Your visit to the

Breast Clinic

Please take time to read this important information to help you during your visit

PLEASE NOTE: ALLOW UP TO 4 HOURS FOR YOUR APPOINTMENT

University Hospital of North Midlands Breast Care Nursing teamRoyal Stoke University Hospital

Vc HF/LG Dec 2014Printed by Sherwin Rivers Ltd. Waterloo Road, Cobridge, Stoke on Trent ST6 3HR

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We are a team of qualified Nurses with Specialist Breast Care training providing;

• Support and advice for women going through breast screening and assessment• Information, support, practical advice and counselling to women and men who have

breast cancer. • Support for patients, their families and carers from diagnosis through treatment and

follow-up.If you would like to speak to a Breast Care Nurse please ask a member of staff

Helen Julie Elizabeth Rachel Lynne HayleyFrancis Boulton Mellor Bayley Scott Simpson

The Breast care Nursing team

We are a team of qualified Nurses with Specialist Breast Care training providing;

• Support and advice for women going through breast screening and assessment• Information, support, practical advice and counselling to women and men who have

breast cancer. • Support for patients, their families and carers from diagnosis through treatment and

follow-up.If you would like to speak to a Breast Care Nurse please ask a member of staff

Helen Julie Elizabeth Rachel Lynne HayleyFrancis Boulton Mellor Bayley Scott Simpson

The Breast care Nursing team

Helen Francis Breast Advanced Nurse Practitioner

Julie Boulton Breast Advanced Nurse Practitioner

Elizabeth Mellor Breast Care

Nurse Specialist

Rachel Bayley Breast Care

Nurse

Helen Francis Julie BoultonBreast care Nurse Specialist Breast care Nurse Specialist

To contact your Breast Care Nurse Specialist/Key worker

01782 674077 to leave a message any time and we will call you back during office hours

Breast Care Nurse Specialists

Helen Francis Julie BoultonBreast care Nurse Specialist Breast care Nurse Specialist

To contact your Breast Care Nurse Specialist/Key worker

01782 674077 to leave a message any time and we will call you back during office hours

Breast Care Nurse Specialists

We are a team of qualified Nurses with Specialist Breast Care training providing;

• Support and advice for women going through breast screening and assessment• Information, support, practical advice and counselling to women and men who have

breast cancer. • Support for patients, their families and carers from diagnosis through treatment and

follow-up.If you would like to speak to a Breast Care Nurse please ask a member of staff

Helen Julie Elizabeth Rachel Lynne HayleyFrancis Boulton Mellor Bayley Scott Simpson

The Breast care Nursing team

We are a team of qualified Nurses with Specialist Breast Care training providing;

• Support and advice for women going through breast screening and assessment• Information, support, practical advice and counselling to women and men who have

breast cancer. • Support for patients, their families and carers from diagnosis through treatment and

follow-up.If you would like to speak to a Breast Care Nurse please ask a member of staff

Helen Julie Elizabeth Rachel Lynne HayleyFrancis Boulton Mellor Bayley Scott Simpson

The Breast care Nursing team

Lynne Scott Breast Care

Nurse

Hayley Simpson Breast Care

Nurse

Bev Belford Breast Care

Clerical Officer

To contact your Breast Care Nurse/Key worker call:

Royal Stoke Hospital - 01782 674077

County Hospital - 01785 230607To leave a message any time and we will

call you back during office hours

County Hospital

Caroline Wheatley La-ffin Breast Care

Nurse

Natasha Holloway Breast Care

Nurse

Reviewed and reprinted November 2018

Michelle Green Breast Care

Nurse

Immacolata Helming Breast Care

Support Worker

With thanks to your donations www.uhnmcharity.org.uk

Funded by

You have been referred to the “One Stop” breast clinic run by the UHNM Breast Care Team. This means your examination and diagnostic tests, if required, will be carried out where possible during one visit on the same day.

The chart below gives a simple outline of what will happen at the clinic followed by a more detailed explanation of some of the tests you may have and how you may receive your results.

We recommend that you read the information as it will help you understand the process.

For patients on WARFARIN, it is important to have an upto date INR result, bring your INR booklet with you.

