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Treatments by Breast Cancer Stage

Treatment Options for Stage 0 Breast Cancer continued...

LCIS raises the risk of getting invasive breast cancer. Treatment may include: 

  • Endocrine therapy with tamoxifen, raloxifene, or examestane to lower the risk of developing cancer.
  • Bilateral mastectomy -- the removal of both breasts. Historically this has been the treatment of choice to prevent breast cancer from developing in either breast. However, with the reducing risk effects of endocrine therapy, experts now think that a bilateral mastectomy is a more extreme approach than women usually need.

Paget's disease of the nipple is usually treated with surgery, without an axillary lymph node dissection, or wide local excision followed by radiation.

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Treatment Options for Stage I Breast Cancer

Stage I breast cancer is a very early stage of breast cancer. Stage I breast cancer has not spread beyond the breast. This stage of breast cancer ranges from microinvasive (less than 0.1 cm) to less than or equal to 2 cm in size. The stage is broken into three subsections: A (tumor size less than 1 mm to 5 mm), B (tumor size 6 mm to 10 mm) and C (tumor size 11 mm to 20 mm). The eight-year survival rate for women with stage I breast cancer is about 90%. This means that 90% of women with this stage of breast cancer will be alive at 8 years, or longer, after their breast cancer diagnosis. Women usually do well with a combination of treatments. Treatment options include:

  • Surgery. Since the tumor is still small,  lumpectomy (wide local excision), is an option. In this procedure, the tumor and some of the normal surrounding tissue are removed. Some women choose to get a mastectomy. In either case, the surgeon will likely take out one or more of the lymph nodes. After a mastectomy, you might choose to get breast reconstruction surgery. Surgical and survival outcomes are equal between lumpectomy and mastectomy. 

Surgery treats the disease doctors know about. Other treatments, called "adjuvant" treatments, may also be used to treat hidden disease and reduce the risk of breast cancer recurrence. 

  • Radiation therapy is standard after a lumpectomy. It can kill off any cancer cells that were missed. Women with stage I cancer who get a mastectomy do not require radiation.
  • Chemotherapy is treatment with drugs that attack cancer cells. It's often used after surgery to reduce the risk of the cancer coming back, or recurring. The presence of endocrine receptor negative disease, or tumors between 10-20 mm may necessitate the need for adjuvant chemotherapy.
  • Endocrine therapy is sometimes used after surgery in women who have hormone receptor-positive cancer (tumors whose growth seems dependant on estrogen). In these women, hormone therapy drugs can prevent the tumor from getting the hormone it needs to grow. These drugs include tamoxifen for premenopausal women and the aromatase inhibitors Arimidex,  Femara, and Aromasin for postmenopausal women. Women who haven't reached menopause may consider having their ovaries removed or taking drugs to stop the ovaries from making hormones that help cancer grow. Women with tumors 6 mm or larger require adjuvant endocrine therapy.
  • Biological therapy . In about 25% of women with breast cancer, an excess of a protein known as HER2 makes the cancer spread quickly. Herceptin is a drug that's been approved to treat women with metastatic breast cancer that is HER2-positive. It stops this protein from making the cancer grow and makes chemotherapy more effective. It is most often used in combination with chemotherapy. Multiple clinical trials have shown an improved outcome, when Herceptin is added to chemotherapy, and then continued for a total of one year, in the adjuvant setting of breast cancers, even those of small sizes.
  • Clinical trials are open to many women with stage I cancer. A clinical trial may allow you access to cutting-edge treatments. Many new therapies -- new drugs, new treatments, and new combinations -- are being studied  in ongoing clinical trials.

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