Breast Cancer - Treatment Overview

Treatment Overview

Breast cancer is usually treated with surgery, medicine, and radiation therapy. Because of improved screening methods, diagnosis at an early stage, and improved treatment techniques, the number of deaths from breast cancer has been steadily declining over the past few years. Decisions about how to treat breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.

When making decisions about treatment for your breast cancer, you and your doctor will consider:

• The size and location of your breast cancer (stage).
• How aggressive the breast cancer is.
• Whether your breast cancer has receptors to the hormones estrogen and progesterone, called estrogen receptor/progesterone receptor (ER/PR) status.
• Whether your breast cancer cells contain human epidermal growth factor (HER-2/neu).
• Whether your breast cancer has spread to the lymph nodes in your underarm area (axilla).

You and your doctor will also consider your personal preferences and health when developing a treatment plan for you. This will include:

• Your feelings about keeping your breast.
• Your personal and family history of breast cancer.
• Your age and whether you have other serious health problems.

Most people with breast cancer have surgery to remove the cancer from the breast. Some or all of the lymph nodes under the arm are also usually removed to find out whether the breast cancer has spread to this area.

Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may be treated with radiation therapy. Chemotherapy or hormone therapy may also be recommended to make sure that the breast cancer cells have been destroyed. You may also be given chemotherapy or hormone therapy to shrink your breast cancer before surgery. This is called neoadjuvant therapy.

Initial treatment

Initial treatment of breast cancer may include:

• Surgery to remove the cancer. This may be done by removing the whole breast (mastectomy) or just the part of the breast that contains the breast cancer (breast-conserving surgery, or lumpectomy). Some of the lymph nodes under the arm will also be removed using either axillary lymph node dissection or sentinel node biopsy.
• Radiation therapy, which is the use of high-dose X-rays to destroy cancer cells and shrink tumors.
• Chemotherapy, which is the use of medicine to destroy cancer cells. Chemotherapy is called a systemic treatment, because the medicines enter the bloodstream, travel through the body, and can destroy cancer cells outside the target area.
• Hormone therapy with tamoxifen or an aromatase inhibitor, to change the way hormones in the body cause cancer growth.
• Treatment with trastuzumab (Herceptin) if your breast cancer tests positive for human epidermal growth factor (HER-2/neu).

What type of surgery should I have to treat early-stage breast cancer?

Should I use chemotherapy for early-stage breast cancer?

Treatment for women over 70

If you are older than 70, you may be a good candidate for having limited treatment and skipping lymph node biopsy or radiation.¹⁹ This depends on your health and what type of breast cancer you have.

Coping with your diagnosis

The diagnosis of breast cancer is devastating and scary. Most women will experience some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to breast cancer. You may find that talking with family and friends helps you with your emotions. Some women find that spending time alone is what they need.

If your reaction interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.²⁰

Nausea and vomiting

One of the biggest concerns about treatment for cancer is managing nausea and vomiting from chemotherapy. Depending on the type of chemotherapy, you may only need home treatment to reduce mild nausea. But for certain types of chemotherapy, it's best to take prescription medicine for nausea and vomiting. In some cases, it's best to take it before the first dose of chemotherapy. Everyone is different. Work with your doctor to develop a plan that works for you.

For more ways to help manage side effects caused by breast cancer or breast cancer treatment, see the Home Treatment section of this topic.

Ongoing treatment

After the initial treatment for breast cancer, you may see your family doctor, general practitioner, medical oncologist, radiation oncologist, or surgeon at regularly scheduled intervals, depending on your individual situation. The length of time between visits will gradually lengthen until at 5 years, if no new problems develop, you are seeing your doctor once each year. As part of your follow-up, you may have:

• Physical exams. The frequency of your physical exams depends on your general health and the type of breast cancer you have. In general, you will see your doctor every 3 to 6 months for 3 years and then every 6 months until 5 years have passed since your diagnosis of breast cancer. You may see your doctor once a year at this point.
• Mammograms to screen for breast cancer and investigate lumps that can be felt during a breast exam.

After treatment for breast cancer, it is important to do regular self-exams. This may help you detect signs of recurrence. Early signs of recurrence may appear in the incision area itself, the opposite breast, under your arm, or in the area above the collarbone.

If new problems develop, you may have additional tests, such as blood tests, bone scans, chest X-rays, CT scans, or MRI tests.

If your breast cancer cells test positive for estrogen and progesterone receptors (ER/PR+), any remaining cancer cells may grow because of estrogen in your body. Medicine such as an aromatase inhibitor (such as Arimidex, Aromasin, or Femara), or tamoxifen (Nolvadex) may be a good treatment option. These hormone therapies block estrogen's effect on the cancer cells.

Studies show that an aromatase inhibitor works even better than tamoxifen in postmenopausal women who are also estrogen receptor-positive (ER+).^{21, 22, 23, 24} For women who have taken tamoxifen for a few years, switching to an aromatase inhibitor improves their chances of successful treatment.²⁵ Talk with your doctor about the risks and benefits of these medicines if your breast cancer is ER/PR+.

Treatment if the condition gets worse

For information about the treatment of metastatic or recurrent breast cancer, see the topic Breast Cancer, Metastatic or Recurrent.

What to Think About

Even if your doctor removes all the cancer that can be seen at the time of the operation, you may need additional treatment. Radiation therapy, chemotherapy, hormone therapy, or a combination of the three therapies may be used after surgery to try to destroy any cancer cells that may be left in your body. This is called adjuvant therapy and is used to reduce the chances that your breast cancer will come back. Talk with your doctor about the risks and benefits of each type of treatment. Your personal preferences and considerations are important when choosing a treatment that is right for you.

Should I use chemotherapy for early-stage breast cancer?

You may also make decisions about using chemotherapy or hormone therapy to shrink your breast cancer before surgery (neoadjuvant therapy). Talk with your doctor about the risks and benefits of each type of treatment.

The likelihood that your breast cancer will return after treatment depends on a number of factors, including the size and grade of your breast cancer, whether you had breast cancer cells in your lymph nodes, and how many lymph nodes were involved with breast cancer.