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Changes to check forTOUCH LOOK CHECK

1 TOUCH• Can you feel a lump? Either in the breast,

upper chest or armpits.• Is there a lumpy area? Or unusual thickening

of the breast tissue that doesn’t go away?• Is there any unusual pain? Either in part of the

breast or the armpit.

2 LOOK• Any change in size or shape? e.g. one breast

might become larger or lower than the other.• Any change in skin texture? Such as

puckering or dimpling of the skin of the breast.• Any change in colour? e.g. the breast may

look red or inflamed.• What about the appearance or direction of

the nipple? e.g. one might become inverted (turned in) when it normally points out.

• Any unusual discharge? One or both nipples might have a discharge.

• Any rash or crusting? Of the nipple or surrounding area.

3 CHECK• Is anything unusual? If so, get it checked out

by your doctor as soon as possible.

Women may normally feel breast tissue changes or pain before or during your periods. This is why it’s important to check your breasts regularly so you get to know how they look and feel at different times of the month, and can notice any changes that are unusual for you.

You have been referred to the “One Stop” breast clinic run by the UHNM Breast Care Team. This means your examination and diagnostic tests, if required, will be carried out where possible during one visit on the same day.

The chart below gives a simple outline of what will happen at the clinic followed by a more detailed explanation of some of the tests you may have and how you may receive your results.

We recommend that you read the information as it will help you understand the process.

Patient arrives in clinic

Breast Specialist takes history & carries out breast examination

Normal examination and no imaging required. Discharge

from clinic

Patient sent for breast imaging

Generally under 40 yrs –breast ultrasound 40 yrs or over-mammogram and ultrasound

(unless had recent mammogram within last 12 mths)

Normal imaging

Cyst aspiration

Requires a needle core biopsy

Results will be sent by letter or a further

appointment sent by post

Seen by Breast Care Nurse and follow up appointment given

usually within 1 week

Changes to check for TOUCH LOOK CHECK

1 TOUCH • Can you feel a lump? Either in the

breast, upper chest or armpits. • Is there a lumpy area? Or unusual

thickening of the breast tissue that doesn’t go away?

• Is there any unusual pain? Either in part of the breast or the armpit.

2 LOOK • Any change in size or shape? e.g. one

breast might become larger or lower than the other.

• Any change in skin texture? Such as puckering or dimpling of the skin of the breast.

• Any change in colour? e.g. the breast may look red or inflamed.

• What about the appearance or direction of the nipple? e.g. one might become inverted (turned in) when it normally points out.

• Any unusual discharge? One or both nipples might have a discharge.

• Any rash or crusting? Of the nipple or surrounding area.

3 CHECK • Is anything unusual? If so, get it

checked out by your doctor as soon as possible.

You may normally feel breast tissue changes or pain before or during your periods. This is why it’s important to check your breasts regularly so you get to know how they look and feel at different times of the month, and can notice any changes that are unusual for you.

Return at end of clinic to discuss results

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Lump - may not be seen, but might be felt

Skin tex-ture e.g. dimpling/puckering

Appear-ance or direction of nipple

Nipple discharge

Rash or crusting

Patient arrives in clinic

Breast Specialist takes history & carries out breast examination

Normal examination and no imaging required. Discharge from clinic

Normal imaging

Return at end of clinic to discuss

results

Cyst aspiration

Results will be sent by letter or

a further appointment sent

by post

Requires a needle core biopsy

Seen by Breast Care Nurse and

follow up appointment given usually within 1 week

Generally under 40 yrs –breast ultrasound 40 yrs or over-mammogram and ultrasound (unless had recent

mammogram within last 12 mths)

Patient sent for breast imaging

either or

What will happen at the breast clinic?Thankfully, most of the people attending clinic will go home reassured that they do not have cancer.

The UHNM Breast Team uses a triple assessment approach (see below) to reach a diagnosis. Not all people will need all three tests. Initially you will be assessed and examined by a Breast Specialist (either a Breast Surgeon or Advanced Breast Nurse Practitioner) experienced in diagnosing and treating breast problems. You will be asked to complete a patient history sheet including, medical history, any medication you are taking and any past personal history or family history of breast problems. Questions for female patients will also include pregnancy history, use of the oral contraceptive pill and HRT and when your periods started and stopped.

