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Best Plan for You


 Your fight against breast cancer is personal and your care plan should feel the same. Remember that what works best for someone else might not be the most effective form of treatment for you. Breast cancer treatments are also performed by a variety of doctors, so finding a strong and supportive team around you is important. Be sure to research doctors with experience treating your type of cancer and discuss all of your treatment options with them. If you have time, seeking a second opinion can help you feel confident in your plan or provide you with one that better fits your health needs.

 

 

Discuss Your Breast Cancer Treatment Options

Hearing you have cancer or are at an increased risk of developing it can be overwhelming. Knowing what questions to ask your doctor(s) can help you feel more prepared. Use the talking points below to make sure you cover the most important topics. Be sure to discuss everything in detail. This information will help you make the right decisions.

 

Breast cancer diagnosis:

  •   Grade, stage, and type of breast cancers
  •   Pros and cons of treatment options
  •   Side effects and possible treatment outcomes
  •   Chances of cancer returning
  •   Technologies and treatments available at the center
  •   Your age and expected life span
  •   Other serious health issues such as heart disease, high blood pressure, poorly controlled diabetes and more

 

High risk of cancer:

  •   Your chances of developing cancer
  •   Possible preventive treatment options
  •   Short- and long-term side effects and outcomes
  •   Your short- and long-term goals

 

Common Types of Breast Cancer Treatments

 

While there is no “standard” treatment plan, there’s a general list of procedures that make up a typical breast cancer treatment regimen. In most cases, a combination is recommended to maximize the effectiveness and/or prolong life. New medical advancements continue to improve treatment methods and outcomes. Be sure to research different treatment centers to see what technologies and procedures are available. Discuss all of the breast cancer treatment guidelines with your team and weigh the benefits of each option against the possible risks and side effects.

 

  • Prophylactic Treatment
  • Surgery
  • Radiation
  • Drug Therapy
  • Clinical Trials

 

 

Prophylactic Treatment Options for Breast Cancer       

Knowing you have a genetic mutation and/or family history of breast cancer can become too stressful. Some women wish to take a more aggressive approach to prevent breast cancer from developing in the future. The most well-known option is to remove your breast(s) and breast tissue through a prophylactic mastectomy. You can also choose to suppress the estrogen hormone linked to cancer cell growth by opting for a prophylactic ovary removal or preventive hormone therapy. While there is no guarantee, studies have found these treatments can reduce your risk and give you a greater peace of mind.

 

Prophylactic Mastectomy

During this operation, a surgeon will perform either a total, skin-sparing or nipple-saving mastectomy. The removal of your breast(s) and breast tissue will help lower the risk of cancer forming in your breast. According to the National Cancer Institute, a prophylactic mastectomy can reduce the risk by 95% for those who carry a BRCA1 or BRCA2 gene mutation and up to 90% for those with a strong family history of breast cancer.

 

Often recommended for those:

-That carry a BRCA1, BRCA2 or gene mutation

-With blood-relative(s) diagnosed

-Diagnosed with lobular carcinoma in situ (LCIS)

-Received radiation to the chest before 30

 

Possible side effects of a prophylactic mastectomy include:

-Bleeding, infection or delayed wound healing

-Fluid collecting under the scar

-Scar tissue formation

 

Pros of a prophylactic mastectomy for breast cancer:

-Reduced risk of cancer developing  

-Peace of mind

 

Cons of a prophylactic mastectomy for breast cancer:

 

-Permanent and irreversible operation

-Significant loss of sensation in the breast

-Losing the ability breastfeed

-Anxiety or depression about body image

-Not a guaranteed method of prevention

 

Prophylactic ovary removal

Because some breast cancers require estrogen to grow, some women choose to remove the ovaries and/or fallopian tubes to prevent or slow the growth of these cancer cells. According to the National Cancer Institute, this surgery can reduce the number of new cases among high-risk women by around 50%. It also gives women a treatment option who are uncomfortable with the idea of losing their breasts.

 

Often recommended for those:

-That carry a BRCA1, BRCA2 or gene mutation

-With a family history of ovarian or breast cancer

-Women who are premenopausal

 

Possible side effects of prophylactic ovary removal include:

-Bleeding or infection

-Menopausal symptoms such as hot flashes, depression, insomnia and lower sex drive

-Greater risk for heart disease and osteoporosis

 

Pros of prophylactic ovary removal for breast cancer:

-Potentially lower risk without visibly changing your body

-Peace of mind

 

Cons of prophylactic ovary removal for breast cancer:

-Permanent and irreversible procedure

-Losing the ability to produce eggs or carry a child

-Anxiety or depression about loss of fertility 

-Not a guaranteed method of prevention

 

Surgery Treatment Options for Breast Cancer

In many cases, surgery is the first step. However, the type of surgery recommended varies based on a variety of health and personal factors. Some of these include the size of your cancer, its location, if it has spread, the size of your breasts, likelihood of recurrence, the aggressiveness of the cancer and your treatment plan. Based on that information, your doctor will likely perform a lumpectomy or mastectomy and lymph node removal. If you’re not comfortable with the idea of wearing a breast prosthesis (i.e., an external breast shape), breast reconstruction may also be an option. This procedure can happen right after surgery or after you’ve completed radiation. 

