Before you choose a treatment plan, you should understand the distinction between standard treatment and clinical trials.
- Breast cancer standard treatments are methods agreed upon by experts to be appropriate, accepted, and widely used. In the past, these standard procedures have proven to be effective in the fight against breast cancer.
- In contrast, a breast cancer clinical trial is an approved research study that some doctors believe has a high potential to improve standard treatments. When clinical trials show that a new treatment outperforms the standard, it becomes the standard. Remember that all of our current standards were once clinical trials.
If a breast cancer clinical trial is an option, your doctor will discuss the potential trade-offs between trial treatment and standard treatment. You and your medical team must decide which treatment is best for you and your health.
Standard Breast Cancer Treatments by Stage
Your treatment options are determined by the stage of your disease as well as the following factors:
- The tumour’s size is about the size of your breast
- The outcomes of various pathology tests (hormone receptors, HER2 receptors, grade of the cells, proliferation rate of the cells)
- Whether or not you have experienced menopause
- Your overall health
- Your age is
- Your family history or other risk factors linked to an increased risk of developing breast or ovarian cancer
Brief descriptions of common treatments for each stage are provided below. Some women may benefit from alternative treatments. At any stage of breast cancer, research studies (clinical trials) may be an option.
Stage 0 (DCIS)
Most women with ductal carcinoma in situ (DCIS), or non-invasive breast cancer, have a lumpectomy followed by radiation therapy. Some women over 70 who have early-stage breast cancer and a hormone receptor-positive tumour may be able to avoid radiation therapy. Though Stage 0 breast cancer is the most severe form, there are cases with many DCIS within the breast tissue. A mastectomy may be required in certain circumstances. Some women may also elect to have a mastectomy. Tamoxifen may be given to women with DCIS to reduce their risk of developing invasive breast cancer.
Stages 1, 2, 3A, and a portion of 3C
Women with Stage 1 breast cancer, Stage 2 breast cancer, Stage 3A breast cancer, or operable Stage 3C breast cancer may receive a combination of treatments. (Operable means that cancer can be treated surgically.)
Some people may have breast-conserving surgery followed by radiation therapy. This is a common option for women with Stage I or II breast cancer. Some women may choose to have a mastectomy. Women (especially those with Stage II or IIIA breast cancer) frequently have lymph nodes under the arm removed with either approach.
The use of radiation therapy after mastectomy is determined by the extent of cancer. If cancer cells are discovered in one to three lymph nodes under the arm, or if the tumour in the breast is large, the doctor may recommend radiation therapy following mastectomy. If cancer cells are found in more than three lymph nodes under the arm and/or the tumour is very close to the chest wall, radiation therapy is usually recommended after mastectomy.
Many factors influence the decision between breast-conserving surgery (followed by radiation therapy) and mastectomy:
- The tumour’s size is about the size of the breast
- The tumour’s location within the breast
- Whether or not multiple tumours are found within the breast, a condition known as multicentricity (which requires mastectomy)
- The presence of a breast cancer gene in the patient
- Certain characteristics of cancer itself
- How the woman feels about having surgery to change the appearance of her breasts
- What the woman thinks of radiation therapy
- The ability of the woman to travel to a radiation treatment centre
- The age of the patient
- The patient’s medical condition
It is worth noting that some women choose bilateral mastectomies for peace of mind. Even though women without a known genetic cause for their breast cancer have a relatively low rate of developing breast cancer in the opposite healthy breast, there is a trend for women to choose bilateral mastectomies with immediate reconstruction.
Breast reconstruction is a benefit provided by health insurance companies and is required by a federal law passed in 1998 for women diagnosed with breast cancer. It is not considered cosmetic surgery but rather a treatment for restoring a woman’s silhouette and psychological well-being.
Some women receive chemotherapy before surgery. This is known as neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumour enough to allow for breast-sparing surgery. This treatment is frequently recommended for women with large Stage II or IIIA breast tumours.
Many women receive adjuvant therapy following surgery. Adjuvant therapy is given after primary treatment to reduce the likelihood of breast cancer recurring. Radiation therapy is a type of local therapy that can kill any cancer cells that remain in or near the breast. Women may also receive hormone therapy, chemotherapy, targeted therapy, or a combination of these treatments. These systemic therapies can destroy cancer cells that have spread throughout the body. They can prevent or postpone the return of cancer in the breast or elsewhere.
Stage 3B and a portion of Stage 3C
Women with Stage 3B (including inflammatory breast cancer) or inoperable Stage 3C breast cancer receive chemotherapy first, and other treatments may be considered. (Inoperable means surgery cannot treat cancer without first shrinking the tumour.) They may also receive targeted therapy.
If the tumour shrinks after chemotherapy or targeted therapy, surgery may be an option:
- Mastectomy: The breast is removed by the surgeon. The lymph nodes under the arm are usually removed, a procedure known as axillary node dissection. Following a mastectomy, a woman may receive radiation therapy to the chest and underarm area.
- Breast-conserving surgery: In rare cases, the cancer is removed but not the breast. Typically, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the breast and underarm area. This may be possible for someone with stage III breast cancer if they received neoadjuvant chemotherapy and the tumour shrank successfully. Even if chemotherapy is given first, women with inflammatory breast cancer are never candidates for breast-conserving surgery. Because the breast cancer started in the underlying skin of the breast, all of that skin must be surgically removed.
Following surgery, the doctor will most likely recommend chemotherapy, targeted therapy, hormone therapy, or a combination of these treatments. This therapy may aid in preventing the disease from returning to the breast or elsewhere.
Stage 4 and Recurrent
Women with Stage 4 breast cancer will be treated differently depending on where cancer has returned. Suppose cancer returns in the chest area or within the breast tissue left after surgery. In that case, your doctor may recommend surgery, radiation therapy, chemotherapy, hormone therapy, or a combination of these treatments.
Women with Stage 4 breast cancer or recurrent cancer that has spread to the bones, liver, or other organs typically receive hormone therapy, chemotherapy, targeted therapy, or a group of these treatments. Radiation therapy can be used to treat tumours in specific areas of the body. These treatments are unlikely to cure the disease but may prolong a woman’s life.
Many women require both supportive care and anti-cancer treatments. Anti-cancer treatments are administered to slow the disease’s progression and, whenever possible, to control cancer, treating it as a chronic illness. Supportive care assists in managing pain, other cancer symptoms, and treatment side effects (such as nausea). This type of care can make a woman feel physically and emotionally better. The goal of supportive care is not to prolong life. Some women with advanced cancer elect to receive only palliative care. More and more research is being conducted on Stage 4 breast cancer, which is expanding treatment options for patients with metastatic breast cancer. It is not uncommon for women with oestrogen receptor-positive tumours to live for a decade or more while maintaining their quality of life.
Metastatic Trial Search
Locate metastatic breast cancer trials that are appropriate for you. To get started, enter your breast cancer type and sites with current evidence of disease, gender, birth year, and zip code. Find out more.
