The main treatments for breast cancer include:
- hormonal therapy (also called endocrine therapy)
- targeted cancer drugs
- bone strengthening drugs (bisphosphonates)
You might have a combination of these treatments, depending on your situation. Your doctor will take many different factors into account when deciding which treatment is best for you.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
Your treatment depends on:
- where your cancer is in the breast
- how big the cancer is
- whether it has spread
- the type of cancer
- how abnormal the cells look under a microscope (the grade)
- whether you have had your menopause
- whether the cancer cells have proteins for targeted cancer drugs
- your general health and level of fitness
Your MDT will discuss your treatment, its benefits and the possible side effects with you.
Most hospitals have specialist breast cancer nurses. They go to the MDT meetings. You usually see the nurses more regularly than your surgeon or oncologist. They can answer your questions and support you and your family and friends.
Surgery for breast cancer
Most people begin their breast cancer treatment with surgery. Your doctor might offer you a choice of treatments. There are different types of surgery.
Breast conserving surgery
Depending on the size and position of the cancer you might be able to have just the cancerous lump removed with a border of normal breast tissue. This is called breast conservation surgery or a wide local excision.
Removal of the breast (mastectomy)
Your surgeon may recommend you have the whole breast removed. This is called a mastectomy. You can have a new breast shape made (a breast reconstruction) at the time of surgery, or sometime later.
Surgery to the lymph nodes
Breast cancer can spread to other parts of the body. It usually first spreads to the lymph nodes in the armpit (axilla) close to the breast. You usually have an ultrasound scan to look at the lymph nodes in the armpit. You may also have a lymph node biopsy.
You might have surgery to the lymph nodes. This may be a sentinel lymph node biopsy where the surgeon removes 1 to 3 nodes. Or you may have an axillary clearance, where more nodes are taken out.
Radiotherapy for breast cancer
Radiotherapy uses high energy x-rays to kill cancer cells. You usually have 3 weeks of radiotherapy after having breast conserving surgery. But in some hospitals, you may have this treatment over a shorter time.
Some people might have radiotherapy after a mastectomy. This depends on the stage of the cancer.
Tests on your breast cancer cells
To work out which treatment you need your doctor will arrange tests on the cancer cells. These tests include checking whether the cells have proteins for hormone treatments or for targeted cancer drugs.
Your doctor might recommend hormone therapy, chemotherapy or a targeted cancer drug. You usually have these treatments after the surgery. They can reduce the chance of the cancer coming back.
You might have chemotherapy or hormone therapy before surgery if you have a large cancer. This treatment can shrink the cancer. It may then be possible for some women to have a smaller area of breast tissue removed rather than having a mastectomy.
You might have targeted cancer drugs with chemotherapy before surgery if you have
You may also have treatment with drugs that strengthen the bones. For some people, this treatment can help reduce the risk of their breast cancer spreading to the bones.
Computer tools to help choose treatment
Specialised computer programmes can help doctors to decide which treatment might be best in your particular case. The programmes contain all the details of trial results for treatments after surgery for early stage breast cancer.
Doctors can type the details of your cancer into the computer database and then add in different types of treatment, such as chemotherapy or hormonal therapy.
The computer tells how much each treatment reduces the chance of the cancer coming back. The computer programmes also give information about the risk of side effects of each treatment. One commonly used programme is called Predict.
Do speak to your doctor if you want to find out more about this.
Testing genes to see if your breast cancer is likely to come back
Gene activity tests are also called tumour profiling tests, genetic expression profiling tests (GEP tests) or gene assays. They look at groups of cancer genes to find out how active they are. The activity of particular genes helps doctors work out whether a cancer is likely to come back
Your doctor may suggest you have a tumour profiling test when the benefit of having chemotherapy is not clear. This gives them more detailed information on whether or not you should have chemotherapy to lower the risk of the cancer coming back.
Some of these tumour profiling tests are available for breast cancer, depending on your situation. Your doctor can explain whether this testing is an option for you. Examples include EndoPredict (EPclin score), Oncotype DX Breast Recurrence Score, and Prosigna.
Doctors do this test using a sample of the cancer taken during your surgery. This means that you will not need any extra tests or examinations.
These tests should not be confused with tests that look for an inherited faulty gene that increases a person’s risk of getting cancer.
Treatment for advanced breast cancer
Advanced breast cancer means the cancer has spread to another part of the body. Treatment aims to control the growth of the cancer and helps to control symptoms. The treatments might include:
- hormone therapy
- targeted cancer drug therapy
- bone strengthening drugs
Getting a second opinion
Treatment decisions can be complicated and confusing. You can ask for a second opinion if you would like to get another doctor's view about your treatment. This means going to see another specialist. They will need to see all your test results and x-rays.
Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which is the best treatment approach to take.
If you want to get a second opinion, your doctor will usually be happy to arrange it for you. It can take time to arrange though and it might mean that your treatment is delayed for a while.
It is worth discussing your treatment again with your current specialist first. Once you have heard why they are suggesting particular treatments for you, you might feel that you don't need a second opinion.
It is always a good idea to jot down a few questions before you go to the hospital for an appointment with your specialist. It can be difficult to remember everything you want to ask once you get there. Writing down your questions beforehand can help you to feel more confident during the discussion.
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.