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.

Prognosis

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) [161]:

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:

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

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 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) [4].

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:

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:

Tumor size
Lymph node status
Tumor characteristics, such as hormone receptor status and HER2 status

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 [8].

Tumor profiling can be used to help guide chemotherapy for early breast cancers that are all of the following [8]:

Estrogen receptor-positive (and will be treated with hormone therapy)
Tumor size smaller than 5 cm
HER2-negative
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.

Neoadjuvant chemotherapy

With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery [8]. 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 [8].

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.

Neoadjuvant immunotherapy

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 [8]. 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 [8].

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.

Throughout your treatment and beyond, you’ll get care from many health care providers. Your health care team may include:

Doctors involved in cancer treatment (medical oncologists, surgeons, radiation oncologists)
Doctors involved in other care for people with breast cancer (radiologists, pathologists, palliative care or pain specialists, and others)
Your primary care doctor
Nurses
Genetic counselors
Patient navigators and social workers
Mental health providers (counselors, clinical social workers, psychologists and others)
Dietitians
Physical therapists
Pharmacists
Other health care providers

These health care providers may be involved in your care throughout diagnosis, treatment and recovery.

If you’re not happy with your care or you’re not connecting with your doctor, consider getting a second opinion. It’s OK to get a second opinion at any point during your care. Your doctor should never discourage you from getting a second opinion.

Learn about choosing a doctor.

Learn more about getting a second opinion.

Susan G. Komen^®‘s Patient Navigator Program

Komen Patient Navigators can help guide you through the health care system. They can help to remove barriers to high-quality breast care. For example, they can help you with insurance, local resources, communication with health care providers and more.

Call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org to learn more about our Patient Navigator program, including eligibility.

Se habla español.

Online access to your medical information

Most hospitals and doctor offices now allow you access to your medical information online. You set up an account with a login name and password. This provides security to protect your privacy.

An online account gives you access to your test results, pathology and radiology reports, prescription drug information, medical appointments, doctors’ notes and more. It also gives you an easy way to communicate with your health care team.

Staying organized

It may be helpful to use a notebook, 3-ring binder or other organizer to keep track of your breast cancer treatments and health care team.

You may want to include:

A directory of the names, addresses and contact information for your health care team
Insurance information
Medication lists
Pharmacy contact information
Other medical information
A calendar to help plan and keep track of appointments
Blank paper to write down any questions you may have, or to record any side effects you’re having or other information you think your health care team needs to know
Pockets to store materials

Susan G. Komen^® has interactive Questions to Ask Your Doctor resources that you can download and may be helpful to include.

How will the status of my lymph nodes affect my treatment plan? Will a sentinel node biopsy be done?
Is my tumor estrogen/progesterone receptor-positive or estrogen/progesterone receptor-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?
If I have triple negative breast cancer, 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? What is my prognosis without treatment?
Is there a clinical trial I can join?
How long do I have to make treatment decisions?
Can I choose the days and times of treatments?
Should I have genetic testing (for inherited gene mutations) done? Should I meet with a genetic counselor?
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 breast reconstruction, what types of prostheses are available? Where can I find them? Will my insurance cover the cost? What if I’d like to “go flat”?
Were my tumor margins negative (clean, not involved, clear)? If not, will I need more surgery?
Will you give me a copy of my pathology report and other test results?
What is my follow-up care? Which health care provider will manage my follow-up care?
How will treatment affect my bone health?
What do I need to consider before treatment begins if I would like to have a child after being treated for breast cancer?
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 stored? 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 or feel too overwhelmed to know where to begin to gather information, it may be helpful to download and print some of Susan G. Komen®‘s resources. For example, we have Questions to Ask Your Doctor About Breast Cancer Surgery and Questions to Ask Your Doctor About Hormone Therapy.

You can download and print resources to bring with you to your next doctor’s appointment or you can save them on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write or type the answers to the questions.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.

Treatment guidelines

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.

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 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:

Make sure cancer patients 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
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 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

If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

The helpline offers breast cancer clinical trial education and support, such as:

Knowing when to consider a trial
How to find a trial
How to decide which trial is best for you
What to expect during a trial
Information about clinical trial resources

Se habla español.

BreastCancerTrials.org in collaboration with Komen offers a custom matching service to help find a clinical trial that fits your needs.

Learn what else Komen is doing to help people find and participate in breast cancer clinical trials, including trials supported by Komen.

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

If you or a loved one needs more information about breast health or breast cancer, contact the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org. All calls are answered by a trained specialist or oncology social worker, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. Se habla español.
Komen Patient Navigators can help guide you through the health care system as you go through a breast cancer diagnosis and treatment. They can help to remove barriers to high-quality breast care. For example, they can help you with insurance, local resources, communication with health care providers and more. Call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org to learn more about our Patient Navigator program, including eligibility.
Komen’s Breast Cancer Facebook Group and Metastatic Breast Cancer Facebook Group provide places where those with a connection to breast cancer can share their experiences and build strong relationships with each other.
Our fact sheets, booklets and other education materials offer additional information.

Updated 09/22/23

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