Understanding the treatment options available for breast cancer can empower patients and their families in making informed choices. The approach to treatment often depends on the stage of cancer, the specific type of breast cancer, and individual patient factors such as age and overall health.
Below are the primary treatment modalities based on the stage of breast cancer:
Early-Stage Breast Cancer
In early-stage breast cancer, treatment often aims to remove the cancerous tissue and prevent recurrence. The primary treatment options include:
Surgery: Surgical intervention is typically the first line of treatment. Depending on the malignancy's characteristics and patient preference, the options include:
- Lumpectomy (Breast-Conserving Surgery): Involves removing only the tumor and a peripheral margin of healthy tissue. This is often followed by radiation therapy.
- Mastectomy: Complete removal of one breast (Unilateral) or both breasts (Bilateral). Recommendations for this option vary based on tumor size, growth patterns, genetic factors and patient preference.
- Radiation Therapy: Adjuvant radiation therapy is commonly recommended post-lumpectomy to decrease the risk of recurrence. It can be delivered using external beam radiation, which directs radiation from outside the body, or brachytherapy, which involves placing radioactive sources inside the breast.
- Chemotherapy: May be utilized depending on the specific characteristics of the tumor (e.g., HER2-positive). Chemotherapy uses anti-cancer medications to kill or inhibit the growth of cancer cells. While it may not be indicated for all early-stage breast cancers, it is particularly recommended for those with a higher risk of recurrence, such as HER2-positive tumors or those with specific genetic markers.
- Hormone (Endocrine) Therapy: For cancers that are hormone receptor-positive (or hormone-sensitive), hormone therapy medications like aromatase inhibitors can significantly reduce the likelihood of cancer recurrence. Treatment duration generally extends for several years post-relapse prevention.
- Targeted Therapy: Targeted therapies, or biologic therapies, are designed to target specific proteins or markers found on or inside cancer cells that promote their growth. Examples are monoclonal antibody therapy, CDK4/6 inhibitors, tyrosine kinases inhibitor therapy and antibody-drug conjugates (ADCs). These treatments can be given on their own or combined with other targeted therapies, hormonal treatments, or chemotherapy drugs.
Locally Advanced Breast Cancer
- Neoadjuvant Chemotherapy: Administered before surgery to reduce the size of tumors and make breast-conserving surgery a possibility.
- Surgery: May involve mastectomy if lumpectomy is not viable due to tumor size or location.
- Radiation Therapy: Often required post-surgery to eliminate remaining cancer cells.
- Adjuvant Chemotherapy: Post-surgery courses of chemotherapy are often given to minimize risk of recurrence.
- Hormone Therapy: Similarly used for hormone receptor-positive cancers in this stage.
- Targeted Therapy: Continues as per the HER2 status of the cancer.
Metastatic Breast Cancer
- Systemic Therapy: The primary focus as the cancer has spread beyond the breast and surrounding lymph nodes. Options include:
- Chemotherapy: Often the foundation of treatment for managing symptoms and controlling cancer progression.
- Hormone Therapy: For patients with hormone receptor-positive metastatic breast cancer.
- Targeted Therapy: Used based on specific gene mutations (e.g., HER2-targeted therapies for those with HER2-positive disease).
- Palliative Care: Essential for managing symptoms and maintaining quality of life at this stage.
- Clinical Trials: : Encourage participation in ongoing research for innovative treatments not yet widely available.
Navigating breast cancer treatment options can be overwhelming, yet understanding the staging of the disease is crucial in determining the most effective therapies.
Shared decision-making in breast cancer care empowers patients to collaborate with their healthcare providers, ensuring personalized treatment plans that align with their values and preferences, ultimately improving outcomes and satisfaction. Speak to your doctor about Shared Decision Making.
References:
1. Kathryn P Trayes et.al. Breast Cancer Treatment. American Fam Physician. 2021 Aug 1;104(2):171-178.
2. BreastCancer.org. Newly Diagnosed. Available at: https://www.breastcancer.org/about-you/newly-diagnosed
