Breast Care

Welcome to the Warwick Breast Care information page

Women should check their breasts regularly and are encouraged to contact their GP to report any breast changes. This could be a change in shape or appearance of the skin, lumps or indentations, nipple changes, nipple discharge, or pain. We also encourage you to attend your local screening appointments which you should be invited to if you are between the ages of 50 – 70 years. Men can also be diagnosed with breast cancer but this is much less common.

It is important to remember that most of the patients referred to see us will have benign problems, indeed for every 20 new patients referred to our clinic, only one will subsequently be found to have breast cancer.

Many of the patients referred to our clinic have been referred with breast pain. Although your GP will have been instructed by the Department of Health to refer all patients with breast symptoms to the clinic, breast pain is not a symptom of breast cancer and only about 1 in 200 patients who present with breast pain will be found to have breast cancer. For more information on breast pain, click here.

The breast care unit consists of consulting rooms, treatment room, digital mammogram (breast X-ray) machine and ultrasound scanning room. The breast care nursing and mammography teams have endeavoured to provide a warm and friendly environment.

We appreciate that finding a breast problem for many men, women and their families can be a very anxious time, we therefore aim to resolve the problem, whatever it is, as quickly as possible.

WHERE ARE WE + FACILITIES

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We have:

  • Waiting Room
  • 2 consulting rooms
  • Breast Care Nurse discussion Room
  • Mammography Room
  • Ultrasound Room
  • Treatment Room
  • Disabled facilities.

Tea, Coffee and Hot Chocolate are available at a cost of £1.

While some breast consultant appointments, breast care nurses and the mammography team are based in the Helen Clark Suite, some breast clinics are currently being run from the Beauchamp Suite. If you are unsure where your appointment is, please call the Breast Care Team.

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BREAST CARE ADVICE

With breast cancer being the most common cancer for women in the UK and although it is rare for men to have breast cancer, it is important that everyone is BREAST AWARE.

Everyone's breasts are different, they are rarely symmetrical, and are in all different shapes and sizes. This is why we emphasise that it is important for each person to know what is normal for them. Not just knowing your usual shape and size but the changes that are normal for you through the day and month.

Current statistics show that most breast cancers are diagnosed between the ages of 50 - 70 years, and this is when screening mammograms are offered. However, it is important to still check your breasts whatever your age regularly.

But what are you checking for?

There are a number of resources available to you to know what you are looking or checking for:


Breast Cancer Now released a project in 2017: Touch, Look, Check.

A mini-guide at giving your breasts some ‘TLC’ and checking for any changes, specifically changes related to possible signs and symptoms for breast cancer. What to look for, What differences when you touch your breasts or check for the changes.

‘Knowing Your Lemons’ Foundation campaign.

Know your lemons also has an accessible, free-to-use app called ‘Lemons’. This app not only sets a reminder for you to check your breasts but also has videos and audio information on how to check your breast and what lumps mean. There is a questionnaire to complete if you have concerns and an area for you to monitor your findings and keep a diary to determine what is normal for you according to your menstrual cycle and hormone changes through the month.

Facebook: knowyourlemonsfoundation

Instagram: @knowyourlemons

Twitter: @knowyourlemons

Youtube: knowyourlemons

Website: https://www.knowyourlemons.com/


CoppaFeel

You can also sign up for shower reminder posters, text or email reminders to check your breasts through CoppaFeel.

CoppaFeel is a friendly website that works with one mission: everyone to regularly check their boob. Their website has a video demonstrating how to check your breasts, why you check and what to look for with ‘Hand meet Boob – Boob check basics’.

Facebook: CoppaFeel!

Instagram: @coppafeelpeople

Twitter: @coppafeelpeople

Website: https://coppafeel.org/.

BRAS

Are you wearing the right sized bra for you?

It is important for women to be wearing the right size bra.

Bras can also differ in a number of ways other than size, which can impact their comfort levels. This may be due to fabric, underwire or bra structure, strap length or width, padding, cup shape or width between the cups, or depth of the ban.

