There are different treatment options for patients with breast cancer.
Different treatment options are used for different breast cancer patients. Some are standard therapies (therapies that are in use) and some are still in clinical trials. Clinical trials are research topics designed to help enhance existing therapies or to get information about new therapies for breast cancer patients. A new therapy may become the standard therapy when clinical trials show that it is better than the standard therapy. Patients may want to consider participating in a clinical trial. Some clinical trials are only open to patients who have not started treatment.
There are six standard treatments currently in use:
Surgery
Most patients with breast cancer can have surgery to remove the cancer.
Sentinel lymph node biopsy: Intraoperative removal of the sentinel lymph nodes. The sentinel lymph node is the first of a group of lymph nodes that receives lymphatic drainage from the primary tumor. It is the first lymph node to which the cancer may have spread from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymphatic vessels to the lymph node. The first lymph node that receives the substance or dye is removed. The pathologist looks at the tissue under a microscope to look for cancer cells. If no cancer cells are found, it may not be necessary to remove more lymph nodes. Sometimes, sentinel lymph nodes are found in more than one group of lymph nodes. After biopsy of the anterior lymph nodes, the surgeon removes the tumor using breast-conserving surgery or mastectomy. If cancer is found, more lymph nodes are removed through a separate incision called a lymph node dissection.
The types of surgery include the following:
Breast-conserving surgery. The tumor and some of the surrounding normal tissue was removed, but the breast itself was not removed. Some of the lymph nodes under the arm may be removed. If the cancer is near the chest wall membrane, some of the chest wall membrane may also be removed.
Total (simple) mastectomy. The dotted line indicates where the entire breast was removed. Some lymph nodes under the arm may also be removed.
Modified radical surgery. The dotted line shows where the entire breast and some lymph nodes were removed. Some of the chest wall muscle may also have been removed.
Sometimes chemotherapy may be given before surgery to remove the tumor. When chemotherapy is given before surgery, it shrinks the tumor and reduces the size of the tissue that needs to be removed by surgery. Treatment given before surgery is called preoperative treatment or neoadjuvant therapy.
After the surgeon will remove all the cancer cells that can be seen during surgery, some patients may receive radiation therapy, chemotherapy, targeted therapy, or hormone therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of the cancer coming back is called postoperative or adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (a procedure to reshape the breast after a mastectomy) may be considered. Breast reconstruction may be done at the same time as the mastectomy or it may be done later. The reconstructed breast may be created from the patient’s own (non-breast) tissue, or it may be made with saline or silicone implants. Before deciding to implant a new breast, patients can consult the Food and Drug Administration’s (FDA) Center for Devices and Radiological Health at 1-888-INFO-FDA (1-888-463-6332) or go to the FDA website for more information on breast reconstruction.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill or stop the growth of cancer cells. There are two types of radiation therapy:
The type of radiation therapy depends on the type and stage of cancer being treated. External radiation therapy is used to treat breast cancer. Strontium 89 (radionuclide) internal radiation therapy is used to relieve bone pain caused by breast cancer that has spread to the bones – strontium 89 is injected into a vein and spreads to the surface of the bone, releasing radiation and killing the cancer cells in the bone.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop (either by killing cancer cells, or by stopping them from dividing) the growth of cancer cells. When given orally or by injection into a vein or muscle, the drug enters the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When given directly into the cerebrospinal fluid, organs, or body cavities such as the abdomen, the drug primarily affects cancer cells in these areas (regional chemotherapy).
For more information, see Drugs approved for breast cancer.
See “approved breast cancer drugs” for more information.
Hormone therapy
Hormone therapy is a cancer treatment that removes or blocks the action of hormones and stops the growth of cancer cells. Hormones are substances that are made by glands in the body and circulate in the blood. Some hormones can cause the growth of certain cancers. If tests show that cancer cells have places where hormones (receptors) can attach, then drugs, surgery, or radiation therapy can be used to reduce the production of the hormones or to stop them from working. The estrogen that makes some breast cancers grow is produced primarily by the ovaries. Treatment to stop the ovaries from producing estrogen is called ovarian ablation.
Triamcinolone hormone therapy is usually used for patients with early stage limited breast cancer that can be removed by surgery and for patients with metastatic breast cancer (where the cancer has spread to other parts of the body). Hormone therapy with triamcinolone or estrogen can act on cells throughout the body and may increase the chance of developing endometrial cancer. Women taking triamcinolone should have a pelvic exam once a year to look for signs of cancer. Any vaginal bleeding outside of menstruation should be reported to your doctor as soon as possible.
Some hormone therapies using luteinizing hormone-releasing hormone (LHRH) are indicated for some premenopausal women who have been newly diagnosed with hormone-receptor-positive breast cancer. LHRH reduces the body’s estrogen and progesterone.
