The aim of treatment for breast cancer and the types of treatment recommended depend on a number of things including:
- the type of breast cancer
- the stages of breast cancer
- whether breast cancer cells are positive for receptors, such as hormone receptors or HER2
- where breast cancer is in the body
- whether the woman has had breast cancer before and if so, what treatments she received
- the woman’s age and general health
- the woman’s preference.
Surgery, including breast reconstruction
Surgery for breast cancer involves either:
- mastectomy, which involves removal of the whole breast (usually including the nipple), which may be followed by breast reconstruction, or
- breast-conserving surgery, which involves removing the breast cancer and a small amount of healthy tissue around it (called the surgical margin).
Both types of breast surgery usually also involve surgery to remove of one or more lymph nodes from the armpit (axilla), by axillary dissection/axillary clearance or sentinel node biopsy.
Further information on surgery for breast cancer and potential side effects of surgery – such as stiffness in the arm or shoulder, or accumulation of fluid (lymph) in the arm – can be found on the Cancer Australia website.
After a mastectomy, several options are available for breast reconstruction. This surgery can occur either at the same time as the mastectomy or months (or years) later.
The two main types of breast reconstruction are:
- surgical insertion of a breast implant
- transfer of tissue from another part of the body – such as the back or abdomen – to the chest; this is called a tissue flap breast reconstruction.
Discuss the various options for breast reconstruction with the multidisciplinary team involved in your care before you begin treatment.
More information about breast reconstruction can be found on the Cancer Australia website.
Radiotherapy
For women with early breast cancer, radiotherapy is almost always recommended after breast conserving surgery. Radiotherapy is sometimes recommended after mastectomy.
Radiotherapy boost to the tumour bed – that is, an additional dose of radiation given to a smaller area after the rest of the breast has been exposed to radiation – has been shown to reduce the rate of breast cancer coming back in younger women.
One side effect of radiotherapy relates to lactation (the ability to produce milk for breastfeeding). At the usual dose of radiation used to treat breast cancer, it is unlikely that lactation will be possible from the treated breast (although the other breast may produce enough milk for a baby to be breastfed).
Further information on radiotherapy for breast cancer and potential side effects of radiotherapy can be found on the Cancer Australia website.
Chemotherapy
Along with surgery, some women may receive chemotherapy.
Chemotherapy can reduce the risk of breast cancer coming back or spreading to other parts of the body. Chemotherapy can also increase the chance of surviving breast cancer.
Discuss your risk for recurrence of the cancer and the side effects of chemotherapy with your treatment team.
Targeted therapy
Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells.
Further information on targeted therapies for breast cancer and their potential side effects can be found on the Cancer Australia website.
Hormone therapy
Hormone (endocrine) therapy is used for women whose breast cancer cells have receptors for the hormones oestrogen and progesterone – these are called hormone receptor–positive tumours. When hormones can attach to these receptors, they cause the tumour to grow.
Hormone therapy can be given either in addition to chemotherapy or by itself.
For premenopausal women, hormone therapy can involve:
- tamoxifen – a medicine that stops oestrogen from attaching to oestrogen receptors
- ovarian treatments – these work by stopping the ovaries from making oestrogen. Drugs like goserelin stop the ovaries from making oestrogen temporarily. They only work while the woman is taking the drug. This is called ovarian suppression. Oestrogen production can be stopped permanently by removing the ovaries surgically (oophorectomy).
Further information on hormonal therapy for breast cancer and its potential side effects can be found on the Cancer Australia website.
Fertility
Some treatments for breast cancer, including chemotherapy and hormone therapy, can affect a woman’s ability to become pregnant. ‘Fertility-sparing options’ may include freezing eggs, freezing embryos, egg donation treatment, ovarian tissue freezing or temporary ovarian suppression.
Speak to your treatment team before starting treatment for breast cancer about seeing a fertility specialist to discuss options for having children.
