Breast Cancer Treatment

Understanding Your Treatment Options

All breast cancer treatments have risks and benefits, and it is important to understand what they mean for you.

Treatment for breast cancer falls into two main categories: systemic treatment affects your whole body and local treatment targets one specific part of your body. You may want to explore additional treatments such as complementary and alternative medicine to help treat your cancer or manage any pain or side effects.

Systemic Treatments

Systemic treatments are intended to kill cancer cells that may have left the original tumor location and be elsewhere in the body. Systemic treatments affect all cells in the body, not just cancer cells, so make sure you discuss possible side effects with your healthcare provider.

Chemotherapy

Chemotherapy (chemo) uses powerful drugs to kill all rapidly dividing cells in the body. There are many different chemotherapy drugs that can be used alone or in combination. Chemo may be prescribed adjuvantly (after surgery) or neoadjuvantly (before surgery) and is typically given intravenously (IV), although some types may be in pill form. Chemo is given on a regular interval, typically once every three weeks or every two weeks (called “dose dense”). Dose dense is a more aggressive treatment schedule, but may be recommended for young women.

Hormonal Therapy

Hormonal therapy helps the body fight hormone-receptor-positive breast cancer by reducing or blocking the hormones that help these cancers grow.

• Tamoxifen is typically recommended for five to 10 years for premenopausal women.
• Aromatase inhibitors may be prescribed to postmenopausal women.
• Ovarian suppression is an injection that temporarily stops your ovaries from functioning and simulates menopause.

Recent study results show that taking Tamoxifen or an aromatase inhibitor along with ovarian suppression may be recommended for young women at higher risk of recurrence (age 35 or younger at diagnosis where chemotherapy is recommended).

Targeted Therapy

Targeted therapies attack genes or proteins in cancer cells to stop them from growing. Targeted treatments only work in specific types of breast cancer, so a targeted treatment that works very well for one woman may not work at all for another. For example, Herceptin is a targeted therapy for HER2+ breast cancer, while PARP (Poly ADP-Ribose Polymerase) inhibitors work best in breast cancer that is triple negative or BRCA1 or 2 positive. Doctors can use targeted therapies in combination with chemotherapy or alone.

Local Treatments

Local treatments are directed at the original tumor location.

Surgery

Surgery removes a tumor or, in the case of reconstruction, repairs the breast. For an early stage breast cancer diagnosis, the two main surgical choices are mastectomy or lumpectomy. A decision on the type of surgery to select is very personal.

• Mastectomy: the removal of the entire breast, typically including the nipple and areola (but not the skin of the breast). Nipple-sparing mastectomies, in which the nipple and areola are not removed, may be an option in certain patients. A prophylactic mastectomy is the removal of a healthy breast and may be recommended if you have a BRCA1 or 2 mutation. If desired, a breast can be rebuilt with breast reconstruction surgery. 
• Lumpectomy (also called breast conservation therapy): removal of the tumor and surrounding area of tissue only. The rest of the breast is left intact. If you choose a lumpectomy, you will also need radiation therapy.

Radiation

Radiation therapy uses high-energy x-rays directed at the breast, surrounding tissue and lymph nodes to kill any cancer cells that may have remained behind after surgery. If you have lymph node removal or a lumpectomy, you will also be treated with radiation. Radiation therapy is typically administered daily for a period of days (at least 28) and lasts for only a few minutes. It is not safe during pregnancy.

Complementary and Alternative Medicine (CAM)

CAM is the term for medical products and practices that are not part of standard medical care. It includes acupuncture, homeopathic medicine, dietary supplements, probiotic therapy, massage and reiki as well as mind-body therapies like relaxation, visualization, yoga, qigong and tai chi. CAM can help minimize side effects, relieve pain and boost your immune system.

CAM can be used as a “complementary medicine” along with conventional medicine or be used as an “alternative medicine” in place of conventional medicine. “Integrative medicine” is the combination of conventional and evidence-based CAM treatments.

If you decide to use CAM therapies, you should find a CAM provider who has experience with cancer patients. You should also talk to your oncologist, especially if you are considering taking supplements or following a special diet, as these may have interactions with your chemotherapy or other treatments.

Find more information on CAM from the National Cancer Institute or from the National Center for Complementary and Alternative Medicine. To find CAM practitioners in your area, visit the Society of Integrative Oncology.

What to Expect From Treatment

For more detailed information on what to expect from treatment, download our free Newly Diagnosed or Metastatic Navigator.