Early Breast Cancer Treatment
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Early and locally advanced breast cancer
Early and locally advanced breast cancers are invasive breast cancers. However, they have not spread beyond the breast and nearby lymph nodes to other parts of the body (they are not metastatic breast cancer).
Early breast cancer
Early breast cancer is contained in the breast. Or it has only spread to the lymph nodes in the underarm area (axillary lymph nodes). This term often describes stage I and stage II breast cancers.
In the U.S., most breast cancers are early breast cancers.
Locally advanced breast cancer
Locally advanced breast cancer refers to a large tumor in the breast and/or a tumor that has spread beyond the breast to the chest wall or the skin of the breast. It can also be a tumor in the breast that has spread to many axillary lymph nodes. This term often describes stage II and stage III breast cancers.
Learn about types of tumors.
With treatment, people with early breast cancer usually have a very good prognosis (chance of survival).
For example, from 2013 to 2019 (most recent data available) :
- 5-year relative survival for women diagnosed with breast cancer that had not spread beyond the breast was 99%. This means these women were 99% as likely to live 5 years beyond diagnosis as women in the general population.
- 5-year relative survival for women diagnosed with breast cancer that had spread to nearby lymph nodes, but not to other parts of the body was 86%. This means these women were 86% as likely to live 5 years beyond diagnosis as women in the general population.
With recent improvements in treatment, survival for women diagnosed today may be even higher. However, prognosis for breast cancer depends on each person’s diagnosis and treatment.
Treatment for early breast cancer
Treatment for early breast cancer (including invasive ductal carcinoma and invasive lobular carcinoma) includes some combination of:
- Radiation therapy
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitor therapy
- PARP inhibitor therapy
Getting a second opinion
It’s OK to get a second opinion at any point during your care. Your oncologist should never discourage you from getting a second opinion.
Learn more about getting a second opinion.
Surgery and radiation therapy for early breast cancer
Surgery is usually the first step in treating early breast cancer.
With either type of surgery, some lymph nodes in the underarm area (axillary lymph nodes) may be removed to find out if they contain cancer.
Radiation therapy and lumpectomy
People who have a lumpectomy usually have radiation therapy to the breast to get rid of any cancer cells that may remain in the breast. This lowers the chances of the breast cancer coming back (breast cancer recurrence) .
Radiation therapy and mastectomy
Most people who have a mastectomy don’t need radiation therapy if there’s no cancer in the lymph nodes.
In some cases, radiation therapy is used after a mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.
For a summary of research studies on a mastectomy versus a lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on radiation therapy following a mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section.
Treatment after surgery for early breast cancer (systemic therapy, adjuvant therapy)
Most people have drug therapies after surgery to lower the risk of breast cancer recurrence. It’s not common to have surgery as the only treatment for early or locally advanced breast cancer.
Drug therapies for early and locally advanced breast cancers include:
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitor therapy
- PARP inhibitor therapy
These drug therapies travel throughout the body to get rid of cancer cells that may have spread from the breast. They may be called systemic therapy or adjuvant therapy.
Some drug therapies are given by vein (through an IV) or injection under the skin, and some are pills.
Which treatments you will need after surgery depends on factors such as:
Whether you are premenopausal or postmenopausal can also play a role in your treatment options. For some people, having a BRCA1 or BRCA2 inherited gene mutation can also affect treatment options.
Talk with your health care provider about the benefits and risk of each treatment recommended in your treatment plan.
Learn more about factors that affect treatment options.
Tumor profiling and chemotherapy
Some women who have hormone receptor-positive, HER2-negative breast cancer should ask their health care providers about getting a tumor profiling test, such as Oncotype DX®, to see if chemotherapy is needed in addition to hormone therapy .
Tumor profiling can be used to help guide chemotherapy for early breast cancers that are all of the following :
- Estrogen receptor-positive (and will be treated with hormone therapy)
- Tumor size smaller than 5 cm
- Lymph node-negative or 1-3 positive lymph nodes
Tumor profiling may also be called genomic testing, molecular profiling or genetic signatures.
