Treatment options for early breast cancer

The aim of treatment for early breast cancer is to remove the breast cancer and any cancer cells that may be left in the breast, armpit or other parts of the body but cannot be detected.

What are HER2 receptors?

Treatment for early breast cancer may involve:

• breast surgery (including surgery to the armpit)
• radiotherapy
• chemotherapy
• hormonal therapies
• targeted therapies.

Breast surgery:Surgery for early breast cancer involves either breast conserving surgery or mastectomy. Breast reconstruction may be possible after a mastectomy.
Both types of breast surgery usually also involve surgery to remove of one or more lymph nodes from the armpit (axilla).
The type of breast surgery recommended for early breast cancer will depend on:

• the size and grade of the cancer (including the size of the cancer in relation to the size of the breast)
• whether the cancer is in more than one place in the breast
• how likely it is that breast cancer will come back or spread
• whether the woman has had genetic testing which confirms she is carrying BRCA1 or BRCA2 gene mutations
• what the woman’s body will look like after surgery
• whether the woman has previously had radiotherapy to the breast area
• the woman’s age and general health and whether she has other medical conditions.

Breast conserving surgery followed by radiotherapy is as effective as mastectomy for most women with early breast cancer. This means that for most women the chance of breast cancer spreading to other parts of the body and the chance of dying from breast cancer is the same after either treatment.

 Radiotherapy:
For women with early breast cancer, radiotherapy is almost always recommended after breast conserving surgery. Radiotherapy is sometimes recommended after mastectomy.

Chemotherapy:

Treatment with chemotherapy is usually recommended for women with early breast cancer if there’s a risk that cancer cells may have spread outside the breast and armpit area.
For women with early breast cancer, treatment with chemotherapy can lower the risk of breast cancer coming back or spreading to other parts of the body. Chemotherapy can also increase the chance of surviving breast cancer.
Doctors will consider a number of things when deciding whether to recommend chemotherapy:

• the risk of breast cancer coming back or spreading to other parts of the body after treatment – the higher the risk, the more likely it is that chemotherapy will be recommended
• whether there are hormone receptors on the breast cancer cells (and whether the woman is having hormonal therapy) – if there are no hormone receptors, chemotherapy is more likely
• whether the breast cancer cells are positive for HER2 and the woman is having trastuzumab (Herceptin^®) – this may affect the timing of chemotherapy and the type of chemotherapy recommended
• the woman’s general health
• the woman’s preference.

The timing of chemotherapy will depend on what other treatments a woman is having. Usually chemotherapy will start after breast surgery. Some women may have chemotherapy before surgery. If a woman is having radiotherapy or hormonal therapy, these treatments will not start until chemotherapy is completed.

Hormonal therapies:

Hormonal therapies are drugs used to treat women with early breast cancer who have hormone receptors on their breast cancer cells. They may be used alone or with other breast cancer treatments.
The decision about whether to recommend treatment with a hormonal therapy and which hormonal therapy to recommend depends on:

• whether there are hormone receptors on the breast cancer cells
• whether the woman has reached menopause
• whether the woman has completed her family
• the woman’s risk of breast cancer coming back
• the likely benefits and possible side effects of different treatments.

Hormonal therapies reduce the risk of breast cancer coming back (in the breasts and in other parts of the body). Some hormonal therapies have also been shown to increase the chance of survival for women with breast cancer.
 

Targeted therapies:Targeted therapies (sometimes called biological therapies) are drugs that stop the growth of particular types of cancer cells. Targeted therapies are only suitable for some women. They may be used with other breast cancer treatments. The most common targeted therapy used to treat early breast cancer is trastuzumab (Herceptin^®).