How much treatment is enough to defeat breast cancer? This question makes me think about Goldilocks: Not too hard, not too soft, but just right.
That's what we are seeking: Just the right amount of treatment to get rid of the cancer and prevent it from ever recurring again, but not so much that you are needlessly overexposed to powerful drugs or radiation.
Determining just the right amount of treatment, while not as precise and scientific a process as you might think, has improved. If we look back 100 years ago, the standard of care for breast cancer was the Halsted radical mastectomy-removal of the entire breast, all lymph nodes, all skin and chest muscles, and sometimes even a few ribs.
Granted, back then a "small" tumor was defined as something around 10 centimeters (about 4 inches) in diameter. Thankfully, as time passed, we learned that lumpectomy with radiation is equal to mastectomy, and that mastectomy does not necessitate removing all the nodes and chest muscles.
But it's the chemotherapy that worries the majority of women the most. How much, if any, is needed, and for how long? Thirty years ago, chemo would be continued for an entire year.
Today, the recommended course is usually three to six months. And now that tests are available that can predict the risk of recurrence even for women with early-stage breast cancer, only those women most likely to benefit from chemotherapy are being advised to take it. Those who wouldn't benefit from chemo are instead taking hormonal therapy to deliver a knockout blow that will prevent recurrence.
What is unfortunate in all this is that we can't yet tell if a treatment was "enough" until we can finally see that we've remained healthy and are free from a recurrence.
If the disease does return some years down the road, then questions arise as to whether the original treatment was sufficient. There will always be cases in which, despite having thrown the entire kitchen sink of available treatments at the disease, the doctors can't prevent the cancer from coming back.
It is good to always remember that no treatment comes with a 100-percent guarantee of non-recurrence. Doctors make decisions based on a multitude of factors: Results of previous clinical trials of the various available treatments; the type of tumor itself; the doctor's own experience treating the disease; how much of a risk-taker or worrywart you are; and your age at the time of treatment (a 95-year-old woman would get less intensive treatment than a 35-year-old).
All of these elements go into devising the best treatment plan possible for your particular situation. Most importantly, you need to feel confident that the treatment plan your doctor recommends is, indeed, the right one for you.