effectiveness of some of the treatments
hormone therapy treatment or ovarian      (particularly the non-prescription
ablation or suppression (stopping the     therapies) are not supported by
ovaries working either permanently or     scientific evidence, but many women
temporarily) in ER positive women.        have found them useful. However, it is
                                          also important to consider the safety of
Women having chemotherapy may have
                                          non-prescription therapies.
an earlier, more sudden menopause as a
result of treatment. Symptoms are often   Different treatments work for different
more intense than when the menopause      women and it can be a case of trial and
occurs naturally, whether they are        error until you find something suitable.
oestrogen receptor positive or not. If    If you decide to try something new, talk
periods only stop temporarily during      to your specialist or breast care nurse.
chemotherapy, menopausal symptoms
may still be experienced.

2 Menopausal symptoms and breast cancer
What can you do to help flushes?
Hot flushes
                                            You might feel that you should put up
Hot flushes are the most commonly
                                            with hot flushes because you have
reported menopausal symptom
                                            been treated for breast cancer, but
associated with breast cancer
                                            they can be very distressing. You may
treatment. They can vary greatly from
                                            think that you shouldn’t bother anyone
being a mild sensation of warming
                                            about them, but it is worth speaking to
which just affects the face or the whole
                                            your specialist team or GP (local
of the upper body, to night sweats
                                            doctor) as there may be treatments
which are an extremely unpleasant
                                            that can help. If you attend a support
feeling affecting the entire body and
                                            group, talking to other women who are
causing drenching perspiration. For
                                            having hot flushes can give you the
most people flushes will fade over time
                                            opportunity to share experiences and
and become less severe, but for some
                                            get advice on ways of dealing with
women they can be long lasting.
                                            them. You may wish to use the
Some women become aware of their            discussion forums on the Breast
heartbeat racing (palpitations) or          Cancer Care website to gain support
develop a sense of anxiety. Many            and tips from other women who have
women also get flushes at night, which      experienced these side effects.
can lead to disturbed sleep and
                                            It may be useful to keep a note of
waking in a cold, wet bed and needing
                                            when you experience hot flushes. This
to change the bed linen. This can be
                                            can help you to identify any patterns to
very disruptive, especially if you share
                                            them or if anything triggers them that
a bed and may be worried about
                                            you might be able to avoid. If you
disturbing your partner. Disturbed
                                            know when to expect hot flushes you
sleep due to hot flushes can result in
                                            can be better prepared for them.
forgetfulness, irritability and a lack of
concentration during the following day.
You may consider hot flushes to be a
nuisance or uncomfortable but some
women find flushes can have a
dramatic impact on the way they feel
about themselves. This can have a
knock-on effect on their social life,
working life and personal relationships.

                                               Menopausal symptoms and breast cancer 3
Tips for dealing with hot flushes          • If you are not sleeping well, try to
                                           find time to have a rest during the day.
The following tips have been
recommended by other women and              • Avoid warm, stuffy rooms as they
may help you cope better with hot          can make flushes worse.
flushes and night sweats.
                                           • Regular, gentle exercise, such as
• Wear cotton or silk clothing as these    going for a walk, may help reduce your
fabrics absorb moisture and still          symptoms.
provide warmth after a flush is over.
                                           • Stopping smoking may help, as
• Wear layers of clothing that can be      smoking increases the rate at which
taken off or put on as your body           the body uses oestrogen, which
temperature changes.                       means there is less oestrogen in the
                                           body.
• Use layers of bedclothes (natural
fabrics are better) that you can remove    • If you have hot flushes from
or replace as required. For couples        tamoxifen, it may help to split the dose
sharing the same bed, using single         (for example taking 10 mg in the
bedclothes on each side can help you       morning and 10 mg at night). Some
both stay comfortable.                     women find that the brand of
                                           tamoxifen they take affects the number
• Put a cool gel pack under your pillow
                                           of flushes they get. Ask your GP,
at night so that you can turn the pillow
                                           cancer specialist or breast care nurse
over for a cooling effect when you
                                           for more information about this.
need to. Many women have found a
pillow that stays cool, such as a
‘Chillow’, useful.
• Use water sprays or moist wipes to
help lower your skin temperature. You
could try adding an aromatherapy oil
to the spray, such as peppermint
which has cooling properties or
lavender which has a relaxing effect.

