Treatment Options for Breast Cancer

by Specialist

For information about the treatments listed below, see the Treatment Options Overview section.

Early, localized, or operable breast cancer

Treatment for early, localized, or operable breast cancer may include:

  • Breast-conserving surgery and biopsy of an anterior lymph node. If cancer is found in the lymph nodes, lymph node dissection may be done.
  • Modified radical mastectomy. Breast reconstruction may also be required.

    For women who have had breast-conserving surgery, radiation therapy to the entire breast to reduce the chance of cancer recurrence. Radiation therapy may also be given to the lymph nodes in the area.

    For women who have undergone a modified radical mastectomy, radiation therapy to reduce the chance of cancer recurrence is possible if any of the following conditions are met:

  • Cancer is found in 4 or more lymph nodes.
  • The cancer has spread to the tissue surrounding the lymph nodes.
  • The tumor is large.
  • Tumors remain near or in the surrounding tissue where they have been removed.

    Systemic therapy is the use of drugs that can get into the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to reduce the chance of the cancer coming back after surgery to remove the tumor.

    Post-operative systemic therapy depends on the following:

  • Whether the tumor is hormone receptor negative or positive.
  • Whether the tumor is HER2/neu-negative or positive.
  • The tumor is hormone receptor negative and HER2/neu negative (triple negative).
  • The size of the tumor.

    For premenopausal women with hormone receptor-positive tumors, no additional therapy is needed or acceptable postoperative therapy includes:

  • Tamoxifen therapy with or without a combination of chemotherapy.
  • Tamoxifen therapy and treatment aimed at stopping or reducing estrogen production by the ovaries. This can be done with medications, oophorectomy, or radiation therapy to the ovaries.
  • Aromatase inhibitor therapy and treatment are aimed at stopping or reducing the amount of estrogen produced by the ovaries.   Medications, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.

    For postmenopausal women with hormone receptor-positive tumors, no additional treatment is needed or acceptable postoperative treatment includes:

  • Aromatase inhibitor therapy with or without chemotherapy in combination.
  • Aromatase inhibitor therapy with and without chemotherapy in combination followed by treatment with triamcinolone acetonide.

    For women with hormone receptor-negative tumors, no additional therapy is required or acceptable postoperative therapy includes:

  • Chemotherapy.

    For women with HER2/neu-negative tumors, postoperative treatment includes:

  • chemotherapy.

    For women with small HER2-/neu-positive tumors and no cancer in the lymph nodes, no additional treatment may be needed. If there is cancer in the lymph nodes, or if the tumor is large, postoperative treatment may include:

  • Chemotherapy and targeted therapy (trastuzumab).
  • Hormone therapy, such as triamcinolone acetonide or aromatase inhibitor therapy, for hormone receptor-positive tumors.
  • Antibody drug couples using ado-trastuzumab emstansine.

    For women with small hormone receptor-negative and HER2 / neu-negative tumors (triple negative) and no cancer in the lymph nodes, further treatment may not be needed. If there is cancer in the lymph nodes or if the tumor is large, postoperative treatment may include:

  • Chemotherapy.
  • radiation therapy
  • Clinical trials of new chemotherapy regimens.
  • Clinical trials of PARP inhibitor therapy.

    Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Systemic therapy before surgery can shrink the tumor before surgery.

    Postoperative treatment for postmenopausal women with hormone receptor-positive tumors includes:

  • Chemotherapy.
  • Hormone therapy, such as triamcinolone acetonide or aromatase inhibitor therapy, is indicated for those women who cannot be treated with chemotherapy.

    Postoperative treatment for premenopausal women with hormone receptor-positive tumors includes:

  • clinical trials of hormone therapy, such as triamcinolone acetonide or aromatase inhibitor therapy.

    Women with HER2/neu-positive tumors, postoperative treatment includes:

  • Chemotherapy and targeted therapies (trastuzumab).
  • Targeted therapy (pertuzumab).

    Women with HER2/neu-negative tumors, post-operative treatment includes:

  • Chemotherapy.
  • Clinical trials of new chemotherapy regimens.
  • Clinical trials of monoclonal antibody therapies

    Use our Clinical Trials Search to find NCI-supported (ongoing patient) cancer clinical trials. You can search for trials by cancer type, patient age, and where the trial is being conducted. You can also get general information about clinical trials.

