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Learn about EC chemotherapy for breast cancer, including what it is, who might have it, how it's given and possible side effects.

1. What is EC chemotherapy?

EC is a combination of two drugs used to treat breast cancer.

It takes its name from the initials of these drugs:

  • Epirubicin
  • Cyclophosphamide

2. Who might be offered EC chemotherapy?

Primary breast cancer

EC chemotherapy can be used to treat

Chemotherapy is given to reduce the risk of breast cancer returning or spreading.

EC chemotherapy may be given before surgery, known as neo-adjuvant treatment (sometimes called primary chemotherapy), or after surgery, known as adjuvant treatment.

If breast cancer has come back or spread

EC chemotherapy may also be given to people whose breast cancer has:

  • Come back in the chest/breast area or in the skin near the original site or scar (local recurrence)
  • Spread to the tissues and lymph nodes around the chest, neck and under the breastbone (locally advanced breast cancer)
  • Spread to other parts of the body (secondary breast cancer)

3. Before starting EC chemotherapy

Before starting your treatment, most hospitals will arrange a chemotherapy information session.

A nurse will discuss how and when you will have your chemotherapy and how side effects can be managed.

You will have blood tests and some people will have an ECG (electrocardiogram), a simple test that checks your heart rhythm. Your height and weight will also be measured. This is used to work out the correct dose of chemotherapy for you.

You’ll be given contact numbers so you know who to phone if you have any questions or concerns.

4. How is EC chemotherapy given?

EC chemotherapy is usually given directly into your vein (intravenously). 

You’ll usually have your chemotherapy as an outpatient so you will be able to go home the same day.

How long is it given for?

You’ll usually have one cycle (dose) of EC chemotherapy every 3 weeks. Both drugs are given on the same day.

In total you will usually have 4 to 6 cycles of EC chemotherapy, over 3 to 4 months.

The time between each cycle of treatment gives your body time to recover. This may vary depending on whether the number of blood cells has returned to normal between each cycle.

If EC chemotherapy is given for 4 cycles, it may be followed by another chemotherapy drug such as docetaxel or paclitaxel.

When having EC followed by paclitaxel, the time between each chemotherapy cycle may be shorter than the standard treatment plan. This is called dose dense.

5. Side effects of EC chemotherapy

Like any treatment, EC chemotherapy can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others.

These side effects can usually be managed and those described here will not affect everyone.

If you’re concerned about any side effects, regardless of whether they are listed here, talk to your chemotherapy nurse or treatment team.

Before starting chemotherapy you should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including at night or at the weekends.

Common side effects

Effects when having EC chemotherapy

If epirubicin leaks out of the vein, it can damage the surrounding soft tissue (called extravasation).

Tell the chemotherapy nurse immediately if you experience pain, stinging or a burning sensation near the while the drug is being given.

While the drug cyclophosphamide is being injected, you may feel hot or flushed and slightly dizzy, and have an itchy nose or a metallic taste in your mouth.

These feelings usually go away when the injection is finished, but tell your chemotherapy nurse if you experience any of them. Some people find sucking a boiled sweet helps.

Effects on the blood

EC chemotherapy can temporarily affect the number of healthy blood cells in the body.

You’ll have regular blood tests to check your blood count. If the number of blood cells is too low, your next course of treatment may be delayed or the dose of chemotherapy reduced.

Risk of infection

Not having enough white blood cells can increase the risk of getting an infection.

Signs of an infection

Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital immediately if you experience any of the following:  

  • A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised  
  • Suddenly feeling unwell, even with a normal temperature  
  • Symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery 

Before starting chemotherapy, your treatment team should give you a 24-hour contact number or tell you where to get emergency care. 

You may need antibiotics. Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.


Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.

Bruising and bleeding

EC chemotherapy can reduce the number of platelets, which help the blood to clot. You may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your treatment team if you have any of these symptoms.

Hair loss

EC chemotherapy causes total hair loss in most people. As well as the hair on your head, this can also affect your body hair including eyebrows, eyelashes and pubic hair, and chest hair for men. Hair loss usually starts after the first cycle of treatment.

Scalp cooling may be possible to try to prevent or lessen hair loss. It’s not available in all areas so ask your treatment team if this is available and suitable for you.

Find out more about hair loss.

Nausea and vomiting

You may feel sick (nausea) or be sick (vomit), but many people will not actually be sick.

You’ll be given anti-sickness medication before the chemotherapy is given, and you’ll be prescribed anti-sickness drugs to take home to reduce nausea or stop it happening.

Bladder irritation and pink or red urine

Chemotherapy drugs (particularly cyclophosphamide) can irritate the lining of the bladder.

It’s important to drink plenty of fluids around the time you have your treatment.

Try to empty your bladder regularly, as soon as you feel the urge. Tell your treatment team if you notice any irritation or a burning/stinging sensation when passing urine.

Epirubicin can cause your urine to become pink or red for a couple of days. This is because of the colour of the drug and is completely normal.

Sore mouth and taste changes

Looking after your mouth, including your teeth and gums, is very important during treatment.

You’ll be given mouthwash to try to reduce soreness, and to try to stop mouth ulcers developing.

