Most breast cancers are HER2-negative. There are many treatment options for this type of breast cancer. Your treatment will depend on factors such as hormone receptor status, cancer stage, and your age and overall health.
According to the American Cancer Society, breast cancer will make up
Most breast cancers —
The goal of treatment for HER2-negative breast cancer can vary based on the extent of your cancer.
Often, the goal of treatment focuses on eliminating the cancer and preventing it from recurring.
However, if the cancer has spread more widely, treatment can instead focus on slowing its growth and preventing it from spreading to additional tissues.
Treatment for more advanced breast cancer can also be used to help reduce cancer symptoms, prevent additional complications, and improve quality of life. This is called palliative care.
There are many potential treatment options for HER2-negative breast cancer. Your treatment options will also depend on the hormone receptor status of your breast cancer — HR-positive or HR-negative. Possible treatment options include:
- surgery
- hormone therapy (for HR-positive breast cancer)
- radiation therapy
- targeted therapy
- chemotherapy
- immunotherapy
We’ll dive a little deeper into each treatment type below.
Surgery is often one of the first-line treatments for breast cancer. The goal is to remove as much of the cancer as possible.
The type of surgery you receive can depend on factors such as the size and location of your cancer and your personal preferences. There are two general types of breast cancer surgery:
- A lumpectomy involves removing the cancer and some surrounding healthy tissue. This is also called breast-conserving surgery.
- A mastectomy involves removing your entire breast. In some mastectomies, the lymph nodes of your underarm are also removed.
One of the main side effects of breast cancer surgery is pain or discomfort as you recover. Additional risks include bleeding, infections, and reactions to anesthesia. If your lymph nodes are removed, you might also develop lymphedema.
Many HER2-negative breast cancers have hormone receptors for estrogen, progesterone, or both. In fact, an estimated
HR-positive breast cancers can be treated with hormone therapy. The drugs used for this treatment can prevent estrogen from binding to its receptors or reduce the amount of estrogen your body makes.
Because binding of hormones to receptors can promote breast cancer growth, hormone therapy can reduce growth. It can be used:
- before surgery to shrink a tumor
- after surgery to help get rid of remaining cancer cells and prevent the cancer from returning
- as a main component of treatment if you cannot have surgery or choose not to have it
The side effects of hormone therapy can include hot flashes, night sweats, and vaginal dryness. If you’re still menstruating, you may notice that hormone therapy disrupts your menstrual cycle. Additional risks include:
- mood swings
- depression
- bone loss
- higher risk of blood clots
- stroke
HR-positive HER2-negative breast cancer might also be treated with a combination of hormone therapy and many targeted agents, such as palbociclib (Ibrance) or ribociclib (Kisqali). Several drugs are approved specifically to be used in combination with hormone therapy in people with this breast cancer subtype.
Radiation therapy is a type of cancer treatment that uses high energy radiation to help kill cancer cells. There are two general types of radiation therapy that may be used:
- During external beam radiation therapy, a machine outside your body delivers the radiation.
- For brachytherapy (also called internal radiation therapy), a device containing small amounts of radiation is placed inside your body.
You typically receive radiation therapy after breast cancer surgery to help kill remaining cancer cells.
Radiation therapy can also be used as a palliative treatment for metastatic breast cancer to help shrink a tumor in order to ease pain, lower the risk of a bone break, or reduce pressure on nerves.
Potential side effects and risks of radiation therapy include:
- skin reactions such as tenderness, redness, or peeling
- breast swelling
- fatigue
- shoulder stiffness
- lymphedema
- damage to your heart or lungs
While targeted therapy is often used to treat HER2-positive breast cancer, it can also be used for HER2-negative breast cancer. Targeted therapy focuses on specific markers found on or in cancer cells. You may have targeted therapy:
- before surgery to shrink a tumor
- after surgery to help get rid of remaining cancer cells and prevent the cancer from returning
- as a main component of treatment if you cannot have surgery or choose not to have it
There are
HR-positive cancers can be treated with:
An antibody-chemotherapy conjugate called sacituzumab govitecan (Trodelvy) can also be used to treat HR-positive HER2-negative breast cancers and triple-negative breast cancer.
The side effects that you have with targeted therapy can depend on the specific drug that’s used. Common side effects include:
- fatigue
- digestive side effects such as:
- low blood counts, which can cause:
- increased infection risk
- easy bruising or bleeding
Chemotherapy involves drugs that interfere with the growth and division of cancer cells. You may receive chemotherapy for HER2-negative breast cancer:
- before surgery to shrink a tumor (neoadjuvant chemotherapy)
- after surgery to help get rid of remaining cancer cells and prevent the cancer from returning (adjuvant chemotherapy)
- as a main component of treatment if you cannot have surgery or choose not to have it
The type of chemotherapy drug you receive can depend on your individual situation. Sometimes, a combination of chemotherapy drugs may be used.
