Breast cancer treatment options

Most women with breast cancer have surgery as first-line treatment. In order to further decrease the risks of the cancer coming back, surgery is normally followed by one or a combination of treatments – these are outlined in this article.

Surgery

The aim of surgery is to reduce the risks of cancer recurrence and to try to prevent it from spreading.

Your surgeon may recommend breast-conserving surgery, which is an operation to excise the tumour along with the surrounding border of normal tissue. Alternatively, you may be advised to have a mastectomy – this involves the removal of the entire breast.

Your doctor may also suggest that you have a neo-adjuvant treatment such as chemotherapy or hormone therapy prior to the surgery in order to shrink the cancer or slow its growth – especially if it is developing rapidly. This can make the surgery less extensive, which may mean you will not require a mastectomy.

Additional treatments

To be successful, treatment for breast cancer needs to be individualised. Your healthcare team will therefore need to review the particularities of your cancer before suggesting one or more of the treatments listed below. The team will be looking at the type of breast cancer you have, its size, growth rate, whether it has invaded nearby tissues or possesses specific surface markers in order to determine which of the following treatment(s) will work best for you.

Chemotherapy

Chemotherapy given after the surgery (referred to as adjuvant chemotherapy) aims to destroy any cancer cells that have not been removed. This treatment involves the use of a combination of cytotoxic (anti-cancer) drugs, which work by either weakening and destroying cancer cells or hindering their growth and division at different stages of development.

Three drugs are usually given at once through a venous drip which delivers them directly into the bloodstream. You may be asked to come for chemotherapy sessions once every two to three weeks for about four to eight months.

Who is usually offered chemotherapy?

Doctors will often recommend chemotherapy to women with a large tumour, a cancer that has spread to or beyond their lymph nodes, a triple negative breast cancer or HER2 positive breast cancer. Chemotherapy may also be warranted if the cancer is spreading rapidly, or if it has the potential to infiltrate nearby tissues.

You will not be offered chemotherapy if your oncologist believes that your cancer is unlikely to recur even without chemotherapy.

Radiotherapy

Radiotherapy is usually given post-surgery or chemotherapy to destroy any remaining malignant cells, using monitored doses of radiation.

There are different types of radiotherapy, namely:

Breast radiotherapy – given after breast conserving surgery to the remaining breast tissue.
Chest wall radiotherapy – recommended after a mastectomy; radiation is applied to the chest wall (the area directly behind the breast).
Lymph nodes radiotherapy – if the surgeon identifies cancer cells in the excised lymph nodes, you may need radiotherapy to the remaining nodes in your armpit, above your collarbone and near your breastbone.

An extra dose of radiotherapy (known as a booster dose or breast boost) may also be applied to the region where the cancer was discovered. One of the drawbacks of the booster dose is that it can affect the appearance of your breast and cause your breast tissue to harden.

To give your body sufficient time to recover, radiotherapy sessions will typically be scheduled a month after surgery and chemotherapy. You will usually need these sessions three to five times weekly for three to six weeks.

Who is usually offered radiotherapy?

This treatment is recommended to most women unless their risk of cancer recurrence is low.

Hormone therapy

Hormone therapy works by decreasing the levels of the female hormone oestrogen or by preventing it from attaching to the cancer cells. Some breast cancers consist of cells that possess receptors for oestrogen – this hormone promotes the growth of the cancer when it attaches to these receptors.

What are the hormone drugs available in the UK?

Tamoxifen prevents oestrogen from attaching to the oestrogen-receptor-positive cancer cells. It can be taken on its own by pre- and post-menopausal women.
Goserelin (more commonly known as Zoladex®) causes ovarian suppression – it prevents the ovaries from producing oestrogen.
Aromatase inhibitors are offered to women who have been through menopause. Although ovaries no longer synthesise oestrogens after menopause, the body continues to produce some oestrogen in the fatty tissue using a substance known as aromatase. As the name suggests, aromatase inhibitors such as Anastrozole, Letrozole or Exemestane work by suppressing aromatase.

What are the hormone therapy treatment options?

Five years on either Tamoxifen or an aromatase inhibitor.
Two or three years of Tamoxifen followed by two or three years on an aromatase inhibitor.
Five years on Tamoxifen and four years on Letrozole.

Your doctor may also recommend an ovarian ablation which involves the surgical removal of the ovaries. You may also opt for a combination of Tamoxifen and either ovarian ablation or Goserelin / Zoladex®.

Who is usually offered hormone therapy?

Women with oestrogen-receptor positive or ER+ breast cancers.

Breast cancer cells may also have receptors for the hormone progesterone. However, the benefits of hormone therapy are quite ambiguous for women whose breast cancer is progesterone receptor positive only (PR+ and ER-). Therefore, if you have progesterone receptors, your cancer specialist will need to evaluate whether this therapy is warranted for you.

Biological therapy

Biological therapy, also known as targeted therapy, ‘targets’ cancer cells and attacks them directly. The advantage of using biological therapy is that it does not usually harm normal tissue and is thus unlikely to have side effects such as hair loss or nausea.

Trastuzumab (more commonly known as Herceptin®) is one example of a targeted therapy – it targets breast cancers with elevated levels of the HER2 protein.

Who is usually offered Herceptin?

Women with HER2 positive breast cancers can benefit from Herceptin provided their cardiovascular function is normal. They must also have had surgery, chemotherapy and, if required, radiotherapy.

For more information about breast cancer treatment, please consult NHS Choices.