There are several ways to approach treatment for breast cancer, and it often takes a combination of therapies. It’s important to weigh the potential benefits, side effects, and risks of each option.
There are many different types of breast cancer. Some treatments target specific characteristics of cancer cells, so they only work on those particular cancers. Some treatments depend on how fast the cancer is growing and how far it has spread.
Breast cancer treatment isn’t the same for everyone. Read on to learn more about breast cancer treatments and factors that may help determine the best therapies for you.
How do I know which treatment is right for me?
Before making a recommendation, a cancer care team will consider many factors, such as:
- breast cancer stage, which describes how far the cancer may have spread
- tumor grade, which describes how quickly the cancer is likely to grow and spread
- estrogen receptor and progesterone receptor status
- human epidermal growth factor receptor 2 (HER2) status
- genetics (gene mutation involvement can influence surgical treatment decisions)
- whether the cancer is recurrent after completing treatment
- your personal preferences
For some people, surgery is a first-line treatment with the goal of removing the cancer. Performing a lymph node biopsy at the same time can help stage the cancer.
A lumpectomy, or “breast-sparing surgery,” involves removing the tumor and a margin of healthy tissue around it. The surgeon might also remove the sentinel lymph nodes under your arm. A lumpectomy may be an option if you have ductal carcinoma in situ or early stage breast cancer.
A lumpectomy is also possible for people with larger tumors who undergo neoadjuvant treatment and have a good response or a “complete response,” which means that all the cancer is gone.
A total mastectomy, also known as a “simple mastectomy,” is a procedure in which the surgeon removes the whole breast. It usually also includes removing sentinel lymph nodes. In a modified radical mastectomy, the surgeon removes the whole breast and most of the lymph nodes under your arm.
A mastectomy may be a better option than a lumpectomy if:
- the tumor is large in relation to breast size
- you have multiple tumors
- you won’t be able to have radiation therapy
- you have a BRCA mutation and opt for it as part of your treatment plan for risk reduction in the future
In some cases, it’s possible to preserve some skin, the nipple, and the areola for reconstruction. Breast reconstruction, if you choose it, can take place at the same time as mastectomy or later.
There are different types of reconstruction surgeries. The surgeon can use an implant or tissue from another part of your body.
Radiation therapy targets high doses of radiation directly to cancer sites. According to the
Radiation therapy can be used after surgery to destroy any cancer cells that may have been left behind, which lowers the chance of recurrence.
If cancer has spread beyond the breasts, radiation therapy can help destroy tumors, slow tumor growth, or ease symptoms in other parts of the body.
Chemotherapy is a systemic therapy, which means it can destroy cancer cells anywhere in the body. Chemotherapy can help:
- Before surgery (neoadjuvant chemotherapy): to shrink large tumors and allow for less extensive surgery (e.g., a lumpectomy rather than a mastectomy)
- After surgery (adjuvant chemotherapy): to treat people who have inflammatory breast cancer or triple-negative breast cancer, to kill cancer cells left behind, and to lower the chances of cancer recurrence
- As the main treatment: to treat cancer that has spread to distant sites (metastatic breast cancer)
It’s worth noting that some people may receive both neoadjuvant and adjuvant therapy, depending on the type of cancer they have and the extent of tumor remaining after surgery.
There are many different chemotherapy drugs for breast cancer treatment. Most of the time, you’ll need a combination of two or more different drugs.
Some types of breast cancer test positive for estrogen receptors or
Some therapies block the production of these hormones and others interfere with the effect the hormones have on cancer cells. An oncologist will make a recommendation based on factors such as your other treatments and menopausal status.
Certain drugs target specific proteins or other characteristics of cancer cells that help them grow and spread. Targeted therapies can:
- stop cancer cells from reproducing
- lower the risk of recurrence
- treat advanced breast cancer that’s no longer responding to other treatments
HER2-positive breast cancers are treated with anti-HER2-positive drugs, such as trastuzumab (Enhertu) or pertuzumab (Perjeta). These drugs are given alongside chemotherapy (either neoadjuvant, adjuvant, or both) and play a significant role in managing HER2-positive cancers as well as early stage breast cancers and cancers that have metastasized.
Targeted therapy drugs and their purpose
- drugs that target HER2
- tyrosine kinase inhibitors, which block specific enzymes that tell cancer cells to grow
- mammalian target of rapamycin inhibitors, which block the action of a protein that helps cancer cells grow and divide
- cyclin-dependent kinase inhibitors, which block proteins that help control the cell cycle
- drugs that help treat people with BRCA gene mutations
The immune system’s checkpoints are turned on and off to start and stop an immune response. This process helps the immune system avoid attacking normal cells, but breast cancer cells can use these checkpoints to hide.
Immune checkpoint inhibitors target checkpoint proteins to turn the immune system back on so that it responds to cancer cells.
PD-1 is a protein on T cells that keeps them from attacking other cells. A PD-1 inhibitor called “pembrolizumab (Keytruda)” can be used:
- along with chemotherapy to treat triple-negative breast cancer
- before or after surgery for stage 2 and stage 3 cancers
- for breast cancer recurrences that are too big for surgery
- to treat metastatic breast cancer
There are several types of breast cancer treatment, including surgery, chemotherapy, and radiation therapy. Some treatments, such as hormonal therapies and targeted therapies, only work on specific characteristics of breast cancer.
Which treatment is right for you depends on many factors, including cancer type and stage, as well as HR and HER2 receptor status.
Before starting treatment, you’ll want to go over the potential benefits and risks of each type of treatment with a cancer care team. Keep in mind that whatever the plan, it’s likely you’ll need to make some adjustments along the way.