It’s advisable to see your dentist for a dental check-up before chemotherapy begins and to avoid dental treatment during chemotherapy if possible. If you do need to have dental treatment during chemotherapy, talk with your oncologist about the best time to have this.

Epirubicin can make some food taste different, for example more salty, bitter or metallic. This usually returns to normal once you have finished treatment, although this may take some time.

Our information on diet during breast cancer treatment includes tips on dealing with taste changes.

Sore eyes and blocked or runny nose

Your eyes may feel sore, gritty or watery. Your treatment team may prescribe eye drops to ease discomfort.

EC chemotherapy can also cause a blocked or runny nose. Tell your treatment team if this happens while your chemotherapy is being given.

Extreme tiredness

Cancer-related fatigue is extreme tiredness that does not go away with rest or sleep. It’s a very common side effect of breast cancer treatment and may affect you physically and emotionally.

If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.

Find out more about managing fatigue.

Effects on fertility

EC chemotherapy can cause temporary or permanent infertility (being unable to get pregnant).

If having your own children is important to you, talk to your specialist before starting your treatment. They may be able to refer you to a fertility specialist to discuss any possible fertility preservation options.

Find out more about fertility and breast cancer treatment.

Menopausal symptoms

For women who haven’t been through the menopause, EC chemotherapy can cause menopausal symptoms. This is because it affects the ovaries, which produce oestrogen.

Common menopausal symptoms can include:

  • Hot flushes and night sweats
  • Mood changes
  • Joint aches and pains
  • Vaginal dryness

You can talk to your breast care nurse or treatment team about ways of coping with any of these symptoms.

Find out more about breast cancer and menopausal symptoms.

Effects on your concentration

You may find it hard to concentrate or think clearly, which can be very frustrating.

This is often referred to as ‘chemo-brain’ or ‘chemo-fog’, but your treatment team may call it cognitive impairment. It usually improves over time after treatment has finished.

Less common side effects of EC chemotherapy

Heart changes

Epirubicin can affect the way your heart works and may not be suitable for people with existing heart conditions.

Heart problems as a result of epirubicin are not common. However, because they can happen, before you start chemotherapy your treatment team will arrange a heart (cardiac) function test to check your heart is working normally.

Skin reactions

Epirubicin may cause your skin to become red and sore, especially if you’ve had radiotherapy recently. Let your treatment team know if this happens.

Your skin may darken due to extra pigment (colour) being produced. Any darkening usually returns to normal a few months after the treatment ends.

During EC chemotherapy treatment, and for several months afterwards, your skin will be more sensitive. You’ll be more likely to get sunburnt so wear sunscreen with a high sun protection (SPF) if you’re out in the sun.

6. Other important information

Blood clots

People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.

Having EC chemotherapy increases the risk of blood clots such as a deep vein thrombosis (DVT).

People with a DVT are at risk of developing a pulmonary embolism (PE). This is when part of the blood clot breaks away and travels to the lung. Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.


Blood clot symptoms

If you have any of the following symptoms, contact your treatment team or go to your local A&E department immediately:

  • Pain, redness/discolouration, heat and swelling of the arm or leg
  • Swelling, redness or tenderness where a central line is inserted to give chemotherapy - for example in the arm, chest area or up into the neck
  • Shortness of breath
  • Pain or tightness in the chest
  • Unexplained cough or coughing up blood

Find out more about blood clots.

Sex, contraception and pregnancy

Sex during treatment

You can still have sex during treatment.

It’s thought that chemotherapy drugs cannot pass into vaginal fluids or semen, but this can’t be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids.

Most hospital specialists will advise using barrier methods of contraception, such as condoms, during treatment and for a few days after chemotherapy is given. 

Find out more about how breast cancer and its treatment can affect sex and intimacy and read our tips on how to manage these changes.

Contraception and pregnancy

You’re advised not to get pregnant while having treatment because EC can harm a developing baby.

If you have not been through the menopause, talk to your team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods become irregular or stop.

You should use contraception during treatment and for 12 months after finishing.

Men having EC should use contraception during treatment and for 6 months after finishing.


You’ll be advised not to breastfeed during treatment with EC. This is because there is a chance that your baby may absorb the drug through your breast milk, which can cause harm.


If you’re planning a holiday or need to travel overseas, check with your treatment team first. 

You shouldn’t have any live vaccines while you’re having chemotherapy. Live vaccines include measles, rubella (German measles), polio, BCG (tuberculosis), shingles and yellow fever.

Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.

It’s safe to have these vaccines 6 months after your chemotherapy finishes. Talk to your GP or treatment team before having any vaccinations.

If someone you have close contact with needs to have a live vaccine speak to your treatment team or GP. They can advise what precautions you may need to take depending on the vaccination.

Coronavirus (Covid-19) vaccination

People having chemotherapy are advised to speak to their treatment team before having the coronavirus (Covid-19) vaccination.

Flu vaccination

Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy. The flu vaccine is not a live vaccine so does not contain any active viruses. Talk to your chemotherapy team or breast care nurse about the best time to have your flu jab.

7. Further support

Your chemotherapy team and breast care nurse can help with any questions you have.

On our online forum, you can find people going through treatment at the same time as you.

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Quality assurance

Last reviewed in May 2021. The next planned review begins in May 2023.

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