More women are being diagnosed with breast cancer now than ever before, due in large part to the aging of the baby boomer population. Every 3 minutes a woman in the U.S. is told she has breast cancer. By the end of this year, more than 42,000 cases will be identified, say experts from the American Cancer Society. It’s hard to hear the words you have breast cancer, and it used to be that when you heard those words providers had very few treatment options to offer. But we’ve come a long way, ladies, regarding best practices in breast cancer treatment. Now, before any treatment can begin, the exact type of the cancer must be identified and staged. Staging refers to the size of the cancer, if the lymph nodes are involved and if the cancer has spread to other organs.

After the cancer is typed and staged, experts want to know if the cancer is hormone stimulated, something they call its receptor status. For example, if the cancer is estrogen or progesterone positive, it means these hormones cause the tumor to grow. Treatment will then most likely include hormone suppression therapies. If the cancer is receptor negative, other treatments are commonly employed, including surgery and radiation.

Receptor-negative breast cancer is believed to be more likely to return in the first five years, but if the recurrence is caught, a woman’s long-term survival is comparable to that of other women with breast cancer. Treatment options for hormone suppression therapies however, are more limited than options for receptor-positive status.

Another form of breast cancer involves HER2/neu, the acronym for human epidermal growth factor receptor 2, which is a receptor responsible for cancer growth that’s both quick and aggressive. The presence of this receptor is another factor in treatment selection.

Once your healthcare team knows the type of tumor, its stage and receptive status, they’ll consider other factors in deciding on your treatment, including your age, general health, the size of the tumor, whether the cancer has spread to other parts of your body and your desires about treatment and quality of life issues surrounding treatment.

Surgery is necessary to remove the tumor (see Types of Breast Cancer Surgeries). In addition, testing the lymph nodes near the tumor site is essential to determine the extent of the breast cancer and its exact stage.

Your healthcare provider has two options for testing your lymph nodes. The more traditional approach is a lymph node dissection of removed nodes. A sentinel node biopsy can also be performed. When breast cancer spreads to the lymph nodes, the first node to drain is the sentinel node. Dye is injected into the system and a map is created. The sentinel node will “light up” and can then be excised and tested. This test can’t be performed, however, on women with previous breast cancer, those who have already had radiation therapy, or women who have large tumors or a history of previous mastectomy.

Often the healthcare team will also recommend a hysterectomy and oopherectomy (removal of the ovaries), as these organs produce estrogen.

Following surgery, your healthcare team will recommend continued treatment to ensure a successful outcome and to prevent future cancer reoccurrence. Radiation therapy is almost always used to kill any remaining cancer cells through high beams of x-ray energy, and there are different types of radiation depending on the depth of penetration of the radiation beams. This is particularly important for women who have opted for lumpectomy, which leaves large amounts of intact breast tissue.

High beam is given to the breast and possibly the surrounding tissues. Most regimens are 5 days a weeks for a defined series of weeks. Brachytherapy is another radiation method. Seeds, or small pellets, are placed under the skin adjacent to the cancerous tissue. The goal of radiation therapy is to leave the breast (or what remains after surgery) intact while killing any remaining cancer cells. Chemotherapy is the use of drugs to kill cancer cells before or after surgery. Chemo is often given before surgery to reduce tumor size, if possible. Chemotherapy can sometimes shrink a large tumor enough so that lumpectomy (also called breast-conserving surgery) becomes an option. Your provider has many different chemo options to choose from, and selection of a therapy is determined by which combinations or drug types work best on your particular cancer type.

Chemo can be administered before surgery (called neo-adjunctive), when there is no evidence that the cancer has spread beyond the tumor site; after surgery, to prevent its re-occurrence (called adjunctive); and for advanced breast cancer, to prevent further growth and prolong life. Most chemo is given in cycles of approximately 2 to 3 weeks for a defined period of time; it’s administered intravenously. Chemo is not without the side effects most women fear from breast cancer treatment: nausea, vomiting, hair loss, fatigue and weight loss, to name a few. Your cancer care team can help you make your way through these troublesome effects with new treatments as well.

