- Hormone receptor-negative cancers. Combination chemotherapy is often used. Trastuzumab (Herceptin) plus standard chemotherapy has shown outstanding promise in increasing disease-free survival for patients with lymph-node positive cancer.
- Hormone receptor-positive cancers. Tamoxifen is the standard drug and is administered for about 5 years. Aromatase inhibitors (letrozole, anastrozole, and exemestane) are showing promise in adjuvant treatment. Some studies indicate that they are more effective than tamoxifen. Ovarian ablation using goserelin alone or in combination with tamoxifen plus goserelin is also showing specific benefits.
Assessing Risk of Recurrence. A new genetic test (Oncotype DX) can help determine the likelihood of late recurrence (for example, recurrence in 5 or 10 years) in newly diagnosed patients whose breast cancer is Stage I or II, node negative, estrogen receptor positive, and who will be treated with tamoxifen. Knowing whether their tumor has a low, moderate, or high risk of recurrence may help women determine the best course of treatment. Importantly, it may help those with low-risk tumors avoid overly aggressive treatment.
Stage III (Locally Advanced)
In this stage, the tumor in the breast is more than 5 cm across, and:
- It has spread (sometimes extensively) to the underarm lymph nodes.
- It has spread to other lymph nodes or tissues near the breast.
A condition called inflammatory breast cancer is also treated as a Stage III cancer.
Treatment Options for Stage III. (1) Standard therapy is mastectomy usually with radiation therapy and systemic treatment (combination chemotherapy, hormonal therapy, or both). (In very advanced Stage III, systemic drug therapy, radiation, or both sometimes achieve a response that allows a woman to avoid mastectomy, although this approach does not increase survival rates.) (2) Radiation after surgery is now recommended for women with four or more involved lymph nodes or an extensive primary tumor. It is not yet clear if radiation would benefit women with one to three involved lymph nodes. (3) Clinical trials: high-dose chemotherapy and stem cell transplantation; new chemotherapeutic, hormonal, or biologic drugs; neoadjuvant therapies using taxanes alone or concurrent taxane and radiation treatment; post surgical radiation for women with one to three involved lymph nodes.
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