Late effects of breast cancer treatment

Most people have side effects during treatment for breast cancer and for a few weeks after treatment ends. Usually, these side effects get better slowly and then stop. But sometimes side effects do not go away. Or they can develop months or years after treatment.

There are 2 commonly used terms for these side effects:

• long-term effects – if they begin during treatment or shortly after treatment has ended, and last for months
• late effects – if they begin months or even years after treatment.

In this information, we use the term late effects to include both long-term and late effects of treatment.

Late effects may be minor and not affect your daily life much. Or they may be more difficult to live with and affect your daily life more.

There are many things that can be done to help manage or treat late effects. It is important that you get support to help you cope with them and live life as well as you can. Some late effects improve over time and may eventually go away on their own.

We have more information about coping with breast cancer.

Surgery and radiotherapy to the breast can cause a number of changes. These can include:

• changes to the appearance of the breast
• pain and changes in sensation
• problems with movement or strength
• cording (cord-like structures under the skin on the inner arm)
• swelling of the arm, hand or breast (lymphoedema), if the armpit is treated.

Peripheral neuropathy (also called neuropathy) is damage to nerves that carry messages between the brain, the spinal cord and the rest of the body. Nerve damage can cause symptoms such as pins and needles, numbness or pain in the hands and feet. For some people, this may lead to problems with balance and walking.

Treatment with the chemotherapy drugs docetaxel or paclitaxel is the most common cause of peripheral neuropathy in breast cancer. Some types of targeted therapy can also cause peripheral neuropathy. Surgery and radiotherapy to the breast may also cause nerve damage on the treated side.

After treatment has stopped, these symptoms usually get better as the nerves recover. This usually takes several months. But sometimes the nerves do not completely recover, and some nerve damage is long term. The symptoms may still get better over time.

We have more information about peripheral neuropathy.

Some breast cancer treatments can affect the way the ovaries work. This can cause an early menopause for some women, which may be temporary or permanent. 

It can also cause side effects similar to menopausal symptoms. Sometimes these effects do not last long.

We have more information about managing menopausal symptoms.

After breast cancer treatment, you may be at a greater risk of bone thinning. This is called osteoporosis. It happens because some treatments can reduce the amount of oestrogen in the body. Oestrogen helps to keep bones healthy and strong.

Treatments for breast cancer that can increase the risk of osteoporosis are:

• chemotherapy, especially if it causes an early menopause
• hormonal therapy with aromatase inhibitors (AI) such as anastrozole, exemestane or letrozole
• drugs called LHRH analogues, such as goserelin (Zoladex^®) and leuprorelin
• ovarian ablation (surgery to remove the ovaries).

Rarely, radiotherapy weakens the bones in the treated area. For example, it may weaken the ribs and collarbone.

Most people are usually offered drugs called bisphosphonates. These help to reduce the risk of breast cancer coming back and help to strengthen the bones. If you have bone thinning you may also be offered supplements to help.

We have more information about bone health.

If you are taking aromatase inhibitors you may have joint pain and sometimes muscle pain. Joint pain is also a common symptom of the menopause.

We have more information about managing joint and muscle pain.

After treatment for breast cancer, you may have difficulties concentrating and remembering things. Doctors call this cognitive impairment.

It is also sometimes called chemo brain or chemo fog. But these changes can also happen with other cancer treatments, such as hormonal therapy.

An early menopause may result in similar symptoms, or make them worse.