• Use an electric fan to help lower your
skin temperature or a desk fan while at
work if you can.

4 Menopausal symptoms and breast cancer
Relaxation                                Complementary therapies
Many women find that reducing stress      Some women find complementary
makes their symptoms less severe.         therapies help with relaxation and
This might just mean learning to          relieve hot flushes. There are many to
become calmer, which may be               choose from, including homeopathy,
achieved by using controlled breathing    acupuncture, reflexology, massage,
techniques, or might involve doing        aromatherapy, hypnotherapy and
things to reduce stress, such as          meditation.
relaxation, increasing rest time or
                                          Acupuncture has been shown to be
decreasing work demands.
                                          effective for some women, although
Being anxious about hot flushes can       the evidence for its use is inconsistent.
make your symptoms worse. Knowing         Massage with aromatherapy oils such
what to expect and being prepared         as sage or chamomile may also help
can help you feel more in control and     improve hot flushes, but again there is
reduce your anxiety.                      no evidence to support this.
Hot flushes usually come and go over      If you want to try a complementary
short periods, so try to relax and wait   approach you should discuss this with
for the sensation to pass. When you       your specialist team first. It is
feel a hot flush coming on, you may       advisable to go to a qualified
find it helps to imagine yourself in a    practitioner. For further information,
cool place. It may also help to know      see Useful addresses at the end of this
that although hot flushes are             factsheet or our Complementary
uncomfortable for you, other people       therapies booklet.
are unlikely to notice them happening.

                                            Menopausal symptoms and breast cancer 5
Diet                                      Evening primrose oil
Food can be one of the triggers for       Some women have found taking
flushes and some women find that          evening primrose oil helpful, but, as
specific things, such as spicy foods,     with vitamin E, studies have shown it
caffeine or alcohol, have this effect.    to have no more benefit than a
You will need to work out for yourself    placebo and there is currently no
what your triggers are. Some women        evidence to support its use for
find that eating frequent small meals     reducing or preventing hot flushes.
rather than larger ones is helpful.
                                          Phytoestrogens (plant oestrogens)
Drinking cold drinks frequently has
been reported as helpful for some         Phytoestrogens are chemicals found in
women, as it temporarily lowers your      plant foods. There is a variety of them,
body temperature and may reduce the       all with different actions, although in
number of flushes. Reducing your          general they mimic the effect of
alcohol intake may also help.             oestrogen in the body. It is unclear if
                                          they help to reduce hot flushes.
If you are overweight, losing weight
                                          Phytoestrogens are found in many
may reduce your symptoms.
                                          fruits, vegetables and grains. There are
Maintaining long-term health, taking
                                          high quantities of them in foods such
regular exercise and stopping or
                                          as soya beans and linseed. You can
reducing smoking may also help.
                                          buy phytoestrogen-rich foods from
Vitamin E                                 health food shops. It is also possible
                                          to buy supplements of extracted
A few women report that taking
                                          phytoestrogen in powder form, such
vitamin E tablets helps to reduce the
                                          as soy protein and isoflavones.
number of hot flushes they have,
although some trials have shown           There has been a lot of research to
vitamin E has no more benefit than a      examine the use of soy proteins and
placebo (a ‘dummy’ pill) and in large     other phytoestrogens to relieve hot
doses vitamin E is toxic. Check with      flushes, but the results are inconsistent
your GP or cancer specialist before       regarding their safety and
you start taking any supplements and      effectiveness. It is currently uncertain
never take more than the                  what effect phytoestrogens have on
recommended dose.                         the body when they are taken in
                                          greater amounts than found in a
                                          normal diet. It is also not clear whether