 

Lumpectomy

This procedure is commonly called breast-conserving surgery because your doctor is able to save part of your breast. During the operation, your surgeon will remove the tumor, a small amount of surrounding tissue and possibly some of your lymph nodes. A pathologist will check to see if the cells around the tumor show a healthy or clear margin, making sure all of the cancer is absent. If there’s not a clear margin around the cancer, you might need more surgery to be reasonably sure it’s gone.

 

Often recommended for those:

-With small tumors compared to breast size

-With cancers located in a close or single position

-Confirming a diagnosis or ruling it out

 

Possible side effects of a lumpectomy include:

-Bleeding, infection or fluid collection

-Formation of hard scar tissue at the surgical site

-Hematoma or blood clots in legs and lungs

-Temporary nerve pain, shoulder stiffness, swelling and tenderness

-Complications with lymph node removal

-Loss of sensation and numbness in breast

 

Pros of lumpectomy for breast cancer:

-Possibility of keeping most of the breast tissue

-Less changes to your body

-Shorter recovery time

-Effective at preventing a recurrence in early-stage breast cancer

 

Cons of lumpectomy for breast cancer:

-Misshapen, dimpled or unequal breast shape

-Possibility of radiation for 3 to 5 weeks

-Possibility that a mastectomy or another operation is needed

 

 

Mastectomy

Over time, this procedure has become more refined and less intrusive. During this operation, your doctor will perform a total, skin-sparing, nipple-saving, double or radical mastectomy. A total mastectomy involves removing the breast tissue, nipple, areola and some of the skin and tissues that cover the chest muscles. Most of the skin over the breast will be left intact in a skin-sparing operation. Similarly, the breast skin and nipple are left in a nipple-saving mastectomy. However, it will result in a loss of sensation in the nipple due to a lack of blood supply and cut nerves. A double mastectomy is performed on both breasts. In severe and specific cases, a radical mastectomy will additionally remove the underarm lymph nodes and pectoral muscles under the breast.

 

Often recommended for those:

-With large lumps relative to breast size

-With a tumor in the middle of the breast

-With cancer in multiple areas

-Unable to receive radiation or who have had it in the past

-Who are pregnant

-Who have a BRCA gene mutation

-With inflammatory or invasive breast cancer

-With large areas of DCIS in the milk glands

 

Possible side effects of a mastectomy include:

-Bleeding, infection or fluid collection

-Formation of hard scar tissue at the surgical site

-Hematoma or blood clots in legs and lungs

-Temporary nerve pain, shoulder stiffness, swelling and tenderness

-Lymphedema or buildup of lymph node fluid

-Loss of sensation in breast

-Post-mastectomy pain syndrome (PMPS)

 

Pros of mastectomy for breast cancer:

-Likely no need for radiation after

-More confidence the cancer is gone

-Option for radiation if cancer comes back

 

Cons of mastectomy for breast cancer:

-Permanent removal of your breast

-Anxiety or depression about body image

-Only a lower future risk of cancer in the same breast

-Not necessarily a better chance for long-term survival

           

Breast Reconstruction

This procedure can take place at the same time as your surgery, after your treatment is complete or another time in the future. Using tissue from another part of your body or implant, your surgeon can create a new breast shape for you. Because an autologous or flap reconstruction requires taking tissue from another area of the body, this option involves more surgery and healing time. For some women, it’s worth it to avoid having an artificial implant. While you may not have an option, reconstruction at the time of the mastectomy generally produces better cosmetic results.

 

Often recommended for those:

-Wanting a permanent or balanced breast shape

-Experiencing anxiety or depression about body image

 

Possible side effects of breast reconstruction include:

-Problems with anesthesia

-Bleeding, blood clots, fluid buildup, infection or loss of muscle strength

-Tissue death or necrosis in tissue flap, skin or fat

-Scarring around the soft implant

 

Pros of breast reconstruction for breast cancer:

-Body image confidence

-Natural breast shape

 

Cons of breast reconstruction for breast cancer:

-Can’t happen before radiation is complete

-Might require multiple surgeries

-Issues may lead to implant removal or replacement

-Doesn’t restore normal feeling to your breast

-May take 1 to 2 years to fully heal

 

Radiation Treatment Options for Breast Cancer

Radiation may be done prior to surgery in cases where your doctor wants to shrink the tumor beforehand. In many cases, however, it’s done after surgery to target and destroy cancer cells that have stuck around or are too small to be detected. If your cancer is advanced, radiation may be used to control, prevent or relieve symptoms. Due to advancements in this field, standard X-ray radiation is no longer the only radiation option. Proton therapy is gaining in popularity.

