Breast Cancer Treatment Guidelines

What are breast cancer treatment options?

 Picture of Breast Cancer Surgery
Many women with breast cancer will require surgery. Picture by iStock

Breast cancer treatments depend upon the type of breast cancer that is present as well as the stage (extent of spread) of the tumor.

  • 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.

Surgery options

Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer include breast-conserving surgery and mastectomy.

Breast-conserving surgery

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.

Mastectomy

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.

  • In this surgery, surgeons remove all the breast tissue, as well, but preserve the overlying skin.
  • A nipple-sparing mastectomy keeps the skin of the breast, as well as the areola and nipple.

Radical mastectomy options

Radical mastectomy

  • 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.

Preventive surgery

Preventive surgery

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

  • genetic testing for BRCA1 or BRCA2 gene mutations,
  • full review of risk factors,
  • family history of cancer and specifically breast cancer, and
  • other preventive options such as medications.

Radiation therapy

Radiation therapy

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.

QUESTION

A lump in the breast is almost always cancer. See Answer

Brachytherapy and chemotherapy

Brachytherapy

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

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.

Hormone therapy

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:

SLIDESHOW

Breast Cancer Diagnosis and Treatment See Slideshow

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]).

Targeted therapy

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.

Alternative treatments

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.

Subscribe to MedicineNet's Cancer Report Newsletter

By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time.

Health Solutions From Our Sponsors

Medically Reviewed on 2/4/2020
References
Kroener, L., D. Dumesic, and Z. Al-Safi. "Use of fertility medications and cancer risk: a review and update." Curr Opin Obstet Gynecol May 22, 2017.

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.
CONTINUE SCROLLING FOR RELATED SLIDESHOW