Breast Cancer Treatment

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Overview

A variety of treatments for breast cancer exist, and treatment is available at every stage of cancer. Most people need a combination of two or more treatments.

After diagnosis, your doctor will determine the stage of your cancer. They will then decide on the best treatment options based on your stage and other factors, such as age, family history, genetic mutation status, and personal medical history.

Treatments for early stage breast cancer may not be effective for advanced stage breast cancer.

Surgery for breast cancer

Most people with breast cancer will undergo surgery to remove cancer cells or tumors from the breast and other affected areas.

are two surgical options. Deciding which option to use is based on:

  • the size and location of the primary tumor
  • personal preference
  • other factors such as genetic predisposition

of the lymph nodes will probably be performed at the same time.

Mastectomy

A is the surgical removal of the entire breast. It’s recommended when cancer is found throughout the breast. Some people will get a double or bilateral mastectomy, where both breasts are removed. Surgery to reconstruct the breast can begin at the time of the mastectomy or at a later date.

Lumpectomy

In a , also called a breast-conserving surgery, the surgeon removes the cancerous cells and spares the rest of the breast. It’s an option when cancer is confined to one area of the breast.

A lumpectomy may be performed as an outpatient procedure. This means you can go home shortly after the surgery and won’t need to stay in a hospital overnight.

Reconstructive

In , a plastic surgeon uses an artificial implant or a flap of tissue from elsewhere on your body to create a breast shape.

Breast reconstructive surgery typically takes place during or soon after a mastectomy or lumpectomy, but can also be done months or years later.

There are two types of reconstruction surgeries: prosthetic reconstruction and tissue flap reconstruction.

In prosthetic reconstruction, a plastic surgeon creates the shape of a breast using an artificial implant filled with either saline or silicone.

In tissue flap surgery, a plastic surgeon uses tissue from various parts of your body, like your stomach, back, thighs, or buttocks, to rebuild the shape of your breasts.

Radiation therapy

is a type of targeted therapy where high-energy X-rays are used to kill cancer cells and prevent them from spreading. It’s usually recommended in the early stages of breast cancer, after lumpectomy for stage 0 breast cancers, and can be used alongside other treatments.

This treatment can lower the risk of cancer recurrence. Radiation therapy is typically administered 5 days per week over the course of 5 to 7 weeks.

Chemotherapy

Chemotherapy is a cancer treatment that uses powerful drugs to kill cancer cells throughout your body. It’s typically given intravenously or orally through pills but is occasionally administered directly into the spinal fluid surrounding the spinal cord.

Not everyone who gets breast cancer will need chemotherapy. It’s typically recommended before surgery to shrink a tumor so it can be removed more easily, or after surgery to kill any remaining cancer cells.

Chemotherapy is also used as a central treatment in people with advanced, metastatic breast cancer that has spread throughout the body.

There are a variety of chemotherapy drugs used to treat breast cancer, including:

  • docetaxel (Taxotere)
  • doxorubicin (Adriamycin)
  • cyclophosphamide (Cytoxan)

You may receive a combination of several chemotherapy drugs.

Chemotherapy drugs are typically administered at a doctor’s office, hospital, or infusion center using an IV or injection. It’s standard for chemotherapy treatments to be given in cycles of 2 to 3 weeks followed by a rest period to give your body time to recover.

The length of chemotherapy treatment depends on how well the treatment is working and .

Hormone therapy for breast cancer

About breast cancer cases are hormone-receptor positive. This means the breast cancer cells grow by attaching to hormones like estrogen and progesterone. Hormone therapy, also called endocrine therapy, stops these hormones from attaching to cancer cells, thus stopping their spread.

There are different types of hormone therapy but most work by altering levels of estrogen and preventing estrogen from connecting to cancer cells.

Hormone therapy is most often used after surgery to reduce the risk of cancer returning but is sometimes used before surgery. It’s a long-term treatment taken for at least 5 to 10 years.