6 Menopausal symptoms and breast cancer
the amount of plant oestrogen in your       Herbal remedies
body has any effect on the risk of your
                                            Some women find herbal remedies to
cancer coming back.
                                            be an effective way of reducing hot
As with herbal remedies,                    flushes. However, opinion is divided on
phytoestrogens are classified as            whether they are suitable and safe for
foodstuffs and so are not covered by        use, or if they have any more effect
drug regulations and clinical trials (see   than a placebo. They are classed as
below).                                     foodstuffs, which means they don’t
                                            come under the same regulations as
                                            other drugs. This means they don’t go
                                            through thorough clinical trials before
                                            being put on the market and their side
                                            effects or interaction with other drugs
                                            or treatments (e.g. tamoxifen or
                                            aromatase inhibitors) may not be
                                            known.
                                            Some herbal remedies, such as red
                                            clover, may help to reduce hot flushes
                                            because they contain phytoestrogens,
                                            but as indicated above their safety and
                                            how effective they are has yet to be
                                            established in women who have been
                                            treated for breast cancer. Wild yam,
                                            ginseng and fennel contain a mixture
                                            of many hormone-like substances, but
                                            the way in which they work is not
                                            entirely clear. Black cohosh does not
                                            appear to have any hormonal actions
                                            although the evidence is unclear, and
                                            the limited number of studies have
                                            shown inconsistent findings regarding
                                            its effectiveness. This remedy has also
                                            been reported to give side-effects
                                            such as dizziness, headaches or
                                            stomach upsets. There may also be a

                                              Menopausal symptoms and breast cancer 7
risk of liver problems in women who        Prescribed drug therapies
already have pre-existing liver disease.
                                           The following drugs have all been
It is important to consult a registered    shown to help relieve hot flushes and
herbalist and discuss any herbal           would need to be prescribed by a
supplements with your cancer               doctor.
specialist or breast care nurse before
                                           Low-dose progesterone
taking them, particularly if you are
having hormone treatment such as           Progesterone in low doses can be
tamoxifen or aromatase inhibitors.         effective in relieving hot flushes,
                                           although there is no evidence it is
                                           effective in reducing symptoms in the
                                           long term. Many doctors are hesitant
                                           to give any hormones to women who
                                           have had breast cancer and for this
                                           reason they are not often prescribed
                                           in women who have had a breast
                                           cancer diagnosis.
                                           These drugs include megestrol
                                           (Megace), medroxyprogesterone
                                           (Provera) and norethisterone (Primolut
                                           N, Utovlan). Side effects from these
                                           drugs can include weight gain,
                                           abdominal bloating and breast
                                           tenderness. You may also experience
                                           vaginal bleeding one or two weeks after
                                           progesterone treatment is stopped as
                                           hormones return to their normal levels.
                                           Clonidine (Dixarit, Catapres)
                                           Clonidine can be effective in some
                                           women in reducing both the frequency
                                           and the intensity of hot flushes but its
                                           effects may wear off over time. As with
                                           all drugs, clonidine can have side
                                           effects, including a dry mouth,

8 Menopausal symptoms and breast cancer
headaches, constipation and                Hormone Replacement Therapy
drowsiness.                                (HRT)
Anti-depressant drugs                       HRT replaces hormones that are no
                                           longer being produced by the ovaries
The anti-depressant drug venlafaxine
                                           and is a very effective way of relieving
(Effexor) has been shown in studies to
                                           menopausal symptoms. It can also
have a good effect in reducing flushes
                                           help to protect against long-term side
in some women, but may have
                                           effects of the menopause such as
unpleasant side effects and its effect
                                           osteoporosis. However, HRT is not
may wear off over time. It is prescribed
                                           usually offered to women who have
in a different dose to help with hot
                                           had breast cancer as there is still
flushes than when prescribed for
                                           uncertainty if HRT increases the risk of
depression, and is not expected to
                                           breast cancer recurring. Some studies
have anti-depressant effects. Side
                                           report that HRT causes cancer to come
effects might include nausea,
                                           back and others that it doesn’t, so the
diarrhoea, sleepiness and dizziness.
                                           safety of HRT is still unclear.
The anti-depressant drugs fluoxetine
(Prozac) and paroxetine (Seroxat), are     A small number of women experience
also sometimes prescribed to help          severe menopausal symptoms that
reduce hot flushes, and have similar       significantly affect their quality of life
side-effects to venlafaxine. However,      and that don’t respond to other
some studies suggest that using these      treatments or complementary
drugs may interfere with the way that      therapies. In these cases HRT may be
tamoxifen works, making it less            prescribed because the benefits are
effective.                                 likely to outweigh any possible risk.
                                           This would be done only once your
Gabapentin (Neurontin)
                                           cancer specialist has discussed all the
Some women have found an                   risks and benefits with you in order to
anti-epilepsy drug, gabapentin, helpful    decide whether it is appropriate. A full
in reducing the severity of hot flushes.   dose of HRT may not be necessary to
As with all drugs, gabapentin can have     reduce hot flushes, so it would be
side effects, including fatigue, sleep     possible to try using smaller amounts.
disturbance and anxiety.