Professional fitting is available in shops or you may do it yourself using a tape measure and a fitting guide. There are a number of bra calculators online but Breast Care Now and Ameona is both widely and professionally utilised. Please find the links below.

So choosing the right bra for you isn’t the simple decision that we all wish it was, but comfort and support are both manageable and achievable.

Breast Care Now has an informative leaflet on wearing a well-fitted bra.

Ameona – Ameona also offers information on their website if you have had breast surgery.

OUR TEAM

Breast Care Team Members

The management of any breast concern requires a team approach and we work very closely as a team with Consultant Breast Surgeons, Consultant Radiologists, Consultant Oncologists, Consultant Breast Pathologists, Breast Care Nurses and Specialist Breast Radiographers in conjunction with Consultant Plastic Surgeons based at the University Hospital Coventry and Warwickshire (UHCW) and Geneticists based at the Birmingham Women’s Hospital. We have strong links with our colleagues in the Breast Screening Unit, also based at the University Hospital Coventry and Warwickshire. We hold a weekly Multidisciplinary Breast Team Meeting (MDTM) on a Monday afternoon.

Consultant Breast Surgeons: Mr Simon Harries (Lead), Miss Lucie Jones, Miss Ruvinder Athwal and Mr Mashuk Khan supported by two Surgical Registrars: Dr Tin Sein and Dr Verda Amin.

Consultant Radiologists: Dr Paul Williams, Dr. Sapna Al Rahimand and Dr Alpna Jain.

Consultant Breast Pathologists: Dr Naresh Chachlani, Dr Farah Sandhu, Dr Sreenivas Muthyala and Dr Amgad Youssef.

Consultant Clinical Oncologists: Dr Nawaz Walji, Dr Denise Hrouda based at Warwick Hospital and Dr Clive Irwin based in the Rigby Unit, Stratford Hospital.

Breast Care Nurses: (Breast care nurses are experienced qualified nurses who have undertaken specialist training in the care of patients with breast cancer) Clinical Nurse Specialist Siân Corrie (lead), Clinical Nurse Specialist Paula Read, Specialist Breast Care Nurse (BCN) Helen Millage, BCN Tracey Burnell, BCN Hannah Cooke, BCN Emma Stokes and Clinical Support Worker Ellen Taylor.

Breast Radiographers: Mrs. Gillian Rowland (Lead), Mrs Sarah Bonsall and Joanne Noel (Advanced Practitioners), Kate Day, Leigh-Anne Keyte, and Farasai Wright. Plus we work very closely with the screening team, based at University Hospital of Coventry and Warwickshire (UHCW), Mrs. Sue Garnett, Mrs. Sandra Riley and Dr. Aradhna Goud.

Additional staff: There will be outpatient nurses present to welcome you into the department who understand the level of anxiety caused by coming to the clinic and will try to keep you informed with clear and concise information at all times.

There is also a Breast Cancer Coordinator Kala Alvarez, Breast Care Administrator Nicole Holmes, Receptionists Ann Beadle and Alison Canning, MDT Coordinator Angie Jones, and Breast Secretaries Ms. Charmaine Domingo and Mrs. Sarah Bates.

WHAT WE DO AND THE PROCESS

.Patients can be referred to the Breast Care team by their GP with breast pain, breast lumps and nipple lesions as “cancer suspected” or “cancer not suspected”. This is done via the “two-week wait” system and by the “Choose and Book” route for routine referrals. Referrals can also be done via the Breast Screening Service or occasionally via Accident and Emergency or from the wards. Patients who have a family history of breast cancer are also referred. We are one of the few trusts, certainly in the West Midlands, that nearly always see all our “two-week wait” patients within this time period.

What to expect at your appointment

Every attempt is made to keep all the clinics on time but sometimes the demands on the service make this difficult. Occasionally it is necessary to see some patients out of time order so that we can make the best use of our resources. Please bear with us as we will always do our best to see each patient as quickly and as effectively as possible.

