Treatment Overview

Breast cancer is usually treated with surgery, medicine, and radiation therapy. Because of improved screening methods, diagnosis at an early stage, and improved treatment techniques, the number of deaths from breast cancer has been steadily declining over the past few years. Decisions about how to treat breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.

When making decisions about treatment for your breast cancer, you and your doctor will consider:

• The size and location of your breast cancer (stage).
• How aggressive the breast cancer is.
• Whether your breast cancer has receptors to the hormones estrogen and progesterone, called estrogen receptor/progesterone receptor (ER/PR) status.
• Whether your breast cancer cells contain high levels of human epidermal growth factor (HER-2/neu).
• Whether your breast cancer has spread to the lymph nodes in your underarm area (axilla).

You and your doctor will also consider your personal preferences and health when developing a treatment plan for you. This will include:

• Your feelings about keeping your breast.
• Your personal and family history of breast cancer.
• Your age and whether you have other serious health problems.

Most people with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are also usually removed to find out whether the breast cancer has spread to this area.

Even if your doctor removes all the cancer that can be seen at the time of your surgery, you may be treated with radiation therapy. Chemotherapy or hormone therapy may also be recommended to make sure that the breast cancer cells have been destroyed. You may also be given chemotherapy or hormone therapy to shrink your breast cancer before surgery. This is called neoadjuvant therapy.

Initial treatment

Initial treatment of breast cancer may include:

• Surgery to remove the cancer. This may be done by removing the whole breast (mastectomy) or just the part of the breast that contains the breast cancer (breast-conserving surgery, or lumpectomy). Some of the lymph nodes under the arm will also be removed using either axillary lymph node dissection or sentinel node biopsy.
• Radiation therapy, which is the use of high-dose X-rays to destroy cancer cells and shrink tumors.
• Chemotherapy, which is the use of medicine to destroy cancer cells. Chemotherapy is called a systemic treatment, because the medicines enter the bloodstream, travel through the body, and can destroy cancer cells outside the target area.
• Hormone therapy with tamoxifen or an aromatase inhibitor, to change the way hormones in the body cause cancer growth.
• Treatment with trastuzumab (Herceptin) if your breast cancer tests positive for human epidermal growth factor (HER-2/neu). Trastuzumab is a monoclonal antibody.