 

Both treatments are a non-invasive procedure and typically take place at an outpatient center. However, intraoperative radiation therapy (IORT) and high-dose-rate remote afterloading intraoperative radiation are newer procedures that can deliver a single, high dose of radiation directly to the exposed tissues during a lumpectomy.

                                                                                               

 

Standard X-Radiation for Breast Cancer

This procedure uses external beams invisible to the human eye and similar to an X-ray. Your team of doctors will map out a radiation plan and position these high-energy beams to target the tumor and/or areas affected. During treatment, the beams will emit highly penetrating rays to kill cancer cells by damaging their DNA — the genetic material cells need to grow and divide.

 

Often recommended for those:

-In most cancer stages

-Not healthy enough for surgery

-Who have undergone a lumpectomy or mastectomy

-With cancer found in one or more lymph nodes

 

Possible side effects of radiation include:

-Lower white blood cell counts 

-Heart, lung and nerve problems

-Breast and/or skin changes such as firmness, shrinkage and mild tanning

-Lymphedema or swelling in arms and legs

-Greater risk of fatigue, nausea, headache and loss of appetite

 

Pros of radiation for breast cancer:

-A possible curative option

-No surgical risks or hospital stays

-Noninvasive, typically painless procedure

-Reduced risk of recurrence

-Likely to live longer and remain cancer-free longer

 

Cons of radiation for breast cancer:

-Not an option if you’re pregnant or have received radiation in this location before

-Frequent treatment sessions; up to 5 days for 5-7 weeks

-Greater risk of damage to healthy tissues and surrounding organs

-Increased risk of cardiac events and secondary cancer

-May not be a cure

 

Proton Therapy for Breast Cancer

Instead of using high-energy rays to destroy cancer cells, proton therapy uses a beam of heavy, charged particles that can be controlled to stop precisely at the tumor wall. This highly accurate and much less invasive form of radiation treatment spares healthy tissues and surrounding organs from damaging radiation—a difference that helps reduce side effects of radiation for breast cancer. Your team will also use a computer-driven machine to map out a plan, shape the beam and adjust the dose at different angles to deliver the maximum dose directly at the cancerous cells.

 

Often recommended for those:

-In most cancer stages

-With triple-negative breast cancer

-With recurrent or secondary cancer

-Not healthy enough for surgery

-Who have undergone a lumpectomy or mastectomy

-Cancer found in one or more lymph nodes

 

Possible side effects of proton therapy include:

Diarrhea, nausea, headache and loss of appetite

-Breast and/or skin changes such as firmness, shrinkage, mild tanning

-Heart, lung and nerve problems

 

Pros of proton therapy for breast cancer:

-A possible curative option

-No surgical risks or hospital stays

-Noninvasive, typically painless procedure

-Treatment of larger and more irregularly shaped tumors

-Lower risk of treatment-related side effects, risk of cardiac events, lung cancer and pneumonitis

-Lower risk of secondary cancer due to radiation

-Up to 81% reduced radiation to lung

-Up to 96% reduced radiation to second breast

-Up to 99% reduced radiation to the heart

-Possible retreatment options for those with secondary or recurrent cancer

-Longer life span and cancer-free periods

 

Cons of proton therapy for breast cancer:

-Frequent treatment sessions; up to 5 days for 5-7 weeks

-Greater risk of damage to healthy tissues and surrounding organs

-Increased risk of cardiac events and secondary cancer

-May not be a cure

 

Hormone Therapy for Breast Cancer

Also known as anti-estrogen therapy, this drug treatment is a type of whole-body or systemic treatment. It aims to lower the amount of the estrogen hormone in the body by blocking or slowing down their growth.

 

This medicine is NOT Hormone Replacement Therapy (HRT), which is prescribed to help relieve the symptoms of menopause.