Chemotherapy drugs have broad activity that can also affect healthy cells in your body that grow and divide at a faster rate. As a result, chemotherapy can lead to side effects such as:
Immunotherapy is a type of cancer treatment that helps your immune system better respond to cancer. An immune checkpoint inhibitor called pembrolizumab (Keytruda) is the type of immunotherapy used for breast cancer.
Immunotherapy is often a potential treatment option for triple-negative breast cancer. This is breast cancer that is HR-negative and HER2-negative.
You may receive immunotherapy:
- before surgery to shrink a tumor
- after surgery to help get rid of remaining cancer cells and prevent the cancer from returning
- as a main component of treatment if you cannot have surgery or choose not to have it
Common side effects of pembrolizumab include:
- fatigue
- digestive side effects such as:
- nausea and vomiting
- diarrhea
- constipation
- reduced appetite
- rash or itchy skin
- fever
- cough
- shortness of breath
- muscle aches and pains
- abdominal pain
There’s no alternative treatment that can effectively treat HER2-negative breast cancer. However, some complementary treatments can be used along with conventional treatment and may help ease symptoms and boost quality of life.
According to the
If you’re interested in trying out a complementary treatment, be sure to talk with your doctor about the potential benefits and risks before starting.
Starting treatment for HER2-negative breast cancer can feel overwhelming, and it’s normal to have questions about your treatment and outlook. Here are some examples of questions you may want to ask your care team as you prepare for treatment:
- What type(s) of treatment are you recommending for my cancer and why?
- Is there another type of treatment that can be used as well? If so, how would it affect my outlook?
- What is the overall goal of my treatment?
- When will I start my treatment?
- How long will my treatment last in total? How long will each treatment session last?
- Where will I receive my treatment?
- What side effects should I be aware of? Is there anything I can do to help prevent or reduce them?
- When should I contact you about treatment side effects? When should I go to the hospital instead?
- Will this treatment have any long-term effects? If so, what are they? Is there anything I can do to help prevent them?
Where to find support if you’re having treatment for HER2-negative breast cancer
If you’ve recently received a diagnosis of HER2-negative breast cancer, you might want to look into some of these resources for support:
- the
American Cancer Society’s patient programs and services and Cancer Survivors Network - BreastCancer.org and its discussion forum for connecting people with breast cancer
- the Susan G. Komen Foundation and its financial assistance program
- Living Beyond Breast Cancer and its three private support groups on social media and funding opportunities for people needing additional financial support
The outlook for HER2-negative breast cancer can depend on a variety of factors, including:
- your cancer’s stage
- the grade of your cancer, which estimates how quickly your cancer may grow and spread
- the HR status of your cancer
- the genetic characteristics of your cancer
- how your cancer responds to your treatment
- whether your cancer has recurred
- your age and overall health
After a HER2-negative breast cancer diagnosis, be sure to ask your care team about your individual outlook. They can consider the factors above to give you a better idea of what to expect.
What’s the first-line treatment for HER2-negative breast cancer?
The first-line treatment for HER2-negative breast cancer depends on factors such as the tumor size and HR status.
Some people who have larger tumors undergo chemotherapy first. Treatment can often involve surgery followed by another treatment. If your cancer is HR-positive, hormone therapy is often used. The role of radiation as a first-line treatment option depends on whether you have a lumpectomy or a mastectomy.
HER2-negative cancer that cannot be removed with surgery may be able to be treated through a variety of other methods, such as:
- hormone therapy (for HR-positive cancers)
- chemotherapy
- targeted therapy
- immunotherapy
- radiation therapy
Is there a new drug for HER2-negative breast cancer?
Yes. In January 2023, the
More new treatments may be on the horizon. A
Is HER2-negative better than positive?
It’s complicated. HER2-positive breast cancer is more likely to grow and spread quickly, but additional targeted therapies are available to treat it.
Meanwhile, HER2-negative breast cancer tends to grow more slowly but can have fewer available treatment options, especially in the case of triple-negative breast cancer.
What is the survival rate for HER2-negative breast cancer?
Survival rates can vary based on HR status. According to the
Most breast cancers are HER2-negative. This type of breast cancer can be either HR-positive or HR-negative (triple-negative).
The type of treatment you have for HER2-negative breast cancer can depend on many factors, including the cancer’s HR status, stage, and grade and your age, overall health, and personal preference.
It’s totally normal to have many questions about your breast cancer treatment. If you have questions or concerns about your treatment or outlook, be sure to raise them with your care team.