Targeted therapy for breast cancer

Targeted therapy refers to a variety of drugs that enter the bloodstream and treat cancer throughout the body. Targeted therapy drugs aim to attack cancer cells without harming healthy cells, and tend to have fewer side effects than chemotherapy drugs.

are often used to treat . These are cancers that have an excess of a protein called HER2 that promotes the growth of cancer cells.

Common targeted therapy drugs for HER2-positive breast cancers include:

  • Monoclonal antibodies like trastuzumab () are synthetic antibodies designed to attach to HER2 proteins and stop cells from growing.
  • Antibody-drug conjugates like ado-trastuzumab emtansine (Kadcyla or TDM-1) attach to HER2 proteins on cancer cells and help chemotherapy reach them.
  • Kinase inhibitors like Lapatinib (Tykerb) block HER2 proteins.

Targeted therapies are also used to treat hormone receptor-positive breast cancer along with hormone therapy.

Common targeted therapy drugs for people with hormone receptor-positive cancers include:

  • CDK4/6 inhibitors, which block CDK proteins in cancer cells to stop them from dividing and slow cancer growth.
  • mTOR inhibitors, which block mTOR proteins in cancer cells to stop them from dividing and growing. This treatment is believed to help hormone therapy drugs work more efficiently.
  • PI3K inhibitors, which block the PI3K proteins in cancer cells and helps prevent them from growing.

(TNBC) is a type of breast cancer that is neither HER2-positive nor hormone-receptor positive. Because of this, it doesn’t respond well to hormone therapy and other drugs must be used.

Common targeted therapy drugs for people with TNBC include:

  • Antibody-drug conjugates, which attach to proteins in the breast cancer cells and help chemotherapy reach them.

Breast cancer treatment by stage

Stage 0 (DCIS)

If precancerous or cancer cells are confined to the milk ducts, it’s called noninvasive breast cancer or ductal carcinoma in situ (DCIS).

Stage 0 breast cancer can become invasive and spread beyond the ducts. Early treatment can stop you from developing . Early treatment can include surgeries like lumpectomy and mastectomy followed by radiation.

Stage 1

Stage 1A breast cancer means the primary tumor is 2 centimeters or less and the axillary lymph nodes aren’t affected. In stage 1B, cancer is found in lymph nodes and there’s no tumor in the breast or the tumor is smaller than 2 centimeters.

Both 1A and 1B are considered early stage invasive breast cancers. Surgery and one or more other therapies, like radiation or hormone therapy, may be recommended.

Stage 2

In stage 2A, the tumor is smaller than 2 centimeters and has spread to between one and three nearby lymph nodes. Or, it’s between 2 and 5 centimeters and hasn’t spread to lymph nodes.

Stage 2B means the tumor is between 2 and 5 centimeters and has spread to between one and three nearby lymph nodes. Or it’s larger than 5 centimeters and hasn’t spread to any lymph nodes.

You’ll probably need a combination of surgery, chemotherapy, and one or more of the following: targeted therapy, radiation, and hormone treatment.

Stage 3

Treatment for stage 3 typically involves a combination of treatments including:

  • Systemic therapies. Systemic therapies include chemotherapy, targeted therapy for HER2-positive cancers, and hormone therapy for hormone receptor-positive cancers.
  • Surgery. If cancer improves with chemo, the next step is surgery. Because IBC is so aggressive and affects a large area of the breasts and skin, breast-conserving surgeries like lumpectomies and partial mastectomies are not an option. Instead, surgery typically involves the removal of the entire breast through a modified radical mastectomy. If cancer doesn’t respond to chemotherapy, surgery cannot be done and other chemotherapy drugs or radiation therapy will be used.
  • Radiation therapy. Radiation treatment given after surgery, called adjuvant radiation, can lower the chances that cancer will come back.