                                              Menopausal symptoms and breast cancer 9
Vaginal dryness                             oestrogen absorbed into the rest of the
                                            body is not fully known, but it is
Low oestrogen levels can result in          thought to be low and therefore safe in
vaginal dryness and irritation. Wearing     the short term, for example three
loose-fitting cotton underwear and          months at a time.
avoiding tight-fitting trousers can help,
                                            The vaginal tablet, Vagifem, can also
as this is less likely to irritate the
                                            cause a small increase in the level of
vaginal area.
                                            oestrogen in your body. It is advisable
Vaginal moisturisers such as Replens        to discuss the use of these locally
MD or Senselle (available from              acting oestrogens with your cancer
chemists and on prescription) may be        specialist.
used every few days. If you experience
discomfort during sexual intercourse it
may be helpful to apply water-based
lubricants such as KY jelly, Astroglide,
Pasante TLC or Sylk. These products
don’t generally cause vaginal irritation
and are fine to use with condoms.
Some women find that spermicidal gel
or even natural yogurt can help make
intercourse more comfortable. If you
can get past the initial dryness, then
intercourse itself helps to stimulate the
blood flow to the vagina and will help
maintain its suppleness and elasticity.
Vaginal dryness and irritation can also
be caused by infection, so it is best to
visit your GP if you are experiencing
problems so they can rule this out.
Oestrogen pessaries and creams such
as Ortho-Gynest and the vaginal ring,
Estring, act locally on the vaginal
tissues and may relieve dryness
effectively. The exact amount of

10 Menopausal symptoms and breast cancer
Decreased sex drive                          Mood changes
People with breast cancer may lose           The brain can be affected by a
interest in sex for many reasons. It may     reduction in oestrogen levels, which
be a result of the diagnosis itself,         can result in lack of concentration,
treatment or side effects, or concerns       forgetfulness and irritability. You may
with body image. If this is a problem for    find that you are experiencing extreme
you, talk to your GP, specialist or breast   mood changes, from feeling positive
care nurse, as there are ways of helping     and happy one day to miserable and
you deal with these issues.                  low the next. These can happen
                                             unexpectedly and for no apparent
Menopausal symptoms such as hot
                                             reason.
flushes and night sweats as well as a
decreased sex drive can effect new           Relaxation classes, meditation, yoga
and existing relationships and your sex      and other similar activities can be
life. You may find it difficult to start a   useful ways of controlling mood
new relationship at this time. You can       changes. These won’t be appropriate
find more information on vaginal             for everyone, but it is worth trying a few
dryness, decreased sex drive and             to see if any of them work for you.
relationships in our booklet Sexuality,      Talking about your feelings can be
intimacy and breast cancer.                  helpful and you may find it useful to
                                             discuss these with other women who
                                             are going through a similar experience.
                                             You can call our helpline for information
                                             on our Peer support service or visit the
                                             discussion forums on our website.
                                             There may also be a breast cancer
                                             support group in your area, your breast
                                             care nurse will be able to tell you if
                                             there is.

