Breast Cancer Treatments

Treatment plans for breast cancer are developed based on a number of factors, including the type and stage of the cancer, the sensitivity of the cancer to certain hormones, whether or not the cancer overexpresses the HER-2/neu gene, and the medical history of the patient. Treatment plans usually include a primary treatment involving surgery to remove the cancer, and some sort of adjuvant therapy to improve effectiveness of the primary treatment, to increase long-term survival rates and to help ease recovery.

Primary Treatments

Primary treatment for breast cancer is surgery, either a lumpectomy or mastectomy.

Lumpectomy

During a lumpectomy, the surgeon removes the tumor and a small margin around it. Lumpectomy is most effective on small tumors that can be excised without involving too much surrounding tissue.

Mastectomy

A mastectomy can be either simple or radical. Simple mastectomy (also called “partial mastectomy) involves removing all of the breast tissue—skin, fatty tissue, lobules, and ducts. Radical mastectomy (also called “total mastectomy”) includes removing the chest wall muscle along with surrounding lymph nodes in the armpit.

Adjuvant Therapy Treatment

In addition to the primary treatment, breast cancer treatment plans usually include additional therapies either before or after the surgery. In neoadjuvant therapy treatments are used before surgery in order shrink large tumors to make the surgery easier. In adjuvant therapy treatments are applied after the surgery in order to help or contribute to your recovery. Both neoadjuvant and adjuvant therapies are intended to increase long-term, disease-free survival rates. These therapies may include:

• Biological or targeted therapy
• Chemotherapy
• Hormone therapy
• Radiation, a local adjuvant therapy

In some cases, these therapies may be combined. The decision made by you and your doctor regarding which therapy to use will depend on many factors. These include your age, the size and nature of the tumor and its cells, cancer cell sensitivity to hormones estrogen and progesterone, human epidermal growth factor receptor 2 (Her-2/neu ) status, and whether the cancer has spread to your lymph nodes. Below are summaries of the four major adjuvant therapies.

Biological or Targeted Therapies

If your breast cancer cells throw off an excess of Her-2/neu, which encourages breast cancer cell growth, you may benefit from a biologic therapy called trastuzumab, commonly known by its brand name, Herceptin.

By inhibiting Her-2/neu actions on cancer cells, Herceptin can stop the growth of the cancer. Taken intravenously, Herceptin is most often used in tandem with chemotherapy or hormone therapy. It is known as a targeted therapy because it kills only the cancer cells impacted by the Her-2/neu protein and does not damage any other cells. Other therapies, such as lapatinib (Tykerb) and bevacizumab (Avastin), also target specific parts of tumors. 

Learn more about Herceptin and other targeted therapies.

Chemotherapy

Overall, there are now hundreds of chemotherapy drugs that have been approved by the U.S. Food and Drug Administration (FDA) to be used in the treatment of breast cancer. These compounds may be taken by injection or in pill form. Some of the drugs have virtually unlimited approval for breast cancer patients, while others are restricted by the particulars of the patient involved or where she is in her battle against the cancer. 

Chemotherapy confers several benefits: It not only destroys cancer cells in the breast (as adjuvant therapy, after a lumpectomy or mastectomy), but it also kills them in other parts of the body where they have spread through the circulatory and lymphatic systems. When used as neoadjuvant therapy—before surgery—chemotherapy can often shrink the size of large tumors, making the surgery less problematic. Finally, when it comes to earlier stages of breast cancer, chemotherapy has been definitively shown to reduce the risk of recurrence and to lengthen survival.

The drawbacks of chemotherapy—short-term, possibly severe side effects and some infrequent long-term diseases and conditions—are often viewed by breast cancer patients and their physicians as not sufficiently disruptive or dangerous enough to preclude its use. Learn more about chemotherapy drugs for breast cancer.

Hormone Therapy

If hormone tests determine that your breast cancer cells are sensitive to estrogen or progesterone receptors, you are receptor-positive and likely to benefit from hormone therapy. In fact, a positive hormone status trumps any aspect of the disease that normally tends to strongly impact its course, including age, tumor size and grade, and lymph node status. For receptor-positive women, hormone therapy will most likely be part of their cancer treatment. The two major hormone therapy choices are tamoxifen and aromatase inhibitors, which block the expression of estrogen and lower estrogen output in the body, respectively. Learn more about hormone therapy.

Radiation Therapy

Using high-powered, precisely targeted X-rays to kill cancer cells can reduce the risk of cancer recurrence. After a lumpectomy, radiation therapy is commonly used to eliminate any cells that avoided excision. At times radiation is recommended for high-risk women after a mastectomy. Besides following a lumpectomy, the following may prompt the use of radiation therapy: a tumor about 2 inches across or larger, multiple lymph node involvement, or tumor invasion of chest muscle. 

Radiation therapy comes in two varieties: external beam radiation delivered by an X-ray machine and internal seed radiation implanted next to the tumor site (such as through needles or catheters).

Most often, radiation therapy will begin about a month after primary surgery, and may be delivered daily for up to two months. If you are prescribed chemotherapy as well, the X-ray treatment will come afterward; if hormone therapy has already begun, no such delay for radiation is required. According to many studies, the risk of recurrence for women who have a lumpectomy followed by radiation is about the same as for women who have mastectomies and no radiation.