Breast cancer develops over months or years. Once it is identified, however, a
certain sense of urgency is felt about the treatment, because breast cancer is
much more difficult to treat as it spreads. You should see your health-care
provider if you experience any of the following:
If an abnormality is found on your mammogram, you should see your health-care
provider right away to make a plan for further evaluation.
Many women have treatment in addition to surgery, which may include radiation
therapy, chemotherapy, or hormonal therapy. The decision about which additional
treatments are needed is based upon the stage and type of cancer, the presence
of hormonal and/or HER-2/neu receptors, and patient health and preferences.
Radiation therapy is used to kill tumor cells if there are any left after
1. Adjuvant chemotherapy is given to people who have had curative treatment for
their breast cancer, such as surgery and radiation. It is given to reduce the
possibility that the cancer will return.
2. Presurgical chemotherapy is given to shrink a large tumor and/or to kill
stray cancer cells. This increases the chances that surgery will get rid of the
3. Therapeutic chemotherapy is routinely administered to women with breast
cancer that has spread beyond the confines of the breast or local area.
Most chemotherapy agents are given through an IV line, but some are given as
Chemotherapy is usually given in "cycles." Each cycle includes a period of
intensive treatment lasting a few days or weeks followed by a week or two of
recovery. Most people with breast cancer receive at least two, more often four,
cycles of chemotherapy to begin with. Tests are then repeated to see what effect
the therapy has had on the cancer.
Chemotherapy differs from radiation in that it treats the entire body and thus
may target stray tumor cells that may have migrated from the breast area.
The side effects of chemotherapy are well known. Side effects depend on which
drugs are used. Many of these drugs have side effects that include loss of hair, nausea and vomiting, loss of appetite, fatigue, and
low blood cell counts. Low blood counts may cause patients to be more
susceptible to infections, to feel sick and tired, or to bleed more easily than
are available to treat or prevent many of these side effects.
Hormonal therapy may be given because breast cancers (especially those that have
ample estrogen or progesterone receptors) are frequently sensitive to changes in
hormones. Hormonal therapy may be given to prevent recurrence of a tumor or for
treatment of existing disease.
In some cases, it is beneficial to suppress a woman's natural hormones with
drugs; in others, it is beneficial to add hormones.
In premenopausal women, ovarian ablation (removal of the hormonal effects of the
ovary) may be useful. This can be accomplished with medications that block the ovaries' ability to produce estrogens or by
surgically removing the ovaries, or less commonly with radiation.
Until recently, tamoxifen (Nolvadex), an antiestrogen (a drug that blocks the
effect of estrogen), has been the most commonly prescribed hormone treatment. It
is used both for breast cancer prevention and for treatment.
Fulvestrant (Faslodex) is another drug that acts via the estrogen receptor, but instead of blocking it, this drug
eliminates it. It can be effective if the breast cancer is no longer responding
to tamoxifen. Fulvestrant is only given to women who are already in menopause and is approved for use in women with advanced breast
Toremifene (Fareston) is another anti-estrogen drug closely related to
Aromatase inhibitors, which block the effect of a key hormone affecting the
tumor, may be more effective than tamoxifen in the adjuvant setting. The drugs
anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femera) have a
different set of side effects and risks than tamoxifen.
Aromatase inhibitors are rapidly moving into first line hormonal therapy
regimens. In addition, they are frequently used after two or more years of
Megace (megestrol acetate) is a drug similar to progesterone which may also be
used as hormonal therapy.
Monoclonal antibodies are antibodies against proteins in or around a cancer
cell. Antibodies recognize an "invader" — in this case, a cancer cell — and
Trastuzumab (Herceptin) is an antibody against the HER-2 protein, a protein
responsible for cancer cell growth in many women with breast cancer (about 15-25% of breast cancers). Adding treatment with
trastuzumab to chemotherapy given after surgery has been shown to lower the
recurrence rate and death rate in women with HER2/neu-positive early breast
cancers. Using trastuzumab along with chemotherapy has become standard adjuvant
treatment for these women.
Lapatinib (Tykerb) is another drug that targets the HER2/neu protein and may be
given combined with chemotherapy. It is used in women with HER2-positive breast
cancer that is no longer helped by chemotherapy and trastuzumab.
Another monoclonal antibody, Bevacixumab (avastin) has been shown to have
activity in the treatment of breast cancer and is used in combinatin with
chemotherapy. This drug targets the ability of cancers cells to form new blood
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