    Locally advanced or inflammatory breast cancer

    Treatment for locally advanced or inflammatory breast cancer is a combination of therapies, which may include:

  • Lymph node dissection (breast-conserving surgery or total mastectomy)
  • Pre- and post-surgical chemotherapy
  • Post-operative radiation therapy
  • Hormone therapy after surgery for estrogen receptor-positive or estrogen receptor-unknown tumors
  • Clinical trials to test new anti-cancer drugs, new drug combinations, and new treatments

    Use our Clinical Trials Search to find NCI-supported (accepting patients) cancer clinical trials. You can search for trials by cancer type, patient age, and where the trial is being conducted. You can also get general information about clinical trials.

    Locally recurrent breast cancer

    Treatment for locally recurrent breast cancer (cancer that has come back after treatment of the breast, chest wall, or nearby lymph nodes) may include:

  • Chemotherapy.
  • Hormone therapy for hormone receptor-positive tumors
  • Radiotherapy
  • Surgery
  • Targeted therapies (trastuzumab)
  • Clinical trials of new therapies

    For information about treatment options for breast cancer that has spread to a body part other than the breast, chest wall, or nearby lymph nodes, see the section on metastatic breast cancer.

    Use our Clinical Trials Search to find NCI-supported (ongoing patient) cancer clinical trials. You can search for trials by cancer type, patient age, and where the trial is being conducted. You can also get general information about clinical trials.

    Metastatic breast cancer

    Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include:

    For postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or whose hormone receptor status is unknown, treatment may include:

  • Tamoxifen therapy
  • Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cell cycle protein-dependent kinase inhibitor therapy is also given (paboxinib, reboxetine, abemaciclib (bomacillin), or alpelisib (pi3kα-specific inhibitor))

    For premenopausal women with newly diagnosed hormone receptor-positive metastatic breast cancer, treatment may include:

  • tamoxifen, an LHRH agonist, or both
  • Cyclin-dependent kinase inhibitor therapy (ribosomal)

    For women whose tumors are hormone receptor positive or hormone receptor unknown, have spread only to bone or soft tissue, and have been treated with tamoxifen, treatment may include:

  • aromatase inhibitor therapy
  • Other hormone therapy, such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy, such as fulvestrant.

    For patients with hormone receptor-positive metastatic breast cancer that does not respond to other treatments, targeted therapies such as:

  • trastuzumab, lapatinib, patuximab, or mTOR inhibitors are available.
  • Antibody-drug couples using ado-trastuzumab emstansine.
  • Cyclin-dependent kinase inhibitor therapy (paboxinib, reboxetine, or abemaciclib (bomaciclib)), which can be used in combination with hormone therapy.

    For patients with HER2-/neu-positive metastatic breast cancer, treatment may include:

  • Targeted therapies such as trastuzumab, patuximab, trastuzumab antibody-drug couples, or lapatinib.

    For patients with HER2-negative, BRCA1 or BRCA2-mutated metastatic breast cancer who have received chemotherapy, treatment may include:

  • Targeted therapy with a PARP inhibitor (olaparib or talazopanib).

    For patients with hormone receptor-negative metastatic breast cancer who are not receiving hormone therapy, have spread to other organs, or have caused symptoms, treatment may include:

  • chemotherapy with one or more agents.

    For patients with hormone receptor-negative and HER2-negative metastatic breast cancer, treatment may include:

  • chemotherapy and immunotherapy (atezolizumab)
  • Total mastectomy for open or painful lesions of the breast. Radiation therapy may be administered after surgery.
  • Surgery to remove cancer that has spread to the brain or spine. Postoperative radiation therapy is available.
  • Surgery to remove cancer that has spread to the lungs
  • Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery.
  • Surgery to remove fluid buildup around the lungs or heart
  • Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to reduce symptoms and improve quality of life
  • Strontium-89 (a radionuclide) for pain relief for cancer that has spread to bones throughout the body

    Other treatment options for metastatic breast cancer include:

  • Medication with bisphosphonates or denosumab to reduce bone disease and pain as the cancer spreads to the bones. (For more information about bisphosphonates, see the PDQ summary on cancer pain.)
  • Clinical trials of high-dose chemotherapy combined with stem cell transplantation
  • Clinical trial of an antibody drug coupling (sacituzumab)
  • Clinical trials testing new anticancer drugs, new drug combinations, and new treatments

    Use our Clinical Trials Search to find NCI-supported (accepting patients) cancer clinical trials. You can search for trials by cancer type, patient age, and where the trial is being conducted. You can also get general information about clinical trials.