Treatment overview for breast cancer
Your doctors look at different factors to help decide which treatments are likely to work best for you.
About treatment for breast cancer
The first treatment for breast cancer is usually surgery to remove it. After surgery, you may have treatments to reduce the risk of the cancer coming back. These treatments can include:
- radiotherapy
- hormonal therapy
- chemotherapy
- targeted and immunotherapy drugs, such as trastuzumab.
You may sometimes have these treatments before you have surgery.
You may have drugs called bisphosphonates to reduce the risk of breast cancer coming back. These can also be used to protect your bones from the side effects of some types of hormonal therapy and chemotherapy.
Your doctors look at different factors to help decide which treatments are likely to work best for you. These include:
- the stage and grade of the cancer
- if the cancer cells have oestrogen receptors (ER positive)
- if the cancer has HER2 receptors (HER2 positive).
Your cancer doctor and breast care nurse will explain the treatments that they think are best for you. They can help you make decisions about your treatment.
Treatments for breast cancer are improving. Better treatments mean that more people are cured or living longer. Your cancer doctor may ask you if you would like to take part in a clinical trial.
We understand that having treatment can be a difficult time for people. We're here to support you. If you want to talk, you can:
- Call the Macmillan Support Line for free on 0808 808 00 00.
- Chat to our specialists online.
- Visit our breast cancer forum to talk with people who have been affected by breast cancer, share your experience, and ask an expert your questions.
Treatments and fertility
Some cancer drugs can affect whether you can get pregnant (your fertility) or make someone pregnant. If you are worried about this, it is important to talk with your cancer doctor before you start treatment. The effect on fertility may be temporary, but for some people it can be permanent.
Before treatment starts, your doctors and nurses will talk to you about this. If treatment could affect your fertility, they will explain what can be done to help preserve your fertility.
Breast cancer and pregnancy
If you have been diagnosed with cancer and you are pregnant or breastfeeding, we have more information.
Treatment before surgery
You may have chemotherapy or hormonal therapy before surgery. This is to shrink the cancer and make it easier to remove. You may also have chemotherapy and targeted therapy before surgery if the cancer is growing more quickly. Treatment before surgery is called neo-adjuvant treatment.
Surgery
Your surgeon will talk to you about having 1 of these operations:
- breast-conserving surgery – this involves removing the cancer and some surrounding normal breast tissue
- a mastectomy – this involves removing all the breast tissue and sometimes the nipple on the affected side.
Most men only have a small amount of breast tissue. This means they can usually only have a mastectomy.
You will usually need some or all the lymph nodes in your armpit removed. This is done in both of these operations.
You may want to have a new breast shape made during the operation. This is called breast reconstruction. You can choose to have it done at a later time.
Treatment after surgery
Your cancer doctor will usually offer you 1 or more of the following treatments after surgery. These treatments can reduce the risk of the cancer coming back.
-
Radiotherapy
After breast-conserving surgery, your cancer doctor will usually advise you to have radiotherapy to the rest of the breast. You may also need radiotherapy to the lymph nodes near the breast.
After a mastectomy, you may need radiotherapy to the chest and possibly the lymph nodes. -
Chemotherapy
Your cancer doctor may advise you to have chemotherapy if:
- the cancer is large
- the cancer has spread to the lymph nodes
- the cancer is a higher grade
- you have triple negative breast cancer
- you have HER2 positive breast cancer.
-
Hormonal therapy
If the cancer is ER positive, you will be given hormonal therapy for a few years.
-
Targeted therapy
If you have HER2 positive breast cancer, you will usually have a targeted therapy drug called trastuzumab. You may also have a drug called pertuzumab.
-
Immunotherapy
Immunotherapy uses the immune system to find and attack cancer cells. Currently, it is only available to people with triple negative breast cancer.
Your cancer doctor and breast care nurse will talk to you about the most effective treatments available to you.
They may use an online tool such as PREDICT. PREDICT is designed to help people make informed decisions with their doctors about treatment after surgery for breast cancer. It can show how much different treatments reduce the risk of the cancer coming back. You might find it helpful, especially if your cancer doctor has asked you to decide whether to have chemotherapy.
Sometimes doctors suggest having a tumour profiling test on the cancer cells. This gives more information about the risk of the cancer coming back.
About our information
-
References
Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
ESMO. Early breast cancer clinical practice guidelines for diagnosis, treatment and follow-up. 2019, Vol 30, pp1192–1220. Available from: https://www.esmo.org/guidelines/guidelines-by-topic/breast-cancer/early-breast-cancer [accessed 2023].
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. 2018. Updated 2023. Available from: https://www.nice.org.uk/guidance/ng101 [accessed 2023].
-
Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Rebecca Roylance, Consultant Medical Oncologist and Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
How we can help