Articles on Breast Cancer
What are breast cancer treatment options?
- Treatment for early breast cancer typically involves surgery to remove the tumor.
- After surgery, medical professionals may administer radiation therapy, chemotherapy, or targeted therapy.
- Doctors then perform tests on the surgically removed tissue to determine what type (for example, hormone receptor-positive, HER2-positive, triple-negative) of cancer is present to help determine the optimum treatment.
- Treatment for metastatic breast cancer usually involves chemotherapy, targeted therapy, and/or advanced hormone therapies.
Overall, patients with breast cancer have many treatment options. These treatment options undergo frequent adjustments, and your health care provider will have the information on the current standard of care available. Discuss treatment options with a health care team. The following are the basic treatment modalities used in the treatment of breast cancer.
This surgery will only remove part of the breast (sometimes referred to as partial mastectomy). The size and location of the tumor determine the extent of the surgery.
- In a lumpectomy, surgeons only remove the breast lump and some surrounding tissue. Medical professionals inspect the surrounding tissue (surgical margins) for cancer cells.
- If doctors find no cancer cells, this indicates "negative" or "clear margins." Frequently, patients receive radiation therapy after lumpectomies.
During a mastectomy (sometimes also referred to as a simple mastectomy), doctors remove all the breast tissue. If considering immediate reconstruction, surgeons sometimes perform a skin-sparing mastectomy.
Radical mastectomy options
- During this surgery, the surgeon removes the axillary lymph nodes, as well as the chest wall muscle in addition to the breast.
- Physicians perform this procedure much less frequently than in the past, as in most cases, a modified radical mastectomy is as effective.
Modified radical mastectomy
- This surgery removes the axillary lymph nodes in addition to the breast tissue.
- Depending on the stage of the cancer, a health care team might give someone a choice between a lumpectomy and a mastectomy.
- Lumpectomy allows sparing of the breast but usually requires radiation therapy afterward. If lumpectomy is indicated, long-term follow-up shows no advantage of a mastectomy over the lumpectomy.
For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.
Double mastectomy is a surgical option to prevent breast cancer. This prophylactic (preventive) surgery can decrease the risk of breast cancer by about 90% for women at moderate to high risk for breast cancer.
Discuss such an approach with a health care team.
The discussion about whether to undergo any preventive surgery should include
Radiation therapy destroys cancer cells with high-energy rays. There are two ways to administer radiation therapy.
External beam radiation
This is the usual way health care providers administer radiation therapy for breast cancer. An external machine beam of radiation focuses onto the affected area. A health care team determines the extent of the treatment and is based on the surgical procedure performed and whether lymph nodes were affected or not.
- The local area will usually be marked after the radiation team has determined the exact location for the treatments.
- Usually, the patient receives the treatment 5 days a week for 5-6 weeks.
Brachytherapy and chemotherapy
This form of delivering radiation uses radioactive seeds or pellets. Instead of a beam from the outside delivering the radiation, these seeds are implanted into the breast next to the cancer.
Chemotherapy is treatment of cancers with medications that travel through the bloodstream to the cancer cells. These medications are given either by intravenous injection or by mouth.
Chemotherapy can have different indications and may be performed in different settings as follows:
- Adjuvant chemotherapy: Though surgery can remove all of the visible cancer, there is still the possibility that cancer cells have broken off or stay behind. If health care providers administer chemotherapy to assure that these small amounts of cells are killed as well, it is called adjunct chemotherapy. Medical professionals don't administer chemotherapy in all cases, since some women have a very low risk of recurrence even without chemotherapy, depending upon the tumor type and characteristics.
- Neoadjuvant chemotherapy: If health care professionals administer chemotherapy before surgery, it is referred to as neoadjuvant chemotherapy. Although there seems to be no advantage to long-term survival whether the therapy is given before or after surgery, there are advantages to see if the cancer responds to the therapy and by shrinking the cancer before surgical removal.
- Chemotherapy for advanced cancer: If the cancer has metastasized to distant sites in the body, chemotherapy can be used for treatment. With cases of metastatic breast cancer, the health care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone or in combination. Usually, these drugs are given in cycles with certain treatment intervals followed by a rest period. The cycle length and rest intervals differ from drug to drug.
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This therapy is often used to help reduce the risk of cancer reoccurrence after surgery, but it can also be an adjunct treatment. Estrogen (a hormone produced by the ovaries) promotes the growth of a few breast cancers, specifically those containing receptors for estrogen (ER positive) or progesterone (PR positive). The following drugs are examples of those health care providers use in hormone therapy:
- Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors on breast cells.
- Toremifene (Fareston) works similar to Tamoxifen and is only indicated in metastatic breast cancer.
- Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and can be used even if tamoxifen is no longer useful.
- Aromatase inhibitors: They stop estrogen production in postmenopausal women. Examples include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).
BRCA-mutated breast cancer therapy
Early in 2018, the U.S. FDA approved olaparib (Lynparza) for treatment of metastatic breast cancer for patients who carry the BRCA mutation.
