Breast cancer is usually treated with surgery, medications, and radiation therapy. Decisions about how to treat breast cancer are based on a combination of factors that include specific information about the cancer, your preferences, and your health.

When making decisions about treatment for your breast cancer, you and your health professional will consider:

• The size and location of your breast cancer.
• How your breast cancer cells look under the microscope.
• Whether your breast cancer responds to hormones.
• Whether lymph nodes in your underarm area (axilla) contain breast cancer cells.

You and your health professional will also consider your personal preferences and health when developing a treatment plan for you. This will include:

• Your feelings about keeping your breast.
• Your personal and family history of breast cancer.
• Whether you have other serious health problems.

Most people with breast cancer have surgery to remove the cancer from the breast. Some or all of the lymph nodes under the arm are also removed.

Even if all the cancer that can be seen at the time of your surgery is removed, you may be treated with radiation therapy.

Chemotherapy or hormone therapy may also be recommended. You may also be given chemotherapy or hormone therapy to shrink your breast cancer before surgery. This is called neoadjuvant therapy.

Initial treatment

Initial treatment of breast cancer may include: ⁴

• Surgery with either mastectomy or breast-conserving surgery (lumpectomy) to remove the cancer. Some of the lymph nodes under the arm will also be removed using either axillary lymph node dissection or sentinel node biopsy.
• Radiation therapy.
• Chemotherapy.
• Hormone therapy with tamoxifen or aromatase inhibitors. Postmenopausal women who are also ER+ may gain additional benefit by using an aromatase inhibitor, such as exemestane (Aromasin), after 2 to 3 years of treatment with tamoxifen. ^{13, 14}

What type of surgery should I have to treat early-stage breast cancer?

If you have recently been diagnosed with breast cancer, you may experience a wide variety of emotions. Most women will experience some denial, anger, and grief. Other women may have fewer emotions. There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to breast cancer. You may find that talking with family and friends helps you with your emotions. Some women may find spending time alone is what they need.

If your reaction is interfering with your ability to make decisions about your health, it is important to talk with your health professional. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you in find a support group. Talking with other people who may have had similar feelings can be very helpful.

You may use home treatment to help you manage the side effects that may accompany any stage of breast cancer or breast cancer treatment. ¹⁵

Ongoing treatment

Following the initial treatment for breast cancer, you may see your family doctor, general practitioner, medical oncologist, radiation oncologist, or surgeon at regularly scheduled intervals, depending on your individual situation. The length of time between visits will gradually lengthen until at 5 years, if no new problems develop, you are seeing your health professionals once each year. As part of your follow-up, you may have:

• Physical examinations. The frequency of your physical examinations depends on your general health and the type of breast cancer you have. In general, you will see your health professional every 3 to 6 months for 3 years and then every 6 months until 5 years have passed since your diagnosis of breast cancer. You may see your health professional annually at this point.
• Mammograms to screen for breast cancer and investigate lumps that can be felt during a breast examination.

After treatment for breast cancer, it is important to continue to do monthly breast self-examinations. Regular self-examinations will help you detect early signs of recurrences. Early signs of recurrence may appear in the incision area itself, the opposite breast, the axilla (armpit), or area above the collarbone.

If new problems develop, you may have additional tests, such as blood tests, bone scans, chest X-rays, CT scans, or MRI tests.

If your breast cancer cells test positive for estrogen and progesterone receptors, you may be instructed to take tamoxifen or other hormonal medications following your initial diagnosis. Postmenopausal women who are also ER+ may gain additional benefit by using an aromatase inhibitor, such as exemestane (Aromasin), after 2 to 3 years of treatment with tamoxifen. ^{13, 14}

Treatment if the condition gets worse

For information about the treatment of metastatic or recurrent breast cancer, see the topic Breast Cancer, Metastatic or Recurrent.

What to Think About

Even if your doctor removes all the cancer that can be seen at the time of the operation, you may be given radiation therapy, chemotherapy, hormone therapy, or a combination of the three therapies after surgery to try to destroy any cancer cells that may be left in your body. You may also be given chemotherapy or hormone therapy to shrink your breast cancer before surgery (neoadjuvant therapy).

The likelihood that your breast cancer will return following treatment depends on a number of factors, including the size and grade of your breast cancer, whether you had breast cancer cells in your lymph nodes, how many lymph nodes were involved with breast cancer, and how well you respond to the treatment.