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Treatment options

What are the treatment options for breast cancer?

There are several ways that breast cancer can be treated. These include:1

  • Surgery
  • Radiotherapy

    • External beam radiotherapy (EBRT)
    • Brachytherapy (internal radiotherapy)

  • Chemotherapy
  • Hormone therapy

Patients typically receive a number of these treatments. Surgery is commonly used to first remove the tumor, after which radiotherapy is given to help prevent the cancer from returning.

If the cancer is advanced, chemotherapy or hormone treatments may be used to help shrink the size of the tumor before surgery. Hormone therapy may also be used after surgery and radiotherapy to further help prevent the cancer from returning. The types of treatment you receive will depend on how far the cancer has progressed. You can find out more about the progression and stages of breast cancer in the introduction section.

The table below provides a broad overview of when the different treatments might be used.2

Treatment
Grade of cancer
Carcinoma in situ Early Advanced
Surgery (lumpectomy or mastectomy)
Removal of just the tumor and surrounding tissue (lumpectomy) or the whole breast tissue (mastectomy).

 

 

Brachytherapy (internal radiotherapy)
Works by precisely targeting the cancerous tumor. The source of radiation is placed directly next to the tumor.  

 

 

 

External beam radiotherapy (EBRT)
The source of radiation is directed at the tumor from outside of the body. The radiation has to pass through healthy tissue to reach the site of the tumor.

 

 

 

Chemotherapy
May be used before surgery to help shrink the tumor, or to treat cancer that has spread beyond the breast. Several drugs are effective and your doctor will be able to advise of the best one for you.  

 

 

Hormone therapy
A course of hormone therapy may be used to prevent the cancer from returning. (Note: this is different to hormone replacement therapy).  

 

 

Advantages and disadvantages of breast cancer treatments

Each treatment has advantages and disadvantages. These should be considered and discussed with your healthcare professional when planning your treatment.

Treatment Advantages Disadvantages
Surgery (lumpectomy or mastectomy) Clinically proven to be highly effective. 
In early breast cancer lumpectomy with additional radiotherapy is a standard of care and avoids the need for removal of the whole breast (mastectomy).3
One-time procedure.
Can be given in combination with other treatments.
May require a hospital stay of up to 1 week.3
Can cause scarring and discomfort.
Brachytherapy (internal radiotherapy) In early breast cancer clinically proven to be highly effective at preventing cancer from returning after surgery.4-9 
Can be used after EBRT as an additional radiotherapy dose or instead of EBRT (see radiotherapy treatment options below).
Short treatment times of 5-7 days when used as APBI (see below).
You can receive treatment on an outpatient basis.
Not available at all hospitals.
May need to stay in hospital for treatment in some cases.
External beam radiotherapy (EBRT) Clinically proven to be highly effective at preventing cancer from returning after surgery.10
You can receive treatment on an outpatient basis.
Can be given in combination with other treatments.

Treatment course can be long (5-6 weeks) and includes repeat visits to hospital on a daily basis.5

Chemotherapy Clinically proven to be highly effective.11
Can be given in combination with other treatments.
Treatment course can be long (spread out over 4-6 months).
Some side effects including fatigue, hair loss and an increased risk of acquiring infections.6
Hormone therapy Clinically proven to be highly effective at preventing the cancer from returning if the cancer is responsive to hormone levels.12
Can be given in combination with other treatments.
Treatment course can be long (spread out over several years).
Can affect the functioning of the ovaries.7

Radiotherapy treatment options

After surgery to remove the cancer, radiotherapy is commonly used to kill any cancerous cells that may be left in the surrounding tissues.

Using radiotherapy after surgery helps prevent the cancer from returning. There are two main radiotherapy approaches used to deliver the radiotherapy: whole breast irradiation (WBI) and accelerated partial breast irradiation (APBI).

Whole breast irradiation (WBI)13

The whole breast is given a dose of radiation using external beam radiotherapy.

Treatment involves visiting the hospital for 5 days a week, for up to 5-6 weeks.

At each treatment session, you will be positioned comfortably on a couch and rays of radiation will be directed at the affected breast from a special machine.

It is not painful, but you will need to lie still for a few minutes at each session while the radiotherapy is being given.

After completion of the full treatment schedule, a further dose of radiation, known as a ‘boost’, may also be given to just the area where the cancer was located.

The ‘boost’ can be given as external beam radiotherapy or brachytherapy.

Read the procedure section to find out what to expect when receiving brachytherapy.

Accelerated partial breast irradiation (APBI)13

Only the region of the breast where the cancer was located is given a dose of radiation This can be performed using external beam radiation therapy or brachytherapy.

Treatment is short compared to WBI as it only involves visiting hospital for 5-7 days.

Read the procedure section to find out what to expect when receiving brachytherapy.

The availability of APBI varies by country and hospital -to see if APBI is available to you, ask your doctor.

 

References

1.     National Cancer Institute. Available at: www.cancer.gov/cancertopics/wyntk/breast/ Accessed:  March 2014

2.     National Cancer Institute. Available at: www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/allpages. Accessed:  March 2014

3.     Freedman GM, Anderson PR, Li T, et al. Cancer 2009;115(5):946-51.

4.     Polgar C et al. Int J Radiat Oncology Biol 2007;69:694-702

5.     Polgar C et al. Radiotherapy and Oncology 2012. Volume 103; supplement 2. OC-87

6.     Polgar C et al. Int J Radiat Oncol Biol Phys 2004;60:1173-1181.

7.     Polgar C et al. Brachytherapy 2008;7:91-92

8.     Van Limbergen E & Mazeron JJ. 18. Breast Cancer. In: The GEC ESTRO Handbook of Brachytherapy. Gerbaulet A, Pötter R, Mazeron J-J, Meertens H and Van Limbergen E (Eds). Leuven, Belgium, ACCO. 2002.

9.     Kamrava M et al. Ann Surg Oncol.. April 2015 [Epub ahead of print].

10.   Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106.

11.   Cancer Help UK. Available at: www.cancerhelp.org.uk/type/breast-cancer/treatment/chemotherapy/about-breast-cancer-chemotherapy. Accessed: March 2014

12.   Cancer Help UK. Available at: www.cancerhelp.org.uk/type/breast-cancer/treatment/hormone/types-of-breast-cancer-hormone-therapy. Accessed:  March 2014.

13.   Cancer Help UK. Available at: http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/radiotherapy/about-breast-cancer-radiotherapy. Accessed: March 2014