There are a number of treatment options for breast cancer. The choice of treatment depends on a number of factors, including:
- The type of breast cancer
- The location of tumour in the breast
- The tumour’s stage and grade
- Molecular characteristics of the tumour (hormone receptor status)
- The age, health and preferences of the patient
- Whether the patient had breast cancer before and what treatments have been used
One or more treatments may be recommended, and treatments may be provided in different sequences and combinations.
Common treatment options for breast cancer are described below. These descriptions are not intended to be exhaustive or replace professional medical advice. Please consult with your doctor or cancer care team if you are concerned about the risks and side effects of any recommended treatment.
Surgical treatment is an operation where the doctor removes the tumour. This is one of the most common treatment options for women with breast cancer. The two main types of surgery are breast-conserving surgery and mastectomy.
- Breast-conserving surgery (also known as lumpectomy or wide local excision). The surgeon removes the tumour and some surrounding healthy tissue, leaving as much breast tissue as possible.
- A mastectomy is the removal of the entire breast. Some women may choose to have a double mastectomy, where both breasts are removed. A woman may opt to have breast reconstruction surgery at the same time as her mastectomy, but it may also occur later as a separate operation.
Chemotherapy (often referred to as ‘chemo’) is the administration of anti-cancer drugs to kill cancer cells.
Chemotherapy can be given intravenously (injected into your vein) or orally. The drugs used will depend on the type and stage of breast cancer. There are often side-effects associated with chemotherapy, including nausea, fatigue, hair loss, mouth ulcers and constipation.
In some cases, chemotherapy may be recommended before surgery (called neoadjuvant chemotherapy) as it may shrink the tumour and provide the patient with more surgical options. When chemotherapy occurs following surgery, it is referred to as adjuvant chemotherapy. Adjuvant chemotherapy may be used to kill any cancer cells that remain or to lower the risk of cancer recurrence.
Radiotherapy (also called radiation therapy) is the use of targeted radiation, such as x-rays, to destroy cancer cells or keep them from growing.
Radiotherapy may be given externally or internally.
• External radiation therapy uses a machine outside the body to irradiate the cancer.
• Internal radiation therapy uses a radioactive source put inside the body for a short period of time. The source is placed directly into or near the cancer.
Radiotherapy may have side-effects such as fatigue, skin changes in the treatment area (such as redness or skin peeling) and swelling of the breast.
Hormone therapy (also called endocrine therapy or hormone-blocking therapy) is used to treat hormone receptor positive breast cancers (cancers with oestrogen and/or progesterone receptor) that likely require hormones to grow.
Hormone therapy can be given orally (such as the medication Tamoxifen), or through injections (such as the drug Fulvestrant, which may be used to treat metastatic breast cancer).
Side effects may include menstrual changes, hot flushes, and night sweats; Tamoxifen can also increase the risk of blood clots, although blood clots are rare.
Targeted therapy is a type of cancer treatment that works differently to chemotherapy. Chemotherapy attacks all rapidly dividing cells in the body, but targeted therapy works by “targeting” those differences that help a cancer cell to survive and grow.
Targeted treatments can be taken orally, injected or given intravenously (through a vein). They may be given along with chemotherapy.
Side effects of targeted therapy can include fever, headache, and a rash; the targeted therapy trastuzumab (brand name Herceptin) may also affect heart function.
Treatment for advanced and metastatic breast cancer
Advanced breast cancer (also referred to as metastatic breast cancer) occurs when breast cancer has spread (or metastasised) to other parts of the body. Treatment of metastatic breast cancer aims to control the growth and spread of the cancer, to relieve symptoms, reduce pain, and improve or maintain quality of life.
Treatment options can include surgery, radiation, chemotherapy, hormonal therapy and/or targeted therapy, depending on the location and molecular makeup of the cancer. Treatment may shrink or slow the growth of tumours, ease symptoms and help women live longer.
New treatment options for breast cancer
With the help of scientific research, a number of new treatment options are currently being developed to improve treatment effectiveness and reduce potential side effects. These include new approaches to treat advanced breast cancer, harnessing the patient’s immune system to fight cancer (immunotherapy) and personalising cancer treatment. Learn more about these different treatment approaches and the related NBCF research projects below.
Immunotherapy in breast cancer
Immunotherapy is a type of cancer treatment that uses the body’s immune system to fight against cancer. Immunotherapy may slow the growth and spread of cancer by helping the immune system destroy existing cancer cells. Rarely, immunotherapies may also cause other severe, potentially life-threatening reactions.
In Australia, immunotherapies have been approved for some cancers (such as melanoma and lung cancer) but not yet for breast cancer. However, immunotherapies are currently being tested in clinical trials (research studies where people volunteer to test new treatments) for breast cancer in Australia. This includes two groundbreaking clinical trials (called CHARIOT and DIAmOND) from NBCF-funded researcher and Endowed Chair, Professor Sherene Loi. These trials will hopefully lead to regulatory approval and ultimately, impact the future of breast cancer treatment.
Towards personalised medicine
Personalised medicine (also referred to as precision medicine) refers to a treatment approach where cancer treatment is tailored to an individual patient, using information such as the tumour’s molecular makeup, size, and spread, as well as the patient’s genes. The goal is for doctors to make optimal treatment choices to maximise effectiveness and avoid side effects, using a customised rather than ‘one-size-fits-all’ treatment approach, leading to fewer deaths and better quality of life for those diagnosed.
However, the success of personalised medicine depends on being able to identify the right treatment for the right person at the right time. This is a great challenge, as breast cancers can vary genetically and biologically from one another; even the same cancer can change over time within the same patient. Therefore, there is an urgent need to identify biological features (or ‘biomarkers’) that can distinguish different patient groups from one another and predict their response to treatment.