The shameful way in which some breast cancer patients are being treated, with little dignity or respect for their feelings, is exposed today in troubling testimony from women affected by the disease.

Patients who have not been told the full truth about the effects of their treatment, and others who have been forced to be seen in humiliating circumstances, suggest that the improvements in speeding up cancer care are not being matched by improvements in the way individuals are cared for.

Working with the charity Breakthrough Breast Cancer, The Observer is supporting a debate on what kind of treatment women feel they should have a right to expect.

One of the most difficult issues is that doctors sometimes ask to photograph women before they undergo surgery, both to help surgeons who may later carry out reconstructive surgery, and for educational purposes.

Done properly, this should not be traumatic. But Lorraine Lloyd, who was diagnosed in June 2000, described how she was asked three times to have her photograph taken before she agreed.

'I was taken into this very large room with no chaperone, just a male photographer, and asked to strip to the waist. I was then asked to stand under these umbrellas in the glare of bright lights and have my photo taken, almost as if I were a Page Three model. I can't describe how awful and humiliating this felt. I came out and burst into tears afterwards.'

After months of complaining, she received an apology from her hospital, the Lister in Stevenage. A spokesman said they have since carried out a full review of the way in which Lloyd and others had been treated, and now insist that a woman has to be with the patient when any picture of an intimate nature is taken.

The surroundings in which women are seen and treated throughout their breast cancer experience are important. Breakthrough Breast Cancer believes that far too many are seen in shabby surroundings which offer little or no privacy. Delyth Morgan, chief executive of the charity, has launched a consultation paper on the kind of treatment patients should be entitled to receive.

'We know there are women waiting for radiotherapy who have to sit in a corridor alongside many other women,' she said. 'Some will be at the beginning of their treatment, some at a far more advanced stage of the disease. This isn't right and it shouldn't be beyond the ability of the hospital staff to find a way of treating patients with a bit more respect.'

Professor Ian Fentiman, breast cancer surgeon at Guy's Hospital in London, agrees. 'Lots of money has gone into equipment and treatment, but very little into bricks and mortar or paint.

'I think where a patient is seen matters a lot, so that it doesn't feel claustrophobic or dirty, and so that they come away feeling that they have been treated with some dignity. People in the NHS are so busy they sometimes forget the stress that patients are under and being put into a depressing waiting room simply makes them feel worse.'

The Government's own survey of NHS patients two years ago showed that there is huge variation in the hospital environment, particularly over hygiene. At the best hospitals, only 16 per cent found it dirty, but that figure rose to 82 per cent at the worst units.

Most also felt that the rooms in which they were seen did give enough privacy, but there remain pockets where women feel unhappy.

One of those used to be Newcastle General Hospital, where women would be asked to strip to the waist to have the X-ray treatment they needed. However, the nurses sympathised with patients' embarrassment and devised a tunic that only exposed one side of the body at a time.

For many patients, the more difficult issue is the freedom to discuss with the doctor or nurse all the ramifications of a treatment programme. Sheila Johnstone told The Observer she had not been told about the full impact of her treatment when she was a private patient at the Royal Marsden Hospital in London. She was happy with the care in her diagnosis and treatment, but after her surgery she began to worry.

The chemotherapy she was given after her lumpectomy (removal of the tumour, but not the whole breast) threw her into an early menopause. 'I had severe hot flushes - so bad that sleep was almost impossible,' she said. 'I was prescribed anti-depressants, but when I stopped taking them I had awful side-effects.'

She says she has tried on several occasions to discuss the issue of fertility, but feels that her oncologist does not want to broach the subject. 'Because of my cancer, I cannot take any oestrogen-based contraception, and what I know now is that I could have had my ovaries removed, which would have avoided those menopausal symptoms. But it is almost as if the issue is off-limits.'

Sheila, who is childless and has a partner, then found out she had become pre-menopausal and was therefore at risk of becoming pregnant, but no one had told her. 'It could have been terrible, because if I had fallen pregnant the baby might have been damaged by the chemotherapy and I would have been looking at a termination.'

Other women said they were not warned about the risk of early menopause which can be brought on by the drugs after surgery.

Another London patient, Chris Mowbray, wrote to us saying: 'When I had the chemotherapy at the age of 46, nobody told me it would send me into an instant menopause and that I would suffer all the symptoms.

'I am still having surgery for reconstruction and learnt in 1997 that if I had had the right investigations when the lump was found, I needn't have had a mastectomy. I feel that some surgeons still have a lot to learn when it comes to listening to the patient.'