Standard systemic (whole-body) treatments include hormonal therapy, chemotherapy, and targeted therapy (for example, Herceptin (chemical name: trastuzumab). Which type of treatment will work best for you depends on what the tumors are like, and where they are growing. An Oncotype DX test may help you and your doctor decide which treatments are right for you.

Hormonal (anti-estrogen) therapy can be the best weapon in the fight against metastatic breast cancer, with the fewest side effects in most women. For this reason, hormonal therapy is often the first treatment of choice for women:

• who have hormone-receptor-positive cancer (either estrogen-receptor-positive or progesterone-receptor-positive)
• who have had a good response in the past to hormonal therapy such as tamoxifen and the aromatase inhibitors Arimidex (chemical name: anastrozole), Femara (chemical name: letrozole), or Aromasin (chemical name: exemestane)

Your doctor might recommend that you try hormonal therapy if you have metastatic disease, your hormone receptor status is unknown, and it's difficult to do a biopsy.

Chemotherapy is usually recommended if the cancer is:

• growing in spite of various hormonal therapies or Herceptin (chemical name: trastuzumab)
• hormone-receptor-negative
• in the liver
• throughout your lung tissue (this is called lymphangitic spread)

Herceptin may also be prescribed if the cancer is HER2-positive.