Doctors consider several factors when treating breast cancer. Different stages, estrogen receptor (ER) and progesterone receptor (PR) status, Human Epidermal growth Factor Receptor 2 (HER-2) status, menopause or not, genetic test results, and patient’s wishes and the medical conditions in their area can all have varying degrees of impact on the treatment of breast cancer.
Impact of breast cancer staging on treatment
Breast cancer staging refers to the degree of progression of breast cancer, and the most widely used is TNM staging, which includes a description of the type of tumor tissue (in situ, invasive), the size of the lesion, the status of regional lymph nodes, and distant organ metastases. Breast cancer staging can determine treatment to some extent, and usually the earlier the stage, the better the outcome with appropriate treatment.
The current approach to curative breast cancer remains a combination of surgery-based treatment strategies. Staging determines to a large extent the choice of surgical approach. The earlier the staging, the wider the choice of surgical approach and the smaller the extent of resection that is possible.
Impact of ER, PR, and HER-2 status on treatment
Our guidelines state that all invasive breast cancers should be tested for ER, PR, Ki-67 and HER-2 after the diagnosis of breast cancer. Based on the test results, breast cancer is classified into 4 molecular staging, and different staging physicians will choose one or more of chemotherapy, endocrine therapy, and targeted therapy, as appropriate.
The impact of whether or not menopause affects breast cancer treatment
Endocrine therapy differs between premenopausal and postmenopausal patients. On the one hand, it is the choice of endocrine therapy that makes a difference, but on the other hand, menopause also determines whether ovarian function suppression (OFS) therapy will be required. In post-menopausal patients, RFS therapy is no longer needed.
Because chemotherapy may induce amenorrhea, to preserve ovarian function, physicians may give medications during chemotherapy to reduce ovarian toxicity of chemotherapy drugs and prevent premature ovarian failure.
Impact of genetic test results on breast cancer treatment
There are several types of genetic tests for breast cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommend that patients with partial ER,PR positive/HER-2 negative breast cancer without axillary lymph node metastases and tumors over a certain size receive 21 genetic testing, whereby the risk of recurrence is analyzed and treatment strategies are selected.
The recurrence index (RS) reported in the breast cancer 21 gene test is a guide to treatment. The lower the recurrence index, the lower the chance of breast cancer recurrence, but it also predicts that patients are less likely to benefit from chemotherapy. In general, chemotherapy is more effective in those at high risk of recurrence (≥31), and for those at low risk of recurrence (<18) physicians will consider endocrine therapy alone.
Impact of patient wishes on breast cancer treatment
Involving patients in clinical decision making reflects the humanization of breast cancer treatment. With any breast cancer treatment including surgery, endocrine therapy, chemotherapy, targeted therapy, and radiation therapy, physicians will seek the patient’s wishes. Literacy, disease awareness, financial ability, and the pursuit of quality of life are all factors that determine a patient’s willingness to be treated.
The impact of medical conditions on breast cancer treatment
The level of diagnosis and treatment received varies depending on the medical conditions of the hospital where one is located. In developed regions, patients’ awareness of disease prevention and superior medical examinations can lead to higher rates of early diagnosis of breast cancer and correspondingly more effective treatment, with higher cure rates and survival. The most important thing is that the patient will be able to get better treatment in areas with good development of breast specialties.
Breast cancer treatment has become individualized, and doctors are taking all of these factors into account when developing treatment strategies to maximize the benefits of treatment and achieve precision in breast cancer treatment.