                                                Menopausal symptoms and breast cancer 11
Further support                            Further help from
Any menopausal problems that you are       Breast Cancer Care
having are in addition to the experience
                                           For further medical information,
of cancer itself, the treatment and its
                                           emotional support, and details of our
side effects. Flushes may be the one
                                           services, call our helpline free on 0808
thing that is stopping you gaining some
                                           800 6000 (for Typetalk prefix 18001).
normality and for some women can be
a constant reminder of their breast        Breast Cancer Care’s website has an
cancer experience. For others, having      email enquiries service called Ask the
this problem on top of everything else     nurse, along with forums and live chat
makes them feel very low. If you find      sessions where you can share your
that you are unable to cope or that you    views with people in a similar situation.
keep feeling down, try talking with your   For more information about these
GP or breast care nurse. They may be       services and other online support, visit
able to refer you to a professional        www.breastcancercare.org.uk
counsellor or therapist who can help.
                                           We run courses and activities for
You may also be referred to a specialist
                                           people with breast cancer, which aim to
menopause clinic if there is one in your
                                           provide information and support and
local area, where you can get further
                                           give people the chance to meet others
advice and information about coping
                                           in a similar situation. For more
with menopausal symptoms.
                                           information about these events, call our
                                           helpline or contact your nearest Breast
                                           Cancer Care centre details on the
                                           reverse.
                                           Breast Cancer Care also has a wide
                                           range of publications to guide you from
                                           diagnosis to living well after treatment.
                                           You can download and order our
                                           publications at
                                           www.breastcancercare.org.uk or call
                                           our helpline on 0808 800 6000 for a
                                           printed order form.

12 Menopausal symptoms and breast cancer
Other organisations                        Northwich CW8 1AQ
                                           Telephone: 01606 786782
British Complementary Medicine             Email:
Association (BCMA)                         admin@medical-acupuncture.org.uk
PO Box 5122, Bournemouth BH8 0WG           Website:
Tel: 0845 345 5977                         www.medical-acupuncture.co.uk
Email: office@bcma.co.uk
                                           Provides acupuncture information and
Website: www.bcma.co.uk
                                           news, and a list of members who are all
Umbrella organisation. Produces a          registered medical practitioners.
guide and a code of conduct for
                                           British Menopause Society (BMS)
practitioners, and a holds a register of
                                           4-6 Eton Place, Marlow SL7 2QA
practitioners.
                                           Telephone: 01628 890199
British Holistic Medical Association       Email: admin@thebms.org.uk
PO Box 371, Bridgewater,                   Website: www.thebms.org.uk
Somerset TA6 9BG
                                           The BMS is a registered charity
Tel: 01278 722000
                                           dedicated to increasing awareness of
Email: admin@bhma.org
                                           post-menopausal healthcare issues
Website: www.bhma.org
                                           and promoting optimal management
Provides information, produces             through conferences, roadshows and
self-help tapes, booklets and a            publications (see further reading).
quarterly magazine.
                                           The Daisy Network
British Homeopathic Association            PO Box 183, Rossendale BB4 6WZ
Hahnemann House, 29 Park Street            Recorded helpline: 0845 122 8616
West, Luton LU1 3BE Tel: 0870 444          Email: daisy@daisynetwork.org.uk
3950 Email: info@trusthomeopathy.org       Website: www.daisynetwork.org.uk
Website: www.trusthomeopathy.org
                                           Voluntary support group for women
Provides information and a directory of    who experience a premature
homeopaths. Produces a booklet             menopause, including information
called ‘How to get Homeopathic             exchange and informal telephone
Treatment on the NHS’ and a quarterly      support by members.
magazine.
British Medical Acupuncture Society
BMAS House, 3 Winnington Court,