Finally, for the two-thirds of women with receptor-positive cancers, or cancers that grow in the presence of estrogen or progesterone, the popular treatment is anti-estrogen therapy. Tamoxifen is the most commonly used therapy and is taken in pill form for years. Side effects include weight gain, hot flashes, vaginal dryness, fatigue and mood swings. In spite of the side effects, tamoxifen is considered the gold standard in preventing cancer re-occurrence and has been proved to increase survival rates. Other therapies, like aromatase inhibitors such as Arimidix (anastrozole), are given to lower the level of estrogen in the body so that the cancer cells cannot get as much estrogen as they need. Herceptin (trastuzumab) is an immune protein that attaches to the HER2/neu protein.

Herceptin is thought to limit the recurrence of certain breast cancers and is used for metastatic disease. The medication is given intravenously once a week, and the length of time of treatment varies.

Tykerb (lapatinib) is a chemotherapeutic drug that targets advanced HER2/neu cancers. It is given in a pill form. Tykerb has shown some promise in extending life in women with advanced disease in the central nervous system. It’s not a cure for breast cancer; it only extends life in select cases. Side effects of Tykerb involve cardiac problems, nausea and vomiting and diarrhea.

Newer therapies for the treatment of advanced breast cancer are on the horizon. These experimental medications are in clinical trials, but they hold hope and promise for future treatment of this tragic disease. Toremifene, a selective estrogen receptor modulator (SERM), and fulvestrant, an aromatase inhibitor, are two promising medications to watch for.

Simple: Breast tissue only is removed, no lymph nodes.

Modified: Breast tissue is removed as well as some lymph nodes; considered a breast-conserving surgery.

Partial/Lumpectomy: Tumor only is removed.

Radical: Breast tissue, pectoral muscle and lymph nodes are removed. This surgery is not as common as before, and research shows that the modified procedure is as effective.

Hysterectomy and Oopherectomy: The uterus and ovaries are removed.


Early breast cancer (stage I or II): These invasive tumors are the most treatable if detected early; women with these cancers enjoy the highest survival longevity post treatment.

Inflammatory breast cancer (stage III): This more aggressive tumor has spread beyond the breast or beyond the lymph nodes in the armpit (axillary nodes) but hasn’t spread to other organs. Its main symptoms are swelling and redness of the breast, which mimic inflammation.

Metastatic breast cancer (stage IV): The most advanced form of breast cancer, which has spread to other organs, typically the lungs, liver or bones. Fewer than 6% of women are diagnosed with cancer at this advanced stage.

Ductal carcinoma in situ: A precancerous condition in which abnormal cells are found in the milk ducts in the breast. Up to (in situ means in place) 30% of women with abnormal cells in the ducts go on to develop breast cancer. A new test called the HALO Breast Pap test is designed to help women detect precancerous conditions years before breast cancer could develop.

Lobular carcinoma in situ (LCIS): A typically non-cancerous condition in which abnormal cells are found in the breast’s lobules. LCIS isn’t typically treated with surgery, but its presence is a sign that a woman has a greatly increased risk of developing breast cancer in either breast. Drug therapies like tamoxifen used for treating cancer can be considered to reduce cancer risk.

Paget’s disease: A rare cancer that forms in and around the nipple; women or men with Paget’s disease typically also have breast cancer within the breast.

Male breast cancer: Although very rare (lifetime risk is 1 in 1,000), cancer can occur in men and usually occurs under the nipple area; prognosis and treatments are similar for women with breast cancer.

Sources: American Cancer Society; Komen.org

About the Author: Gay Goss, PhD, RNC, WHNP, CNS, is a nurse practitioner in Southern California and a professor at California State University at Dominguez Hills, CA.