The need for further investigations will be dependent on your symptoms, your age and any recent breast imaging.

Most breast clinics are very busy. We try hard to keep you for as short a time as possible, but as each test takes about 15 minutes queues can develop. The aim is to carry out all tests on the same day (although this may not always be possible) so please allow at least 4 hours to give enough time for all of the necessary tests to be performed and results, if available, to be processed and discussed with you.

If you do not require a biopsy following breast imaging you will be sent back to the clinic to see the Breast specialist to discuss your imaging results. Clinics can sometimes run behind and you may sometimes notice patients who arrived back after you being seen before you, depending on which Specialist they need to see.

Triple assessmentA combination of clinical examination, radiological imaging and tissue sampling (needle core biopsy) is known as a triple assessment. Using several tests increases the thoroughness of the examination and following the clinical breast examination you may be sent to the breast imaging department for a mammogram or an ultra-sound scan or both followed by a needle core biopsy if necessary. We aim to do these on the same day whenever possible.

Please note that if you have had previous breast imaging at another hospital we will request the images so that we can use them as a comparison. If we have not received them in time for your visit , it may not be in your best interests to have imaging the on the same day — this will be discussed with you at the time.

Breast Awareness

Whatever happens at the breast clinic it is still important to be breast aware.

Most cases of breast cancer are found by women noticing unusual changes and taking the initiative to visit their doctor. The earlier breast cancer is found, the better the chance of beating it – so you can see how important it is to make regular checks.

Being breast aware simply means knowing what your breasts look and feel like normally, being on the lookout for any unusual changes and getting them checked out by your doctor. It is important to be breast aware in between your screening mammograms.

Lumps are vital to look out for – but there can be other important signs too. And even if you do find a lump, in most cases they do not turn out to be cancer.

So stay calm – remain in control.

It’s as simple as TLC...

TOUCH your breasts. Can you feel anything unusual?

LOOK for changes. Is there any change in shape or texture?

CHECK anything unusual with your doctor.

No one knows your body better than you and everyone will have their own way of touching and looking for changes – there’s no special technique and you don’t need any training.

It’s good to get into the habit of doing this regularly – maybe when you’re in the bath or shower, or while getting dressed in the morning. You might prefer to do it while standing up or lying down. Either way, the important thing is to be familiar with how your breasts look and feel normally, so you notice anything unusual – and remember to check the whole breast area, including your upper chest and armpits.

If you would like further information on breast awareness please ask the clinic staff or breast imaging staff for an information leaflet or visit the

Breast cancer care website at www.breastcancercare.org.uk

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Clinical Breast ExaminationA clinical breast examination is the physical examination of the breast tissue and axilla (armpit) by palpation (feeling) and visual observation. The patient’s breasts are observed in several positions to evaluate the breasts and the breast tissue is examined by hand to detect any palpable abnormalities.

For the examination, you will be required to undress from the waist up. Your breast specialist will look at your breasts for changes in size or shape and may ask you to lift your arms over your head, put your hands on your hips or lean forward. The breast specialist will examine your breasts for any skin changes including rashes, dimpling or redness. This is a good time to learn how to do breast self-examination if you don’t already know how to. As you lay on your back with your arms behind your head your breast specialist will examine your breasts with the pads of the fingers to detect lumps or other changes. The area under both arms will also be examined.

The breast specialist will gently press around your nipple to check for any discharge. If there is a discharge a sample may be collected for examination.

If the Breast Specialist recommends that you undergo breast imaging you will be sent to the breast imaging department next to the clinic. The clinic staff will direct you.

Breast ImagingAny breast imaging tests you have will be dependent on your symptoms, your age and any recent breast imaging you may have had. Breast imaging will usually include one or more of the following:

A mammogram (breast x-ray)

An ultrasound scan

An image guided needle core biopsy.

If you have recently had any of these tests it is important to tell the Breast Specialist and the breast imaging staff.

Mammogram

A mammogram is a low-dose x-ray of the breast tissue. You will be required to take off the clothes from the top part of your body, for females this will include your bra. The radiographer will then position you so that the breast is against the x-ray machine and gently but firmly compressed (squashed) with a flat, clear, plastic plate. Two mammograms (from different angles) are taken of each breast.