                                             Menopausal symptoms and breast cancer 13
Tel: 01273 609699
Institute for Complementary and             Email: enquiries@naturalhealthas.com
Natural Medicine                            Website: www.naturalhealthas.com
Can-Mezzanine, 32-36 Loman Street,
                                            Offers specific dietary, nutrition and
London SE1 0EH
                                            exercise advice for women with
Tel: 020 7922 7980
                                            pre-menstrual syndrome, menopausal
Email: info@icnm.org.uk
                                            symptoms, prevention of osteoporosis
Website: www.i-c-m.org.uk
                                            and other hormone-related problems.
Provides information, training and a
                                            Penny Brohn Cancer Care
register of professional practitioners.
                                            Chapel Pill Lane, Pill, Bristol BS20 0HH
The Menopause Exchange                      Helpline: 0845 123 2310 (Mon-Fri
PO Box 250, Bushey WD23 1ZS                 9.30am-5pm)
Tel: 020 8420 7245                          Email: helpline@pennybrohn.org
                                            Website:
The Menopause Exchange is a
                                            www.pennybrohncancercare.org
quarterly newsletter for anyone
interested in the menopause and             Offers two and five day holistic courses
midlife issues. It specialises in           (led by doctors and therapists) for
independent information about HRT,          cancer patients which include
complementary therapies, nutrition,         counselling, relaxation, visualisation,
osteoporosis. Annual subscrption starts     meditation, art and music therapy,
at £18.                                     healing and dietary advice. Helpline
                                            offers emotional support, and
National Institute of Medical
                                            information on finding complementary
Herbalists
                                            therapists and services in your area.
Elm House, 54 Mary Arches Street,
Exeter EX4 3BA                              The Society of Homeopaths
Tel: 01392 426022                           11 Brookfield, Duncan Close,
Email: info@nimh.org.uk                     Moulton Park, Northampton NN3 6WL
Website: www.nimh.org.uk                    Tel: 0845 450 6611
                                            Email: info@homeopathy-soh.org
Produces information, training and a
                                            Website: www.homeopathy-soh.org
register of qualified medical herbalists.
                                            Provides information leaflets, news, a
Natural Health Advisory Service
                                            register of members and a newsletter.
PO Box 117, Rottingdean, Brighton,
East Sussex BN51 9BG

14 Menopausal symptoms and breast cancer
Women’s Health Concern
4-6 Eton Place, Marlow,                   Further reading
Buckinghamshire SL7 2QA
                                          Understanding the Menopause
Tel: 0845 123 2319 (Mon-Fri 10-1pm)
                                          and HRT
Email:
                                          Anne MacGregor Family Doctor
info@womens-health-concern.org
                                          Publications, 2005 ISBN 1903474116
Website:
www.womens-health-concern.org             Menopause
                                          Miriam Stoppard Dorling Kindersley,
Specialist nurses will answer queries
                                          London, 2002 ISBN 0789483572
about the menopause and a wide
variety of gynaecological and sexual      Natural Menopause
health conditions.                        Miriam Stoppard Dorling Kindersley,
                                          London, 2003 ISBN 0751369829
Websites
                                          Books available from The British
www.chillow.net
                                          Menopause Society
This website offers more information on
                                          The Menopause: What You Need to
the chillow. Items can be purchased
                                          Know
online or by phone on 0871 200 1533.
                                          Rees, Purdie and Hope RSM Press,
www.menopausematters.co.uk                2006 ISBN 1853156728
Menopausematters.co.uk is an
independent, clinician-led website. It
aims to provide easily accessible,
up-to-date, accurate information about    This factsheet has been produced by Breast
the menopause, menopausal                 Cancer Care’s clinical specialists and reviewed by
symptoms and treatment options,           healthcare professionals and people affected by
                                          breast cancer.
including Hormone Replacement
Therapy (HRT) and alternative             Factsheet © Breast Cancer Care 2006. Revised
therapies, so that women and health       November 2008. All rights are reserved. No part of
professionals can make informed           this publication may be reproduced, stored or
                                          transmitted, in any form or by any means, without
choices about menopause
                                          the prior permission of the publishers.
management.
                                          Registered charity in England and Wales 1017658
                                          Registered charity in Scotland SC038104
                                          Registered company in England 2447182

                                             Menopausal symptoms and breast cancer 15
Central Office
                                          About Breast
Breast Cancer Care
5-13 Great Suffolk Street                 Cancer Care
London SE1 0NS
                                          Breast Cancer Care is here for
Telephone 0845 092 0800
                                          anyone affected by breast cancer.
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Email info@breastcancercare.org.uk        We bring people together, provide
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Centres                                   campaign for improved standards of
London and the South East                 care. We use our understanding of
of England                                people’s experience of breast
Telephone 0845 077 1895                   cancer and our clinical expertise
Email src@breastcancercare.org.uk
                                          in everything we do. Visit
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England                                   or call our free helpline on 0808 800
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Email cym@breastcancercare.org.uk
                                          training purposes. Confidentiality is
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