Breast Cancer Treatment

Any breast cancer treatment has risks and benefits. So it's important to understand what they mean for you.

Treatment for breast cancer falls into two main categories: systemic treatment - which affects your whole body, and local treatment - which targets one specific part of your body. You may also want to explore additional treatments such as complementary and alternative medicine to help treat your cancer or manage any pain or side effects.

Systemic Treatments for Breast Cancer

Systemic treatments are intended to kill cancer cells that may have left the original tumor location and be elsewhere in the body. These treatments affect all cells in the body, not just cancer cells. So make sure you discuss possible side effects with your healthcare provider.

Chemotherapy

Chemotherapy (chemo) uses powerful drugs to kill all rapidly dividing cells in the body. There are many different chemotherapy drugs that can be used alone or in combination. Chemo may be prescribed adjuvantly (after surgery) or neoadjuvantly (before surgery). It is typically given intravenously (IV), although some types may be in pill form. Chemo is given on a regular interval, typically once every three weeks or every two weeks (called “dose dense”). Dose dense is a more aggressive treatment schedule. But it may be recommended for young adults.

Hormonal Therapy

Hormonal therapy helps the body fight hormone-receptor-positive breast cancer by reducing or blocking the hormones that help these cancers grow.

Tamoxifen is typically recommended for five to 10 years for premenopausal women.
Aromatase inhibitors may be prescribed to postmenopausal women.
Ovarian suppression is an injection that temporarily stops your ovaries from functioning and simulates menopause.

Recent study results show that taking Tamoxifen or an aromatase inhibitor along with ovarian suppression may be recommended for young women at higher risk of recurrence (age 35 or younger at diagnosis where chemotherapy is recommended).

Targeted Therapy

Targeted therapies attack genes or proteins in cancer cells to stop them from growing. These treatments only work in specific breast cancer types. So a targeted treatment that works very well for one woman may not work at all for another. For example, Herceptin is a targeted therapy for HER2+ breast cancer. Whereas PARP (Poly ADP-Ribose Polymerase) inhibitors work best in breast cancer that is triple negative or BRCA1 or 2 positive. Doctors can use targeted therapies in combination with chemotherapy or alone.

Local Breast Cancer Treatments

Local treatments are directed at the original tumor location.

Surgery

Surgery removes a tumor or, in the case of reconstruction, repairs the breast. For an early stage breast cancer diagnosis, the two main surgical choices are mastectomy or lumpectomy. A decision on the type of surgery to select is very personal.

Mastectomy: removal of the entire breast. This typically includes the nipple and areola. But not the skin of the breast. Nipple-sparing mastectomies - in which the nipple and areola are not removed - may be an option in certain patients. A prophylactic mastectomy is the removal of a healthy breast. It may be recommended if you have a BRCA1 or 2 mutation. If desired, a breast can be rebuilt with breast reconstruction surgery.

Lumpectomy (also called breast conservation therapy): removal of the tumor and surrounding area of tissue only. The rest of the breast is left intact. If you choose a lumpectomy, you will also need radiation therapy.

Radiation (Local) Therapy

Radiation (local) therapy is standard treatment if you have had a lumpectomy. It may also be recommended in certain circumstances even if you had a mastectomy. It is typically administered daily for a period of days. The length (# of sessions) and duration (how long each session lasts) of radiation treatment varies according to your situation. If you are pregnant, please discuss the safety of radiation with your providers.

There are different types of radiation therapy treatments. Most commonly, it will involve an external beam that targets the cancer tissue, but radiation can also be delivered from inside your body through use of an implant. Because there are different options, speak to your oncology team about the best one for you.

With every type of radiation treatment, it is important to ensure the right area is targeted, while avoiding vital organs as much as possible. To help with this, there are several different methods your medical team might use:

Surface Guided Radiation Therapy (SGRT) to help precisely target your cancer and can eliminate the need for permanent tattoos and marks
Deep Inspiration Breath Hold (DIBH) to help move your heart away from your chest wall to help prevent heart radiation and potential side effects.
Immobilization devices to keep you from moving during treatment
The use of tattoos and marks to help align your body
The use of additional X-Ray imaging

Parts of this section come from contributions by SaferRadiationTherapy.com.

Complementary and Alternative Medicine (CAM)

CAM is the term for medical products and practices that are not part of standard medical care. This includes acupuncture, homeopathic medicine, dietary supplements, probiotic therapy, massage and reiki. And mind-body therapies such as relaxation, visualization, yoga, qigong and tai chi. CAM can also help minimize side effects, relieve pain and boost your immune system.

CAM can be used as a “complementary medicine” - along with conventional medicine. Or it can be used as an “alternative medicine” - in place of conventional medicine. Finally, “Integrative medicine” is the combination of conventional and evidence-based CAM treatments.

Find a CAM provider who has experience with cancer patients if you decide to use CAM therapies. You should also talk to your oncologist. Especially if you are considering taking supplements or following a special diet. Those may have interactions with your chemotherapy or other treatments.

Find more information on CAM from the National Center for Complementary and Alternative Medicine. To find CAM practitioners in your area, visit the Society of Integrative Oncology.