Please allow two to three hours for your visit as a new patient. Although many patients are in the department for a much shorter period of time. You are welcome to bring a friend/partner with you, both to the initial visit and for any follow-up visits. Interpreter services are available on request.

On arrival, if you are a new patient, we will ask you to fill in an information leaflet (which can be filled in by you prior to your visit if you wish). A breast concern requires what is called the “triple assessment” approach. The three elements are clinical, radiological and pathological. Not all patients will require the full triple assessment with the majority needing only the clinical and radiological assessments.

Clinical Assessment

Firstly, the doctor will take a full history of your breast problem plus background information such as any previous breast problems, family history, use of Hormone Replacement Therapy (HRT), previous mammograms etc. and an inquiry made about your general health and medication. Please make reception aware if you would like a chaperone.


Radiological Assessment

In many, but not all, cases the doctor will recommend that you have some breast imaging. This may be a mammogram - an X-ray technique used to examine the breast. Both breasts will be examined. The breast is held firmly between two plastic plates and X-ray pictures are taken; or an ultrasound scan - a painless test, that only takes a few minutes, where a special gel is placed on the breast and a small probe emitting sound waves, is passed over the area. Mammograms are performed in women over the age of 40 and ultrasound scans in women under 40, a woman over 40 may have both a mammogram and an ultrasound.

Pathological Assessment

Sometimes, a core biopsy needs to be taken to obtain pieces of breast tissue that need further investigation for diagnosis. A local anesthetic is used to numb the area and make the procedure as comfortable as possible. The biopsy is done under either ultrasound, X-ray guidance or occasionally by the breast doctor in the clinic. Any specimen of breast tissue taken is sent to the pathology laboratory to be examined which can take up to fourteen days. The breast can bruise and be tender following a core biopsy, and if you came to the clinic with a lump, this can make it feel like it has got bigger but generally it settles within seven days. You may be offered an appointment to come back to the breast clinic within the following two weeks to discuss the results of your investigations. Otherwise, you will be contacted by letter with your investigation results, a copy of the letter will also be sent to your GP. You can read more in this biopsy leaflet here.


Whenever possible, all investigations are undertaken at one appointment, however, there are times when this is not possible. If that is the case an appointment will be made for you to return to the Breast Care Unit, as soon as possible, to complete your investigations.

BENIGN – PATIENT LEAFLETS AND INFO

Breasts can change regularly for many reasons including the time of the month, your menstrual cycle, genetics, or as part of ageing. However, this doesn’t stop these changes from being worrying and so it is important to be checked by your GP. However, it is important to remember that 95% of breast changes that are found and referred to breast specialists are benign.

Most benign breast cancer changes don’t require any further treatment and you will be discharged from the hospital breast team. However, sometimes you may need surgery to remove the area of concern with a margin of healthy tissue. Whether you do or do not need surgery, the health care professional you speak to will explain what the best action is and why.

Breast Cancer Now is a charity that has a lot of information on breast lumps and other benign conditions. To go to their website, click here.

Most common benign conditions:

  • Breast Pain - this can be very common in women of all ages. When experiencing breast pain it can be uncomfortable and can be due to a number of reasons, rarely cancer. Before the GP refers you to the breast clinic at the hospital it is important to consider a number of things and explore a few avenues first. See this leaflet for further information and details on this.
  • Fibroadenoma – Currently there is no known cause of fibroadenomas but they are a common benign breast condition, mainly found within younger women but can occur and be found at any age. They are confirmed as being a fibroadenoma by a biopsy being taken and investigated under the microscope. They can fluctuate in size for some women but are harmless. The majority of the time no further follow-up from the hospital is required, although sometimes it can be surgically removed. See this leaflet for further information and details on this.
  • Breast cysts – Breast cysts are fluid-filled sacs within the breast that are completely benign and can vary in size, shape and softness. A breast cyst does not require special monitoring or follow-up, however, if it is uncomfortable and very large it can be drained (aspirated). See this leaflet for further information and details on this.
  • Calcifications – These are chalk-like changes within the breast that are symptomless and often found on mammograms and through screening. The images of the calcifications will be examined by experienced mammography or radiologist, who will sometimes biopsy the area to determine their nature. See this leaflet for further information and details on this.
  • Breast Rash (Intertrigo) – The main causes of a rash under the breast is moisture, heat, skin friction and a reduced amount of airflow, because of these sometimes your skin can get very uncomfortable and sore. Using a gentle soap to wash, thoroughly drying the area and a well-supported bra can all help. It is best to make these changes and monitor, Your GP could also give recommendations if it feels like it is worsening. However, this is rarely a concern that needs to be seen by a specialist and is not a sign of cancer.

