Should You Get Chemotherapy for Breast Cancer?

Chemotherapy, or chemo, uses strong drugs to kill cancer cells. It's one of several treatments for breast cancer. Your doctor might recommend chemo based on the stage of your cancer, how aggressive it is, and whether it's likely to come back.

Like other cancer treatments, chemotherapy has benefits and risks. It can shrink breast tumors to the point where they're easier to remove with surgery. It kills cancer cells all over your body, which is helpful if your cancer has spread. But it can cause unpleasant side effects like hair loss, nausea, and mouth sores.

Whether to get chemotherapy is a decision that you'll make together with your doctor. To help you make the right choice, learn as much as you can about your cancer. Ask about all of your treatment options. Then, weigh the benefits and risks of each one when you talk to cancer care team. As with all of your health care, you’re the decision maker.

Why You Might Get Chemotherapy

Here are some of the reasons why your doctor might recommend that you get chemotherapy:

  • You're having surgery to remove your cancer.
  • The cancer has spread to your lymph nodes.
  • You have an aggressive type of breast cancer that could spread quickly.
  • Your cancer is likely to come back after treatment.
  • Hormone therapy probably won't work for you.

Sometimes people with late-stage breast cancer get chemotherapy not to treat their cancer, but to relieve pain and other symptoms. This is called palliative chemotherapy.

It’s a balancing act. Pain relief is a major consideration. But it's not certain that this type of chemo will improve your quality of life, given how the chemo may make you feel. So if palliative chemotherapy is an option, ask your doctor how it could help you and what the side effects are.

Pros

Chemotherapy shrinks tumors before surgery, sometimes to the point where they're easier to remove. Getting chemotherapy first may let you have a less invasive lumpectomy instead of open surgery.

After surgery, you may get chemo to kill any cancer cells that were left behind or that might have spread. Getting chemo after surgery could lower the chance that your cancer will come back.

Chemotherapy could be your main treatment if your cancer has spread and surgery isn't an option, because it kills cancer cells all over your body.

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Cons

Chemotherapy has well-known side effects. Some of them, like hair loss, can affect the way you look and feel about yourself. Mouth sores and nausea may make it hard for you to eat. Fatigue is common, too, and leaves you feeling wiped out.

Chemo affects everyone differently. You may have mild side effects or more severe ones. Many of them will go away once your treatment ends. But some effects, like nerve damage, memory loss, and heart problems, can last longer and be more serious.

You and your doctor will decide whether the benefits of having chemotherapy are worth the side effects this treatment might cause.

The Decision

The choice to have chemo is based on the stage and type of your cancer, how chemotherapy might help, and your personal preferences when you know the risks and benefits.

Many things may affect your decision. If you have an early-stage breast cancer or one with lots of treatment options, your decision may be very different than if your cancer has spread and your options are limited. Your age and overall health are also important. If you're older or in poor health, you might find that the risks of chemo could outweigh the benefits. Or you might feel ready to not continue treatment.

One tool that could help inform your decision is the Oncotype DX test. This test looks at cancer genes in a sample of your tumor. Then it comes up with a number between 0 and 100. This score estimates the odds that your cancer will come back over the next 10 years.

The lower your score, the lower the risk that your cancer will return, and the less likely that you'll need chemotherapy. One study using the Oncotype DX test showed that women with the most common type of early-stage breast cancer did as well with treatments that didn’t include chemo after surgery. But there was some benefit from including chemotherapy for women in certain groups, depending in part on how likely their cancer was to come back. Keep in mind that one study doesn’t change treatment guidelines.

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You can get the Oncotype DX test if your breast cancer:

  • Is hormone receptor-positive, which means that it grows in response to the hormones estrogen and/or progesterone
  • Is HER2-negative, which means the cancer cells don't have many of a protein receptor called HER2. This protein makes cancer grow more aggressively.
  • Hasn't spread to lymph nodes under your arm

If you have a late-stage cancer, you'll want to know how chemo will affect both the length and the quality of your life. You might decide that the side effects may not be worth it if you aren’t likely to get much time in return. Or you may want to try it and see how it goes. But that’s a very personal call -- and that decision is yours alone.

The doctor who treats your cancer can guide you through this decision-making process. If it’s a hard decision, ask your doctor how long you can take to make it so you’re not rushed but also not taking too long. It may also be helpful to get advice from a nurse navigator, your family members and friends, and an organization like the American Cancer Society. Also, treatment decisions like whether to get chemotherapy are something that you could discuss with a palliative care doctor. Palliative care involves all the usual treatment decisions and also includes your mental, emotional, social, and spiritual health. It’s for anyone with a serious illness, including people with any stage of breast cancer.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on June 23, 2020

Sources

SOURCES:

American Cancer Society: "Breast Cancer Gene Expression Tests," "Chemotherapy for Breast Cancer," "Study: More Breast Cancer Patients Can Safely Skip Chemotherapy."

BreastCancer.Org: "Chemotherapy Before Surgery Increases Chances of Lumpectomy," "Does End-Stage Chemotherapy Improve Quality of Life?" "Who Gets Chemotherapy?"

Breast Cancer Now: "Do I need chemotherapy for breast cancer?"

Cancer Research UK: "When, where and how you have chemotherapy."

JACS: "Neoadjuvant Chemotherapy for Breast Cancer Increases the Rate of Breast Conservation: Results from the National Cancer Database."

JAMA Oncology: "Chemotherapy Use, Performance Status, and Quality of Life at the End of Life."

Mayo Clinic: "Cancer treatment decisions: 5 steps to help you decide."

The New England Journal of Medicine: “Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer.”

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