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Choosing the Right Breast Cancer Treatment

The primary treatment for breast cancer is surgery to remove the cancer. There are three main types of surgery:

Breast-conserving surgery, either a lumpectomy or partial mastectomy to remove part of the breast.
Mastectomy to remove the whole breast.
Sentinel node biopsy or axillary node dissection to remove lymph nodes that may be affected by cancer.

Breast cancer patients with early-stage cancer may opt for breast-conserving surgery -- either a lumpectomy -- removal only of the "lump" of tumor as well as the normal breast tissue closely surrounding the tumor, or partial mastectomy -- removal of the tumor and a larger portion of surrounding breast tissue. This is usually followed by radiation therapy.

If the cancer is advanced or if there is a high risk of recurrence, the surgeon may recommend a mastectomy, which is complete removal of the breast. The woman should also be informed about her options for breast reconstruction, which sometimes is done right after mastectomy.

At the time of surgery, most patients also have either axillary node dissection or sentinel node biopsy to see if breast cancer has spread to the lymph nodes. These procedures remove lymph nodes from the armpit to test them for cancer cells. Sentinel node biopsies have largely replaced axillary node dissection.

Surgery is often combined with additional treatments, known as adjuvant therapy, to destroy any remaining cancer cells. Sometimes, the additional treatment may be given before surgery (called neoadjuvant therapy) when the breast cancer has been found to have already spread widely. These methods of treatment include:

Treatment for breast cancer will depend on a woman's:

Personal preferences.
Overall health.
Stage of the breast cancer, including whether cancer has spread to the lymph nodes.
The type of cancer and whether the cancer is an aggressive type.
Whether she has gone through menopause.
Whether the cancer she has depends on female hormones to grow. If it is "sensitive" to the female hormones, then the cancer is called "estrogen-receptor positive" (ER positive). If not, it is ER negative. This can usually be determined by testing a tissue sample in the lab.
The presence of other markers suggestive of aggressive cancer behaviors, such as progesterone receptors and the HER2 oncogene.

Most doctors who treat cancer patients in the U.S. follow national guidelines set by the National Comprehensive Cancer Network (NCCN) or the American Society of Clinical Oncology (ASCO), which have helped improve patient care. Still, treatment will vary from one doctor to the next or from one hospital to the next, depending on the woman's needs and circumstances.

Before you begin treatment for breast cancer, print out these questions to ask your specialists so you can better understand your care: Questions to Ask.

WebMD Medical Reference

Reviewed by Arnold Wax, MD on June 20, 2009