Treatment
The three major treatments of breast cancer are surgery, radiation, and drug therapy. No one treatment fits every patient, and combination therapy is usually required. The choice is determined by many factors, including the age of the patient, menopausal status, the kind of cancer (ductal vs. lobular), its stage, and whether or not the tumor contains hormone-receptors.
Breast cancer treatments are defined as local or systemic:
- Local Treatment. Surgery and radiation are considered local therapies because they directly treat the tumor, breast, lymph nodes, or other specific regions. Surgery is usually the standard initial treatment.
- Systemic Treatment. Drug treatment is called systemic therapy, because it affects the whole body.
Any or all of these therapies may be used separately or, most often, in different combinations. For example, radiation alone or with chemotherapy or hormone therapy may be beneficial before surgery, if the tumor is large or not easily removed at prevention. The optimal sequence for these therapies is being investigated. (Specific treatments and combinations are discussed in the sections below.)
Stage 0
This stage is also called noninvasive carcinoma or carcinoma in situ.
Treatment Options for Lobular Carcinoma in Situ. These are abnormal cells that pose a long-term risk for invasive cancer. (1) Careful monitoring with or without preventive use of tamoxifen or other selective estrogen-receptor modulators (SERMs). (2) In selected cases, consideration of removal of both breasts, since if the cancer does develop, it tends to do so in both breasts or to be invasive. In one study, chance for invasive cancer over a 25-year period was 25%.
Treatment Options for Ductal Carcinoma in Situ. These are cancer cells in the lining of a duct that have not invaded the surrounding breast tissue. (1) Mastectomy previously was the commonly recommended treatment. (2) Breast-sparing surgery (typically without lymph-node removal) followed by radiation therapy is reasonable for many women. The risk for recurrence with a more invasive cancer is higher in women under 45 than in older women with this approach. (3) Use of tamoxifen or other SERMs after surgery and radiation to prevent recurrence in selected patients.
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