The Who, What, Where, When and Sometimes, Why.

Early Breast Cancer Treatment

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).

Early breast cancer

Early breast cancer is contained in the breast. Or, it has only spread to the lymph nodes in the underarm area. This term often describes stage I and stage II breast cancer.

In the U.S., most breast cancers are early breast cancers. 

Locally advanced breast cancer

Locally advanced breast cancer has spread beyond the breast to the chest wall or the skin of the breast. Or, it has spread to many lymph nodes in the underarm area (axillary lymph nodes). Locally advanced breast cancer can also refer to a large tumor.

Prognosis

With treatment, people with early breast cancer usually have a very good prognosis.

For example, from 2009-2015 (most recent data available) [132]:

  • Women diagnosed with breast cancer that had not spread beyond the breast were 99 percent as likely to live 5 years beyond diagnosis as women in the general population.
  • Women diagnosed with breast cancer that had spread to nearby lymph nodes, but not to other parts of the body were 86 percent 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) usually involves some combination of surgery, radiation therapy, chemotherapy, hormone therapy and/or HER2-targeted therapy.

Surgery and radiation therapy

Surgery

Surgery is usually the first step in treating early breast cancer.

You may have a mastectomy (the entire breast is removed) or a lumpectomy (only the tumor and some surrounding tissue are removed). 

With either type of surgery, some lymph nodes in the underarm area (axillary nodes) may be removed to find out whether or not they contain cancer.

Radiation therapy and lumpectomy

Women who have a lumpectomy also have radiation therapy to the breast to get rid of any cancer cells that may remain. This lowers the chances of the breast cancer coming back (recurrence) [2].

Radiation therapy and mastectomy

Most women 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 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 mastectomy versus 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 mastectomy in women with invasive breast cancer, visit the Breast Cancer Research Studies section.

 

Treatment after surgery (systemic therapy, adjuvant therapy)

Most people have treatments after surgery to lower the risk of breast cancer recurrence. It’s not common to have surgery as the only treatment. 

Some combination of chemotherapy, hormone therapy and/or HER2-targeted therapy almost always follows breast surgery.

These drug therapies travel throughout the body to help ensure there’s no more cancer in the body. They may be called systemic therapy or adjuvant therapy.

Some drug therapies are given by vein (through an IV) or injection and some are pills.

Which treatments you will need after surgery depends on:

For women, whether you are pre- or postmenopausal can also play a role in your treatment options.

Women with lymph node-negative, hormone receptor-positive tumors larger than 0.5 cm should consider getting tumor profiling (such as Oncotype DX®) to see if chemotherapy is needed [6]. Tumor profiling may also be called genomic testing or molecular profiling.

Learn more about factors that affect treatment options.

 

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)

Neoadjuvant therapy is treatment given before surgery. Treatment can be chemotherapy, HER2-targeted therapy or hormone therapy. Neoadjuvant therapy may also be called preoperative therapy.

Some women with early breast cancer may 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.

Learn more about neoadjuvant therapy.

Neoadjuvant chemotherapy and neoadjuvant HER2-targeted therapy

With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery [6]. If the tumor doesn’t get smaller with the first combination of chemotherapy drugs, other combinations can be tried.

If your tumor is HER2-positive, you may get neoadjuvant trastuzumab (Herceptin) and neoadjuvant pertuzumab (Perjeta), but not at the same time as the chemotherapy drug doxorubicin (Adriamycin) [6].

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 [6].

For a summary of studies on neoadjuvant chemotherapy, visit the Breast Cancer Research Studies section.

 

For a summary of studies on neoadjuvant hormone therapy for women with estrogen receptor-positive breast cancer, visit the Breast Cancer Research Studies section. 

  

  • Will a sentinel node biopsy be done? How will the status of my lymph nodes affect my treatment plan?
  • Is my tumor estrogen/progesterone receptor-positive or -negative? How does this affect my treatment plan? If my tumor is estrogen receptor-positive,  will my tumor be tested with Oncotype DX or another tumor profiling test to help decide if I need chemotherapy?
  • Is my tumor HER2-positive or HER2-negative? How does this affect my treatment plan?
  • What are my treatment options? Which treatments do you recommend for me and why?
  • What is my prognosis with treatment?
  • How long do I have to make treatment decisions?
  • Can I have a lumpectomy (breast conserving surgery) plus radiation therapy? Will chemotherapy or hormone therapy before surgery improve my chances of being able to have a lumpectomy?
  • If I have a lumpectomy, when will I meet with a radiation oncologist to discuss radiation therapy?
  • If I have a lumpectomy plus radiation therapy now, and the breast cancer returns in the future, will I need to have a mastectomy at that time?
  • Can breast reconstruction be done at the time of the surgery, as well as later? How much later can it be done? Can you refer me to a plastic surgeon?
  • If I choose not to have reconstruction, what types of prostheses are available? Where can I find them? Will my insurance cover the cost?
  • Were my tumor margins negative (uninvolved, clean, clear)? If not, what more will be done?
  • What is my follow-up care? Which health care provider will manage this care?
  • What do I need to consider before treatment begins if I would like to have a child after being treated for breast cancer?
  • Is there a clinical trial I can join?
  • Who can talk with me about the cost of my treatment (including the expenses covered by my insurance and the costs I should expect to pay out-of-pocket)?
  • Will part of my tumor be saved? Where will it be stored? For how long? How can it be accessed in the future?

Learn more about talking with your health care provider.

If you have been diagnosed with early breast cancer, Susan G. Komen® has a series of Questions to Ask Your Doctor resources that may be helpful. For example, we have a Questions to Ask Your Doctor About Breast Cancer Surgery resource and a Questions to Ask Your Doctor About Hormone Therapy resource.

You can download and print these resources and take them with you to your next doctor appointment. There’s plenty of space to write down the answers to these questions, which you can refer to later.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download. They are a nice tool for people recently diagnosed with breast cancer, who may be too overwhelmed to know where to begin to gather information.

 

Treatment guidelines

Although the exact treatment for breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care providers about which treatment guidelines they use.

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. 

In 2013, the Health and Medicine Division of the National Academy of Sciences (formerly the Institutes of Medicine) released a set of recommendations (below) on improving cancer care in the U.S. The report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis recommended improvements to fix shortcomings that add cost and burden to cancer care. Susan G. Komen® was one of 13 organizations that sponsored this study.

The report identified key ways to improve quality of care:

  • Ensure cancer patients are engaged and understand their diagnoses so they can make informed treatment decisions with their health care providers
  • Develop a trained and coordinated workforce of cancer professionals
  • Focus on evidence-based care, using information technology to provide better information about the potential benefits of treatments
  • Focus on quality measures
  • Provide accessible and affordable care for all

Read the full report.

 

Clinical trials

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 standard 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 Cancer Clinical Trial Information Helpline

If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

BreastCancerTrials.org in collaboration with Susan G. 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

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