If you’ve been diagnosed with breast cancer, your treatment will depend on your test results and type of cancer. Usually, you will have more than one type of treatment and the order will be personalised according to your diagnosis.
- How do oncologists work out the best treatments?
Your specialty team will do a variety of tests to determine what type of cancer you have and how likely it is to respond to various treatment options. Through mammogram, ultrasound, biopsy, microscopic examination, blood tests and other scans, they will work out the stage (how large the tumour is and whether it’s spread to other parts of the body) and the grade (how fast growing the cancer cells are). They may understand whether the cancer is resistant to certain treatments, what cancer subtype it is and what its hormone receptor status is.
Genetic and biomarker testing will help determine whether there are any genetic mutations or cancer biomarkers that will show whether one treatment would work better than another. You may like to be involved in deciding on your treatment. Or you may prefer the doctor to advise the best way to go. You may also like to get a second opinion.
You can question your treatment options and make the best decision for you and your family.
Here are some treatment options you may have.
- Treatments for breast cancer
Your treatment choice will depend on where your cancer is in your breast, your test results, the cancer’s stage and grade, whether the cancer is hormone receptor or HER2 positive or triple negative. Other things that can come into your treatment are your age, general health and what your preferences are. Some common treatments for breast cancer are:
- Surgery – There are two types of surgery - breast conserving surgery or mastectomy (breast removal). The type of surgery you’re offered will depend on your stage and grade of cancer and also on your preference. Research has shown that breast conserving surgery followed by radiotherapy is as effective as mastectomy for most women with early breast cancer. This means the chance of cancer spreading to other parts of the body is the same. However, there is a higher chance of the cancer returning to the breast area, which is called ‘local recurrence’. Sometimes, the surgeon may also remove one or more lymph nodes in the armpit. This surgery is to see whether the cancer has spread to the lymph nodes.
- Chemotherapy – Chemotherapy is a drugs-based therapy that is designed to destroy cancer cells. Most commonly, chemotherapy is injected into a vein through a drip in the arm or hand. Chemotherapy works by killing the cancer cells that divide rapidly. Unfortunately, many healthy cells such as skin, hair and blood cells also grow rapidly, and chemotherapy can kill these cells too.
- Radiotherapy – Radiotherapy or radiation therapy uses x-ray beams to target cancer cells so they can’t grow, multiply or spread. It’s often recommended after breast-conserving surgery to remove any undetected cancer cells, after a mastectomy if there’s a risk of the cancer returning to the chest area and if the lymph nodes were removed and the risk of cancer returning to this area is high.
- Hormonal therapies – If your cancer has hormone receptors detected such as oestrogen or progesterone, doctors may offer you hormonal therapies. These therapies lower the level of hormones in the body or change the way your body responds to them. Some therapies include anti-oestrogens such as Tamoxifen, which stops cancer cells from responding to oestrogen. Tamoxifen is taken as a single table, once a day for five years. Fulvestrant (Faslodex®) is sometimes recommended for women with metastatic cancer and is taken as a monthly injection. For women who haven’t reached menopause, they can take treatments to stop the ovaries from releasing oestrogen. Drugs like goserelin (Zoladex®) temporarily stop the ovaries from making oestrogen.
- Targeted therapies – Targeted therapies work for specific types of HER2-positive breast cancer. They target the HER2-positive cells within the cancer and stop them growing and dividing. The most common targeted therapies in Australia are trastuzumab (Herceptin®) and lapatinib (Tykerb®) (currently only used for metastatic breast cancer).
- New therapies – There are many new treatment options that are being trialled to help improve treatment effectiveness for breast cancer. Immunotherapy uses the body’s own immune system to fight cancer and has been approved for melanoma and lung cancer. It has had limited effectiveness for breast cancer however recent research has looked into better ways of using immunotherapy in metastatic breast cancer. Personalised medicine or precision medicine can help the oncologists determine the right treatment for each patient. There continues to be more research to determine biological features or ‘biomarkers’ that differentiate patient groups and predict their response to treatment.