- Olaparib has already been used in ovarian cancer. The drug acts as an inhibitor of the enzyme PARP (known as a PARP-inhibitor drug), which is involved in the repair of damaged DNA. Blocking this enzyme may make it less likely to repair cancerous cells, leading to a slowdown or even stoppage of tumor growth.
- Two other PARP inhibitors are approved for treating ovarian cancer but do not currently have approval in breast cancer (rucaparib [Rubraca], niraparib [Zejula]).
As we are learning more about gene changes and their involvement in causing cancer, medical researchers are developing drugs that specifically target the cancer cells.
- As an example, researchers have developed drugs that attack cells carrying the HER2 protein for use in patients with HER2-positive breast cancer.
- Targeted therapy drugs tend to have fewer side effects than chemotherapy (as they target only the cancer cells) but usually are still used in adjunct with chemotherapy.
Whenever a disease has the potential for much harm and death, physicians search for alternative treatments.
- As a patient or the loved one of a patient, there may be an inclination to try everything and leave no option unexplored.
- The danger in this approach is usually found in the fact that the patient might not avail themselves of existing, proven therapies.
- One should discuss any interest in alternative treatments with a qualified health care team and together explore the different options.
Health Solutions From Our Sponsors
Salerno, K.E. "NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer." J Natl Compr Canc Netw 15(5S) May 2017: 682-684.
Shield, Kevin D., et al. "Alcohol Use and Breast Cancer: A Critical Review." Alcoholism: Clinical and Experimental Research Apr. 30, 2016.
Top Breast Cancer/Treatment Related Articles
Breast cancer is an invasive tumor that develops in the mammary gland. Breast cancer is detected via mammograms, breast self-examination (BSE), biopsy, and specialized testing on breast cancer tissue. Treatment of breast cancer may involve surgery, radiation, hormone therapy, chemotherapy, and targeted therapy. Breast cancer risk may be lowered by managing controllable risk factors.
What you should know about breast cancer
- Breast cancer is the most common cancer among American women.
- One in every eight women in the United States develops breast cancer.
- There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
- The causes of breast cancer are unknown, although medical professionals have identified a number of risk factors.
- There are many different types of breast cancer.
- Breast cancer symptoms and signs include
- a lump in the breast or armpit,
- bloody nipple discharge,
- inverted nipple,
- orange-peel texture or dimpling of the breast's skin (peau d'orange),
- breast pain or sore nipple,
- swollen lymph nodes in the neck or armpit, and
- a change in the size or shape of the breast or nipple.
- Breast cancer can also be symptom free, which makes following national screening recommendations an important practice.
- Breast cancer is diagnosed during a physical exam, by a self-exam of the breasts, mammography, ultrasound testing, and biopsy.
- Treatment of breast cancer depends on the type of cancer and its stage (0-IV) and may involve surgery, radiation, or chemotherapy.
Breast Cancer and Coping With StressBeing diagnosed with breast cancer is stressful. Learning relaxation techniques, exercising, eating well, getting adequate sleep, receiving psychotherapy, and maintaining a positive attitude can help you cope. Creating documents, such as an advance directive, living will, and durable power of attorney will outline your wishes in the event that you are no longer able to make decisions regarding your care.
Breast Cancer Clinical TrialsBreast cancer clinical trials are research programs designed to evaluate new medical treatments, drugs, or devices for the treatment of breast cancer. Clinical trials are designed to test the safety and efficacy of new treatments as well as assess potential side effects. Clinical trials also compare new treatment to existing treatments to determine if it's any better. There are many important questions to ask your doctor before taking part in a breast cancer clinical trial.
Breast Cancer During PregnancyBreast cancer occurs in about 1 in every 1,000 pregnant women. Treatment of breast cancer during pregnancy involves surgery, but it is very difficult to protect the baby from the dangerous effects of radiation and chemotherapy. It can be an agonizing to decide whether or not to undergo breast cancer treatment while one is pregnant.
Breast Cancer in Young WomenAbout 5% of cases of breast cancer occur in women under the age of 40 years old. Some risk factors for breast cancer in young women include a personal history of breast cancer or breast disease, family history of breast cancer, prior radiation therapy, and the presence of BRCA1/BRCA2 gene mutations. Breast self-exams, clinical breast exams, and screening mammograms may help detect breast cancer. Treatment may include surgery, chemotherapy, radiation, and hormone therapy.
Breast Cancer PreventionLifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
What Questions Should I Ask My Doctor About Breast Cancer?A diagnosis of breast cancer can be overwhelming, so it's important to write down all your questions before meeting with your doctor.
Breast Cancer RecurrenceBreast cancer most often recurs within the first three to five years after the initial treatment. Changes in the look, feel, or appearance of the breast may indicate breast cancer recurrence. Factors related to recurrence include tumor size, tumor grade, hormone receptor status, lymph node involvement, and oncogene expression. Treatment for recurrent breast cancer depends on the initial treatment.
Estimating Breast Cancer Risk: Questions and AnswersAs breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
Inflammatory Breast CancerInflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.