The Breast Care Nurse will provide you with support and written information and can be a point of contact for you throughout your diagnosis, treatment and afterwards. The proposed plans for a results appointment and on-going care will be discussed with you.

If you have further questions or need further support after you have left clinic the

UHNM Breast Care Nursing teamcan be contacted on their helplines on

Royal Stoke Hospital 01782 674077 County Hospital 01785 230607

Our working hours are Monday to Friday 9.00am and 4.30pm. The direct line is linked to an answer machine where the messages are collected regularly and answered confidentially.

Breast screening factsThe North Midlands breast screening service is part of the NHS breast screening programme. It currently provides breast screening for women from the age of 50 to 70 years. Any woman over the age of 70 may self-refer for screening by ringing North Midlands Breast Screening on 0300 123 1463.

Breast screening aims to find breast cancer at an early stage, often before there are any symptoms. To do this, an x-ray is taken of each breast (mammogram). Early detection may often mean simpler and more successful treatment.

For further information about breast screening in North Staffordshire visit: www.bscreen.org.uk/northstaffordshire

National information and SupportBreast Cancer Care has a helpline for information & support: 0808 800 6000 or

Email: bcc@breastcancercare.org.uk

Web site for information on benign (non-cancerous) breast conditions and breast cancer - www.breastcancercare.org.uk

Macmillan Cancer Support on 0808 808 0000. Web site - www.macmillan.org.uk

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The breast tissue needs to be compressed firmly to keep the breast still and to get a clear picture. Some will find this uncomfortable and occasionally it is painful for a short time. You will need to stay still for less than a minute while the picture is taken.

Mammograms are usually the primary test used for women aged 40 or over.In younger women the breast tissue is denser and this can make it difficult to detect any changes on the mammogram and so is not routinely used on women under 40. Mammograms and breast ultrasound scans are also used to investigate breast symptoms in men. (Note – please make sure that you have not used talcum powder before this investigation).

Ultrasound scan

An ultrasound uses sound waves to build up a picture of the breast tissue. Ultrasound can often tell whether a lump is solid (made of cells) or is a fluid-filled cyst. It can also often characterize whether a solid lump is likely to be cancerous or not.

You will be asked to take off the clothes from the upper part of your body and lie down on a couch. An ultrasound specialist will then put gel onto the breast and gently rub a small probe over the affected area. This shows a picture of the internal tissue of the breast on a screen. Ultrasound is painless and only takes a few minutes.

Ultrasound guided cyst aspiration

Breast cysts are common. If a cyst is identified on breast imaging aspiration (drainage) is often required, especially if the cyst is palpable to relieve discomfort or for reassurance. On occasion it is used when it is difficult to distinguish between a solid lesion and a complex cyst. The ultra sound probe is used to visualise the tip of a small bore needle as it is inserted to the relevant cyst, then an attached syringe is used to aspirate the fluid under ultrasound guidance.

Needle Core BiopsyA core biopsy is the removal of a small piece of tissue under local anaesthetic using a special needle. A core biopsy can help your Breast Specialist diagnose your breast problem by taking a piece of tissue from the area of concern or lump. This tissue is then sent for examination in the laboratory for analysis. This analysis usually takes approximately 1 week. A leaflet explaining aftercare instructions will be given to you after your biopsy. Needle core biopsies can be performed using imaging equipment in the breast imaging department to guide the specialist or if it can be felt easily it may be biopsied by your Breast Specialist in the clinic.

Receiving the results of your testsWe will tell you when to expect your results. It can be helpful to have your partner or a close friend or relative with you when you get them.

Results Following Breast imaging only

If you do not require a biopsy, the results of your imaging will usually be available on the same day. The breast imaging staff will direct you back to the clinic to discuss your results with the Breast Specialist. The length of your whole visit could take at least 4 hours.

Results following a needle core biopsy

Needle core biopsy results can take approximately 1 week to process as the tissue samples will be analysed under the microscope. In some cases you will be given a follow-up appointment to return to discuss results, further investigations or appropriate treatment. For others the Breast Specialist may decide to inform you by letter. If you are unsure how you will get your results please ask a member of staff. Imaging staff will be able to answer questions during your investigations and a Breast Care Nurse Specialist will be available in the breast imaging department for information and support if required.