PRIMARY BREAST CANCER – PATIENT LEAFLETS AND INFO

Patients with a breast cancer diagnosis

Breast cancer is the most common type of cancer in the UK, there is a very good recovery rate, particularly if it is detected at an early stage.

A cancer diagnosis or a diagnosis of pre-cancerous changes (known as ductal carcinoma in situ or DCIS) has a significant impact on a person’s life and the Breast Care team aims to provide the best possible care for all patients who are diagnosed. This includes practical and emotional support and information for patients, their families, and carers.

Most breast cancer treatment plans include surgery, radiotherapy and hormone treatments. Some types of breast cancers require chemotherapy and targeted treatments such as Herceptin and bone-strengthening drugs.

The purpose of treatment is to remove cancer (local treatment) and treat the rest of your body (systemic treatment) with the aim of reducing the risk of recurrence in the long term.

Surgery is usually the first treatment for breast cancer, although sometimes chemotherapy or hormone treatments can be given initially. If patients have other health conditions which limit their surgical options they may be advised to have hormone therapy to treat their cancer as a first and only line of treatment.

There are a number of surgical options available, depending on your cancer and your wishes.

  • Breast-conserving surgery or wide local excision (lumpectomy) – removal of the breast cancer site with a margin of healthy tissue.
  • Mastectomy - removal of all the breast tissue including the nipple.

All patients who are advised of a mastectomy will have an opportunity to discuss breast reconstruction. If this is not appropriate for you a rationale will be given and the Breast Care Nurse team will ensure you are fitted with a breast prosthesis when suitable. For more information on prosthesis fittings, please go to our clinics and additional services tab.

Testing of the lymph node under your arm is advised for all patients who have invasive cancer. It may also be discussed if you have a diagnosis of ductal carcinoma in situ (DCIS).

A Sentinel Lymph Node Biopsy (SLNB) is performed at the same time as your breast surgery and involves removing a lymph node from your armpit, which is tested whilst you are under the anaesthetic. If the node is negative, no further nodes will be removed but if it shows cancer cells an axillary node clearance (ANC) will be performed.

Axillary node clearance will be planned with your breast surgery if cancer has been confirmed in your lymph nodes at diagnosis.

Surgery is usually followed by medical adjuvant treatments to help reduce the risk of cancer returning. Around two weeks after surgery, you will have an appointment with your Consultant surgeon and BCN where the results of your operation and follow on treatments will be explained to you. You may only require surgery or in combination with one or all treatments including radiotherapy, hormone treatment, chemotherapy, targeted treatments and bone-strengthening therapy. When you have additional treatments like chemotherapy and radiotherapy you will then see one of our breast oncologists.

We also provide a reconstruction service for women who are considering a mastectomy because of a high risk of breast cancer in the family especially those who carry the BrCa1 and 2 genes.

Please find information booklets on each surgery and treatment option below:

SUPPORT PROVIDED BY BCN

Help and support provided by your Breast Care Nurse team

Our team of Clinical Nurse Specialists (CNSs) and Breast Care Nurses (BCNs) are available to support you and your family through your diagnosis and treatment. They provide clinical guidance and evidence-based information to help with your decision-making related to treatments and wellbeing. We are able to offer emotional support and provide signposting to additional services offered locally and nationally.

