Types of secondary breast cancer treatment

Your specialist will take a number of different factors into account when deciding which treatment is best for you, including

• The part of your body affected
• Any treatment you have already had
• Your general health
• Whether you have had your menopause

Secondary breast cancer may respond to several types of treatment. Doctors try to start with treatment that has as few side effects as possible.

Remember that treatment can often keep secondary breast cancer under control for a long time. Scientists and doctors are working constantly to develop new treatments through research. If you are interested in finding out more about research and clinical trials, you may want to look at our

• Pages about breast cancer research
• Information explaining clinical trials
• Database of clinical trials – on any page in the breast cancer section, click on the 'breast cancer trials button' in the left hand menu to get to the trials database

For most people, it comes as a great shock to find out that they have secondary cancer and will need more treatment. Even if you already thought the cancer had come back, you may be shocked at the strength of your feelings when it is confirmed. 

Don't feel shy about asking how the treatment works or how it may affect you. You may want to talk over the aims and side effects of your treatment with your family and friends. Or you can talk to a counsellor or your breast care nurse. You may find that being involved in the decision about your treatment helps you to feel more in control over the cancer and your feelings.

Your doctor will understand if you don't want to decide about treatment straight away. You may want to find out about other treatment options. Or you may just need more time to come to terms with your new situation. It can be hard to take in a lot of information about treatment when you have just learned that the cancer has spread and are feeling shocked and upset. You can take some time to decide what to do.

Hormone therapy is a common treatment for secondary breast cancer. It can often shrink and control the cancer wherever it is in the body. If one hormone therapy stops working so well, another may then help.

Your doctor may arrange for particular tests on your cancer cells. Many breast cancer cells have proteins called oestrogen receptors. A cancer with oestrogen receptors is called oestrogen receptor positive or ER positive. The more oestrogen receptor positive cells a cancer has, the more likely it is that hormone therapy will work. Progesterone receptors can also be measured. A breast cancer that has cells with many progesterone receptors is called PGR positive. Hormone treatments do not work so well for hormone receptor negative cancers.

The Cochrane Collaboration has looked at all the research comparing hormone therapy with chemotherapy for secondary breast cancer. They found that both treatments are as good as each other, but hormone therapy has fewer unpleasant and harmful side effects. Doctors may try hormone therapy first if the cancer is ER positive. For cancer in the liver or lungs they may give chemotherapy first and then hormone therapy.

If your cancer is hormone receptor negative, your specialist may suggest chemotherapy. Chemotherapy drugs treat cancer cells all over the body. It is often the best treatment for breast cancer that has spread to the liver or lungs.

Your doctor may suggest that you have treatment with a biological therapy such as the monoclonal antibody trastuzumab (Herceptin). Herceptin works by targeting and blocking a protein that stimulates breast cancer cells to grow and multiply. Not everyone with breast cancer will benefit from this treatment. It only works if your breast cancer cells make too much of a protein called HER2. Up to 3 out of 10 women with secondary breast cancer (30%) are HER2 positive and so may benefit from Herceptin. Sometimes doctors combine Herceptin with other treatments. 

You can find out about treatment with Herceptin for secondary breast cancer in this section.

If your cancer has spread to your bones it can weaken your bones making you at higher risk of breaking them. A monoclonal antibody called denosumab (Prolia, Xgeva) can help to reduce problems caused by secondary bone cancer. The National Institute for Health and Clinical Excellence (NICE) has said that denosumab should be available as a treatment within the NHS in England and Wales for people whose breast cancer has spread to the bones. 

Radiotherapy treats one part of the body. So it is good for treating individual areas of cancer. Radiotherapy works well against secondary breast cancer cells in

• The bones
• The brain
• The skin near the breast or on the mastectomy scar

Whether or not you have had your menopause is also important in deciding on the best treatment

• Before the menopause (premenopausal), women have high levels of female hormones
• After the menopause (postmenopausal), women have low levels of these hormones

The hormone levels influence which treatment will work best on the secondary breast cancer cells. If you are premenopausal, your doctor may suggest that you have radiotherapy or hormone therapy to stop the ovaries making hormones. Some women have surgery to remove their ovaries. Any of these treatments can help to control your breast cancer. 

Your doctor also considers

• Whether the secondary cancer is growing slowly or more quickly
• Which treatment, if any, you had along with your original surgery

You can get another medical opinion if you want. It may help you to decide about your treatment. Most doctors are happy to refer you to another specialist for a second opinion. On the other hand, you may already have enough on your mind. Making decisions about treatments could make it even harder. In this case, don't feel that you have to get involved in treatment decisions. Each woman has her own way of coping. Your doctors and nurses will respect your wishes.

If the treatment you are having is not mentioned here it may be because it is a newer type of treatment. You might find it on our clinical trial database, if it is currently being tested in the UK. Or you may find it mentioned on our breast cancer research pages.