Stage 4

People with stage 4 are primarily treated with systemic therapy, although surgery and radiation may be options in certain situations. Systemic therapy may include:

  • chemotherapy
  • hormonal therapy (for hormone receptor-positive cancers)
  • targeted therapy (for HER2-positive cancers)

Inflammatory breast cancer treatment

(IBC) is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.

All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic (has spread to other parts of the body), it’s considered stage 4.

Treatments for IBC depend on what stage the cancer is in.

Immunotherapy as an emerging treatment

is a relatively new treatment option, and while it hasn’t been approved by the Food and Drug Administration (FDA) for breast cancer yet, it’s a promising area.

Immunotherapy works by raising the body’s natural defenses to fight off the cancer. It has fewer side effects than chemotherapy and is less likely to cause resistance.

Pembrolizumab is an immune checkpoint inhibitor. It’s a type of immunotherapy that has shown particular promise in the treatment of metastatic breast cancer.

It works by blocking specific antibodies that make it harder for the immune system to fight the cancer. This allows the body to fight back more efficiently. A found 37.5 percent of patients with triple-negative breast cancer saw a benefit from the therapy.

Because immunotherapy isn’t FDA approved yet, treatment is mostly available through clinical trials at this time.

Complementary and alternative treatments

Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.

These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.

Examples of alternative therapy include:

  • using massage to relax
  • using peppermint tea to reduce nausea
  • using cannabis to relieve pain

While some alternative medicine treatments might help you feel more comfortable, it’s important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments you’re interested in pursuing.

Pain management

Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.

Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs (), such as .

For severe pain in a later stage, your doctor may recommend an opioid such as , , , or . These opioids have the potential for addiction, so they are only recommended in certain cases.

In recent years, a growing number of people with cancer are using cannabis to manage cancer symptoms and pain. A of cancer patients using cannabis over 6 months showed a decreased number of patients with severe pain, as well as decreased opioid use.

Factors impacting breast cancer treatment

While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.

Age

The prognosis for breast cancer is usually worse in people younger than 40 because breast cancer tends to be more aggressive in .

Balancing body image with perceived risk reduction may play a role in the decision between lumpectomy and mastectomy.

In addition to surgery, chemotherapy, and radiation, several years of hormonal therapy for hormone-positive breast cancers is often recommended for young people. This can help prevent a recurrence or spread of breast cancer.

For premenopausal people, ovarian suppression may be recommended in addition to hormone therapy.

Pregnancy

Being also impacts breast cancer treatment. Breast cancer surgery is usually safe for people who are pregnant, but doctors may discourage chemotherapy until the second or third trimester.

Hormone therapy and radiation therapy can harm an unborn baby and aren’t recommended during pregnancy.

Tumor growth

Treatment also depends on how fast the cancer grows and spreads.

If you have an aggressive form of breast cancer, your doctor may recommend a more aggressive approach, such as surgery and a combination of other therapies.

Genetics and family history

Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.

Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.

Clinical trials

are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.

Emerging treatments for breast cancer being studied in clinical trials include:

  • that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
  • Drugs that or prevent androgen production are being used and tested for TNBC.

If you’re interested, ask your oncologist for information about available trials.

Is there a breast cancer cure?

There is currently no cure for metastatic breast cancer, or breast cancer that has spread to distant parts of the body. However, early stages of breast cancer that remain localized are highly treatable — 99 percent of people who receive treatment in the earliest stages of breast cancer live for 5 years or longer after diagnosis, according to the .

Outlook

The outlook for breast cancer depends, in large part, on the stage at the time of diagnosis. The earlier you’re diagnosed, the better the outcome.

This is why it’s important be aware of any changes you notice to your breasts. It’s also important to schedule . Talk with your doctor about which screening schedule is right for you. Learn about screening schedules and more in this comprehensive guide to breast cancer.

There are standard treatments for the different types and stages of breast cancer, but your treatment will be tailored to your individual needs.

In addition to the stage at diagnosis, your doctors will consider the type of breast cancer you have and other health factors. They will adjust your treatment plan according to how well you respond to it.