 

Often recommended for those:

-At higher risk of developing ER- or PR-positive breast cancer

-With advanced or metastatic cancer

-In pre-radiation therapy to increase effectiveness

-In post-treatment to prevent recurrence

 

Possible side effects of hormone therapy include:

-Menopausal symptoms such as hot flashes, night sweats, vaginal dryness and/or irritation

-Menstrual cycle changes

-Joint and muscle pain

-Weight gain

 

Pros of hormone therapy for breast cancer:

-Shrinking and inhibiting breast cancer cells

-Potentially higher efficacy when used with other treatments

-Possibly preventing breast cancer in high-risk women

-Reducing risks of breast cancer returning in same or second breast

 

Cons of hormone therapy for breast cancer:

-Not a cure for cancer alone

-Temporarily suppressed ovarian function

-Lack of efficacy against ER- or PR-negative breast cancers

-Not an option for pregnant women

-The possible need for 5 years after surgery

  

Chemotherapy for Breast Cancer

A form of systemic therapy or whole-body drug treatment, chemotherapy is used to weaken and destroy cancer cells. By traveling through the bloodstream, this medicine is able to affect cancer cells found in the original tumor site and others that have broken away and traveled to different places in the body. This is particularly helpful for fast-growing cancers. Chemotherapy can be the first form of treatment in aggressive cancers or follow surgery and/or radiation to lower the risk of the cancer coming back. Studies show that it can make the cancer shrink or disappear in about 30 to 60% of advanced breast cancer cases.

 

Often recommended for those:

-With invasive, advanced and metastatic cancer

-Before surgery to shrink the cancer

-With cancer in lymph nodes

-Looking to reduce risk of recurrence

 

Possible side effects of chemotherapy include:

-Hair changes and loss

-Fatigue, diarrhea, nausea and infection

-Low red blood cell counts

-Menopause and related symptoms such as hot flashes and vaginal dryness

-Mouth and throat sores

-Weight changes

 

Pros of chemotherapy for breast cancer:

-Easy movement throughout the body via the bloodstream

-Ability to be taken intravenously or orally

-Alternative to hormone therapy

-More options for medicine

 

Cons of chemotherapy for breast cancer:

-Not a cure for cancer alone

-Not recommended for noninvasive or DCIS cancer

-Rest periods needed between cycles

 

Targeted Therapy for Breast Cancer

Another form of systematic or whole-body drug therapy, these medicines are designed to block the growth and spread of cancer cells. Unlike chemotherapy, which attacks all cells growing quickly, this treatment targets specific, growth-promoting proteins. This is especially beneficial for the 1 in 5 women diagnosed with HER-2 positive breast cancer, which creates too much of this protein.

 

Often recommended for those:

-With HER2-positive cases

-With BRCA gene mutations

-In most stages, including early and advanced

 

Possible side effects of targeted therapy include:

-Diarrhea

-Hand-foot syndrome

-Heart damage

 

Pros of proton therapy for breast cancer:

-Works even if chemotherapy doesn’t

-Aids the efficacy of other treatments

-Less likely to harm healthy cells

 

Cons of targeted therapy for breast cancer:

-Not an option for pregnant women

-Not effective against ER-, PR- and HER2-negative breast cancers

-Does not cure cancer alone

 

New Treatment Options for Breast Cancer

Participating in a carefully controlled clinical trial is usually the only way to access newer treatments and procedures. During these trials, you’ll receive state-of-the-art care and an opportunity to have a portion or entire cost of treatment covered. Still, less than 5% of women receive breast cancer treatment through a clinical trial. Mostly due to eligibility and researchers limiting the group to women with very specific characteristics to ensure the accuracy of the results. Other women opt out because of the demands of frequent testing and supervision, or the discomfort in choosing a treatment with lesser-known side effects and long-term outcomes.

Breast Cancer Stages and Possible Treatment Options

Stage 1

The cancer has started to attack healthy breast tissue but is still relatively small. It hasn’t spread to the lymph nodes or has spread to a very limited area in the sentinel lymph node. Surgery is the most common treatment and typically followed by radiation therapy to reduce the risk of cancer spreading or returning. Depending on your case, a form of systematic drug therapy may be recommended.

 

Stage 2

At this stage, the cancer is larger and/or has spread to a few of the surrounding lymph nodes. Surgery is still the most common treatment. Based on your case and personal factors, a lumpectomy or mastectomy may be performed. Often times radiation therapy is recommended after surgery to reduce the risk of cancer spreading or returning. If cancer was found in the lymph nodes, systematic drug therapy might also be used to make sure the cancer has been destroyed.

 

Stage 3

Now referred to as advanced, the cancer is larger than 5 cm or has started to grow into nearby skin or muscle tissue. In many cases, surgery is the most common treatment for stage III breast cancer. Radiation therapy is often performed afterward to destroy cancerous cells that might have stuck around after surgery. Systematic therapy may also be recommended to reduce the risk of cancer spreading or returning.

 

Stage 4

Once breast cancer has metastasized, it’s considered incurable because it has spread beyond the breast to your bones and other organs. Drug therapy such as chemotherapy and/or hormone therapy are usually the main treatments. Other treatments like surgery or radiation may be recommended to shrink the tumors, prolong life or control the pain.