Treating breast cancer in women - overview
For most women, the first treatment for breast cancer is surgery to remove it. You will usually have additional treatments to reduce the risk of the cancer coming back. This is called adjuvant treatment.
These treatments may include radiotherapy, hormonal therapy, chemotherapy and targeted therapy with trastuzumbab (Herceptin).
Your doctor and breast care nurse will explain the treatments they think are best for you.
They will ask about your preferences, explain options available and can help you if you need to make decisions about treatment.
Surgery is one of the main treatments for breast cancer. Your surgeon may advise that you have an operation to remove the cancer and some surrounding tissue. This is called breast-conserving surgery.
Alternatively, they may advise you have the whole breast removed. This is called a mastectomy. Both these operations usually involve having some or all of the lymph nodes in your armpit removed.
Breast reconstruction can be done at the same time as these operations or later.
Sometimes, doctors give chemotherapy or hormonal therapy before surgery to shrink the cancer, making it easier to remove. This is called neo-adjuvant treatment.
You are likely to be offered one or more of the following treatments after surgery to reduce the risk of the cancer coming back.
After breast-conserving surgery, your doctor will usually advise you to have radiotherapy to the rest of the breast. This gets rid of any cancer cells that may have been left behind. Some women who have had a mastectomy will also need radiotherapy to the chest.
If the cancer is large, was in the lymph nodes or is high-grade, your doctor will usually talk to you about having chemotherapy. Women with triple negative or HER2 positive breast cancer are also likely to have chemotherapy.
If the cancer is oestrogen-receptor positive, your doctor will ask you to take hormonal therapy for a number of years.
If you have HER2 positive breast cancer, you’ll usually have treatment with trastuzumbab and chemotherapy.
Research into breast cancer is going on all the time. Better treatments mean more women are cured or living for longer.
Your breast specialist may ask you if you would like to take part in a clinical trial.
How treatment is planned (MDT)
A team of specialists will meet to discuss and decide on the best treatment for you. This multidisciplinary team (MDT) will include:
a surgeon, who specialises in breast surgery and may also specialise in breast reconstruction
a plastic surgeon, who specialises in breast reconstruction
an oncologist (cancer specialist), who specialises in chemotherapy, radiotherapy, hormonal therapy and targeted therapy
a specialist breast care nurse, who gives information and support
a radiologist, who analyses x-rays and scans
a pathologist, who advises on the type and extent of the cancer.
It may also include other healthcare professionals, such as a research nurse, physiotherapist, psychologist, social worker or counsellor.
Your cancer team looks at different factors to help decide which treatments are likely to work best for you.
They will also assess the chance of your cancer coming back when planning how much treatment to offer you.
After the MDT meeting, your cancer specialist or nurse will talk to you about the best treatment for your situation.
They may sometimes use a computer programme such as PREDICT or Adjuvant Online. These can help to show how much having a treatment like chemotherapy will reduce the chance of your cancer coming back. You might find this helpful, especially if your doctor has asked you to make a decision about having chemotherapy.
Gene expression tests
The National Institute for Health and Care Excellence (NICE) has recommended the use of a gene expression test called Oncotype DX for women with ER positive cancer that hasn’t spread to the lymph nodes. This test provides more information about the risk of early breast cancer coming back.
The results can help women and their doctors make a more informed decision about whether or not to have chemotherapy after surgery. If the results show a low risk of the cancer coming back, it means you can avoid unnecessary chemotherapy and side effects.
Ask your cancer specialist or specialist nurse if you would benefit from this test. Oncotype DX may be covered by some private health insurance companies.
NICE guidance only covers England and Wales. If you live in Scotland or Northern Ireland, your cancer specialist will be able to tell you if this test is likely to be available. NICE recommends that other gene expression tests called MammaPrint, IHC4 and Mammostrat are still only used in research trials.
Giving your consent
Before you have any treatment, your doctor will explain its aims. They will ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment.
No medical treatment can be given without your consent. Before you are asked to sign the form, you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion.
You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
Your multidisciplinary team uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion.
Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.