For a summary of research studies on chemotherapy and early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on tamoxifen in women with hormone receptor-positive early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on aromatase inhibitors in women with hormone receptor-positive early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of studies on trastuzumab (Herceptin) and early breast cancer, visit the Breast Cancer Research Studies section.
Treatment before surgery (neoadjuvant therapy) for early breast cancer
Neoadjuvant therapy is treatment given before surgery. Treatment can be chemotherapy, HER2-targeted therapy, immunotherapy or hormone therapy. Neoadjuvant therapy may also be called preoperative therapy.
Some people with early breast cancer have neoadjuvant therapy as a first treatment. Neoadjuvant therapy may shrink a tumor enough so a lumpectomy becomes an option instead of a mastectomy.
Treatment for locally advanced breast cancer usually begins with neoadjuvant therapy. Neoadjuvant therapy helps shrink the tumor(s) in the breast and lymph nodes so surgery can more easily remove all the cancer.
In some cases, response to neoadjuvant chemotherapy can help guide treatment after breast cancer surgery.
Learn more about neoadjuvant therapy.
With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery . If the tumor doesn’t get smaller with the first combination of chemotherapy drugs, other combinations can be tried.
Learn more about chemotherapy.
For a summary of studies on neoadjuvant chemotherapy, visit the Breast Cancer Research Studies section.
Neoadjuvant HER2-targeted therapy
If your tumor is HER2-positive, you may get neoadjuvant trastuzumab (Herceptin) and neoadjuvant pertuzumab (Perjeta) in addition to neoadjuvant chemotherapy .
Since trastuzumab and pertuzumab are given for one year, you won’t get all the trastuzumab and pertuzumab before surgery. You’ll get some before surgery and some after surgery.
Whether you will continue to get pertuzumab and trastuzumab after surgery depends on the pathology of the tissue removed.
Learn more about HER2-targeted therapy.
If your tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative (triple negative breast cancer) with a high risk of recurrence, you may get neoadjuvant pembrolizumab (Keytruda) in addition to neoadjuvant chemotherapy . Pembrolizumab is an immunotherapy drug.
After surgery, you will continue to get pembrolizumab to complete one year of treatment.
Learn more about immunotherapy.
Neoadjuvant hormone therapy
Some postmenopausal women with hormone receptor-positive tumors may get neoadjuvant hormone therapy (usually with an aromatase inhibitor) instead of neoadjuvant chemotherapy .
Since hormone therapy is given over a long period of time, you won’t get all the hormone therapy before surgery. You’ll get some before surgery and some after surgery.
Learn more about hormone therapy.
For a summary of studies on neoadjuvant hormone therapy for women with estrogen receptor-positive breast cancer, visit the Breast Cancer Research Studies section.
Although the exact treatment for breast cancer varies from person to person, evidence-based guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.
In addition, the National Cancer Institute (NCI) has treatment overviews.
Talk with your health care team about which treatment guidelines they use.
After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment option has risks and benefits to consider along with your own values and lifestyle.
Playing an active role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
Read the full report.
Research is ongoing to improve all areas of treatment for breast cancer.
New therapies are being studied in clinical trials. The results of these studies will decide whether these therapies will become part of the standard of care.
After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
Susan G. Komen® Breast Care Helpline
The helpline offers breast cancer clinical trial education and support, such as:
Se habla español.
BreastCancerTrials.org in collaboration with Komen offers a custom matching service to help find a clinical trial that fits your needs.
When to consider joining a clinical trial
If you’re newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesn’t usually start right after diagnosis. So, there’s time to look for a clinical trial that you’re eligible for and fits your needs.
Once you’ve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.
Learn more about clinical trials.
Susan G. Komen® Support Resources
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