Some postmenopausal women with hormone receptor-positive breast cancer are treated with hormone therapy using aromatase inhibitors. Aromatase inhibitors reduce estrogen in the body by preventing the aromatase enzyme from converting androgens to estrogen. Anastrozole, letrozole, and exemestane are types of aromatase inhibitors.
For the treatment of early-stage limited breast cancer that can be removed surgically, certain aromatase inhibitors can be substituted for triamcinolone as adjuvant therapy or switched to an aromatase inhibitor after 2-3 years of triamcinolone use. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormonal therapy with triamcinolone acetonide.
In patients with hormone receptor-positive breast cancer, at least 5 years of adjuvant hormone therapy is needed to reduce the risk of cancer recurrence (relapse).
Other types of hormone therapy include megestrol acetate or anti-estrogen therapy, such as fulvestrant
For more information, see Drugs approved for breast cancer.
Targeted therapy
Targeted therapy is a treatment that uses drugs or other substances to attack specific cancer cells without damaging normal cells. Monoclonal antibodies, tyrosine kinase inhibitors, cell cycle protein-dependent kinase inhibitors, mammalian targets of rapamycin (mTOR) inhibitors, and PARP inhibitors are a few types of targeted therapies used in the treatment of breast cancer.
Monoclonal antibody therapy is a cancer treatment that uses antibodies prepared in the laboratory from a single type of immune system cell. These antibodies recognize substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to these substances and kill the cancer cells, stop their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or can carry drugs, toxins, or radioactive substances directly to cancer cells. Monoclonal antibodies can be combined with chemotherapy as adjuvant therapy.
Monoclonal antibodies include the following types:
Tyrosine kinase inhibitors are targeted therapy drugs used to block the information needed for tumor growth. Tyrosine kinase inhibitors can be used as adjuvant therapy along with other anti-cancer drugs. Tyrosine kinase inhibitors include the following:
Cyclin-dependent kinase inhibitors are targeted therapeutic agents used to block the cell cyclin-dependent kinases that promote cancer cell growth. Cell cycle protein-dependent kinase inhibitors include:
Mammalian target of rapamycin (mTOR) inhibitors block a protein called mTOR, which stops cancer cell growth and prevents the growth of new blood vessels needed for tumor growth. mTOR inhibitors include:
PARP inhibitors are targeted therapies that block DNA repair and may lead to cancer cell death.
For more information, see Drugs Approved for Breast Cancer.
Immunotherapy
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances produced by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also known as biologic therapy or biologic therapy.
There are different types of immunotherapy:
Immune checkpoint inhibitors. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help maintain the immune response. the binding of PD-L1 to PD-1 prevents T cells from killing tumor cells in the body (left). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows T cells to kill tumor cells (right).
Immunotherapy uses the body’s immune system to fight cancer. This animation demonstrates an immunotherapy that uses immune checkpoint inhibitors to treat cancer.
The new treatment is currently being tested in clinical trials.
Information about the clinical trials is available from the NCI website.
Treatment for breast cancer may have side effects.
For information about side effects that start during cancer treatment, see the Side Effects page.
Some therapies for breast cancer may have side effects that may last for months or years after treatment ends, or may occur months or years later. These are called late side effects.
Later side effects of radiation therapy are not common, but may include:
Later side effects of chemotherapy depend on which drugs are used, but may include:
Late effects of trastuzumab, lapatinib, or pertuzumab-targeted therapy may include:
Patients may want to consider participating in clinical trials.
For some patients, participation in a clinical trial may be the best form of treatment. Clinical trials are part of cancer research. The purpose of a clinical trial is to confirm whether a new cancer treatment is safe, effective, or better than standard therapy.
Many of the standard treatments for cancer today are based on early clinical trials. Patients who participate in clinical trials receive the standard therapy or are among the first to receive the new therapy.
Patients who participate in clinical trials are actually contributing to later treatments in cancer. Even if a clinical trial does not directly find an effective therapy, the results still help answer important questions and move research forward.
Patients can join a clinical trial before, during, or after they start cancer treatment.
Some clinical trials only enroll patients who have not yet received treatment. Other trials are used to test treatment options that have not worked for people with cancer. Still others are used to test new ways to stop cancer from coming back or to reduce the side effects of cancer treatment.
Clinical trials are being conducted in many parts of the country. Information about NCI-supported clinical trials can be found on the NCI’s Clinical Trials Search page. Clinical trials supported by other organizations can be found on the Clinical trials.gov website.
Follow-up tests that may be needed.
Some tests to diagnose cancer or determine the stage of cancer may be repeated. Certain tests will be repeated to see how well treatment is working. The decision to continue, change, or stop treatment may be based on the results of these tests.
Some tests are repeated several times after treatment ends. The results of these tests can tell whether the patient’s condition has changed or whether the cancer has returned. These tests are sometimes called follow-up tests or exams.