For the majority of women and men breast investigations will show normal breast changes or a benign breast condition. In these cases the Breast Specialist will explain what this means for you and whether you need any treatment or follow up. Women and men with no significant findings will be reassured and discharged.

If your results show that you may have breast cancer you will feel all sorts of emotions such as shock, fear, anger and helplessness. You may find it hard to take in what you are being told. Having someone with you who can listen carefully or ask questions can be very helpful. You will also meet a Breast Care Nurse, who will talk to you about your possible diagnosis and if you wish possible treatments.

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An image guided core biopsy in the x-ray department

If the area of concern cannot be felt or felt easily, your biopsy will be performed in the x-ray department. The procedure will be carried out using the mammogram machine or ultrasound machine to guide a Radiologist (a Specialist Imaging doctor) or a Consultant/Advanced Practitioner in Breast imaging (a Specialist Radiographer) to the area of concern and is called an image guided core biopsy. This may also include taking a biopsy of lymph nodes under your arm.

It is standard practice after an image guide biopsy for a breast marker clip to be left in the breast, ensuring we know exactly where in the breast the biopsy has been taken from. This titanium marker clip is safe, can not be felt and will not interfere with any other investigations you may require in the future.

Ultrasound guided core biopsy

This is a method used to sample ultrasound visible abnormalities and lymph nodes under your arm. An ultrasound technique is used to guide the needle to the required position. The procedure will be explained to you by the Radiologist or Consultant/Advanced Practitioner in order to obtain your written consent and co-operation. You will be asked to undress to the waist and will be positioned on a couch. You will be given a local anaesthetic injection to anaesthetise (numb) your breast. This injection may sting for a few moments. A special biopsy needle is then used to take some pieces (cores) of tissue. It will be necessary to take a few cores to obtain an adequate sample. The staff will need to apply firm pressure to your breast in between samples being taken to try to minimise bruising. You should not feel pain during the procedure however if you do experience pain at any point please tell the staff. Once the procedure is finished a firm dressing will be applied and you will be able to sit for a while recover before going home. You will be provided with an after care information leaflet and a copy of the consent form.

X-ray (mammogram) guided biopsy

This is a method used to sample x-ray visible abnormalities. An x-ray technique is used to guide the needle to the required position. The procedure will be explained to you by the Radiologist or Consultant/Advanced Practitioner in order to obtain your written consent and co-operation. You will be asked to undress to the waist and will be positioned on a special chair. Your breast will be pressed between two special plates so that the breast tissue and area of concern can be clearly seen. After that, you will be given an local anaesthetic injection to anaesthetise (numb) your breast.

This injection may sting for a few moments. A special biopsy needle is then used to take some pieces (cores) of tissue. It will be necessary to take a few cores to obtain an adequate sample. The staff will need to apply firm pressure to your breast in between each sample being taken to try to minimise bruising. You should not feel pain during the procedure however if you do experience pain at any point please tell the staff. Once the procedure is finished a firm dressing will be applied and you will be able to sit for a while to recover before going home. You will be provided with an after care information leaflet and a copy of the consent form.

Note: This technique can be time consuming and requires the use of highly specialist equipment which may not be available the same day. If this is the case you will be offered the next available appointment for the test.

A core biopsy in clinic

If you have a lump that can be easily felt a Breast Surgeon may perform your biopsy in clinic.

The procedure will be explained to you by the doctor in order to obtain your written consent and co-operation. You will be asked to undress to the waist and will be positioned on the examination couch. You will be given a local anaesthetic injection to anaesthetise (numb) your breast. This injection may sting for a few moments. A special biopsy needle is then used to take some pieces (cores) of tissue. It will be necessary to take a few cores to obtain an adequate sample. The staff will need to apply firm pressure to your breast in between each sample being taken to try to minimise bruising. You should not feel pain during the procedure however if you do experience pain at any point please tell the staff. Once the procedure is finished a firm dressing will be applied and you will be able to sit for a while to recover before going home. You will be provided with an after care information leaflet and a copy of the consent form.

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