We aim to meet you at the appointment when you receive your diagnosis of breast cancer and at various points throughout your treatment.

The Breast Care Nurses support the National Living with and Beyond Cancer initiative. We aim to ensure that patients living with and beyond cancer access the care and support they need to lead as healthy and as active a life as possible, for as long as possible.

Personalising patient care is part of this objective and has four main elements:

VIDEOS

There are currently no videos available but is something we endeavour to have completed by the end of 2021.

  • When you have a drain in.
  • Breathing exercises
  • Post-surgery exercises
  • HNA assessment
  • Breast Pain
  • Reducing the risks of lymphedema

CLINICAL TRIALS

Research and clinical trials are for the overall learning and development to improve current procedures in healthcare. For our department, it means we can learn more about breast cancer itself: how it forms, how it changes and develops, as well as telling us more about breast cancer treatments, diagnosis, identification and follow ups.

For clinical trials to be at the point of recruiting participants they have to go through a strict review and assessment process by a scientific ethics and regulatory board. Due to the nature of breast cancer trials, majority of them are done over a long period of time: a matter of years.

Warwick Hospital has a number of professional connections with different companies carrying out clinical trials. If you are suitable and meet the criteria for a recruiting trial, it will be offered to you by a Breast Care Nurse, Breast Surgeon or Oncologist.

However if they aren’t mentioned and you are unsure if you are eligible for any trials, please feel free to contact us. For an overview of clinical trials currently underway, you can also visit the Cancer Research UK website. https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial

OUR CLINICS AND ADDITIONAL SERVICES

Clinics

New patient breast clinics are mainly conducted in the Helen Clark Suite with some follow-up clinics conducted in the Aylesford Unit. Oncology clinics (for patients diagnosed with breast cancer) are held in the Aylesford Unit at Warwick Hospital and in the Rigby Unit at Stratford Hospital. New patient clinics take place on Monday afternoons, Tuesday mornings, Thursday mornings and afternoons and Friday mornings. Follow-up clinics are held on Monday, Tuesday and Thursday mornings. We often add, extra, new patient clinics as required.

Prosthesis Services

In this Trust, we are fortunate to be able to offer women a prosthesis who have had a mastectomy or a partial excision. Prosthesis are silicone based breast form to go within a woman’s bra, which can come in a wide range of shapes, colours and sizes. We work closely with the company, Ameona, who hold fitting clinics most Wednesdays at Stratford Hospital, offering breast and nipple prosthesis as well as bras from their own range as well as from Trulife and Silima. If you would like to arrange an appointment, please call the Breast Care Nurses.

Please find the prosthesis links below:

We pride ourselves on providing a high-quality breast care service to the patients of South Warwickshire. The breast service recently scoring the fourth highest in terms of patient satisfaction out of 132 Trusts in England.

USEFUL LINKS

For further general information:

For further support:

This is a national charity that gives vital holistic support and advice to anyone (families too) affected by breast cancer.

A charity based in Bristol that provides to support to people with all types of cancer, taking a holistic approach to care and support including complimentary care, self-care and meditation.

Links to help support children of people with cancer:

If you ever feel you need further support or information please contact the Breast Care Nurses who can help with information, or signpost you to appropriate links specific to you and your situation.

CONTACT DETAILS

Breast Care Nurses:

We are accessible by telephone Monday to Friday, 8.30am - 4pm and there is a message facility.

Breast Care Nurses telephone number – 01926 495321 extension 4503 and email warwick.breastcare@swft.nhs.uk. We can offer advice and support over the phone or arrange an appointment to meet in person.

  • Helen Clark Suite Reception - 01926 495321 extension 8412
  • Breast Care Secretaries - 01926 495321 extension 4325
  • Breast Care Two Week Wait Team - 01926 495321 extension 8201
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