Typically more than one therapy is required to treat breast cancer. This often includes surgery as well as one or more treatment regimens proven to fight the type of breast cancer a patient has.
Your oncologist will conduct tests to determine if the breast cancer is:
- Hormone receptor negative or positive
- HER2/neu negative or positive
Based on the results of these tests a combination of therapies will be determined, using research to choose a treatment plan that has shown the best results for patients with similar cancer.
The following are general categories of breast cancer therapies that the doctor may choose to use alone or in combination with one another. The specific set of treatments will be determined by the stage and type of breast cancer as well as the patient’s health status.
Chemotherapy
Chemotherapy for breast cancer may be given before or after surgery:
- Before surgery (neoadjuvant chemotherapy): Your oncologist may choose to give chemotherapy before surgery to shrink the tumor before it’s removed. Also, by giving chemotherapy before surgery the doctor can see how well the cancer responds. If the doctor does not see the desired response, a different breast cancer chemotherapy may be needed. This may also allow for a patient to have a better likelihood of completing breast conservation surgery.
- After surgery (adjuvant chemotherapy): Chemotherapy is often given to patients after breast cancer surgery to try to kill any cancer cells that may have been left behind or spread but can't be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemotherapy can also reduce the risk of breast cancer coming back.
The specific medicines administered are dependent on the type of breast cancer and the woman’s health status. At NYOH, we follow the National Comprehensive Cancer Network Clinical Practice Guidelines.
Radiation Therapy for Breast Cancer
Oncologists often use radiation therapy to treat breast cancer. The type of radiation therapy that may be most effective will be determined by the breast cancer treatment team and discussed with the patient. The most common radiation treatment is external radiation therapy.
In external radiation therapy, the radiation comes from a large machine outside the body. This type of treatment is given often -- typically 5 days a week -- over several weeks.
At New York Oncology Hematology, patients receive treatment at one of our seven convenient office locations. You do not need to go to a hospital for this treatment. New York Oncology Hematology offers the latest radiation therapy at technology, including IMRT, 3-D Conformal Radiation Therapy, and TruBeam Radiotherapy.
Hormone Therapy for Breast Cancer
If the patient’s breast cancer shows that it has hormone receptors then hormone therapy may be an option. Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow. Hormone therapy may be given in combination with other treatments.
Options before menopause
If the patient has not gone through menopause, the options include:
- Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As a treatment for metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells that are in the body. It’s a pill that you take every day for up to five years.
- LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain.
- Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body’s main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn’t benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. The side effects are often more severe than those caused by natural menopause. Your health care team can suggest ways to cope with these side effects.
Options after menopause
If the patient has already gone through menopause, the options change:
- Aromatase inhibitor: This type of drug, which includes anastrozole, exemestane, and letrozole, can be used to block the activity of an enzyme called aromatase which the body uses to make estrogen in the ovaries and in other tissues. Aromatase inhibitors are used primarily in postmenopausal women because the ovaries in premenopausal women produce too much estrogen to block effectively.
- Tamoxifen: Hormone therapy is often given for at least five years to prevent recurrence of breast cancer. Some women have hormone therapy for longer. See above for more information about tamoxifen.
Targeted Therapy
Targeted therapy blocks the breast cancer cell’s ability to grow. This is especially useful for patients with HER2 positive breast cancer. Targeted therapies will block the HER2 protein so that it can’t help to grow the cancer. These medicines can be given through an IV, with or without chemotherapy, or in a pill form. Options will vary based on what type of treatment your doctor feels would work best for you.
Breast Brachytherapy
Breast HDR brachytherapy is a form of high dose rate radiation therapy that is delivered from within the breast using catheters rather than external radiation beams.