The treatment options for breast cancer may include surgery, chemotherapy, radiation therapy, hormone therapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of breast cancer you have, its stage – which takes into account the size of the breast cancer and if the lymph glands (also known as lymph nodes) contain cancer cells, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how breast cancer treatment works in the private health system.
Surgery for breast cancerSurgery
Surgery is commonly performed for people with breast cancer to remove cancerous tissue, identify whether the cancer has spread to the lymph nodes and, if possible, restore the breast’s shape. Most people with breast cancer will receive surgery at some point during their treatment.
There are two types of surgery: breast conservation, also known as a lumpectomy, where the cancer is removed with a rim of normal tissue, or a mastectomy where the entire breast is removed.
After breast conservation surgery, a course of radiation therapy is typically recommended.
Cancer cells can travel from the breast in channels called lymphatic vessels and collect in nearby lymph nodes. To find out if the breast cancer has spread to lymph nodes in your underarm, one or more of these lymph nodes will be removed and looked at under the microscope. The most common form of lymph node surgery is called a sentinel node biopsy.
The sentinel lymph nodes are the first lymph nodes(s) that breast tissue, in the area of the tumour, drain into. This procedure requires injection of a special form of dye into the breast just prior to the surgery. A nuclear scan, called lymphoscintiography, and/or blue dye helps the surgeon locate the sentinel lymph nodes at the time of surgery.
If a sentinel lymph node biopsy is not appropriate or possible in your case, the surgeon will usually perform an axillary dissection. This is when the surgeon removes most of the lymph nodes from the armpit, also called the axilla. Every person has a different number of axillary lymph nodes. An axillary dissection may also be recommended if cancer cells are found in your sentinel lymph nodes. This can occur as part of your breast cancer surgery or as a separate operation.
A lumpectomy, also known as breast-conserving surgery or partial mastectomy, is a procedure which focuses on removing the least amount of healthy tissue as possible when excising the breast cancer tumour/s. Lumpectomy may help in maintaining the appearance of your breast. Most women will be recommended radiation therapy after a lumpectomy.
Mastectomy refers to the surgical removal of the entire breast to prevent or treat breast cancer. There are many different types of mastectomies performed today including:
Removal of the entire breast including the nipple, areola and skin.
Removal of the breast tissue, nipple and areola but not the skin. This offers an improved appearance but may not be suitable for certain cancers.
Removal of the breast tissue but not the skin or nipple. This may be an option for small, early tumours that do not affect the nipple or skin.
Removal of both breasts. This is often a preventive surgery for women at high risk of breast cancer.
Chemotherapy for breast cancerChemotherapy
Chemotherapy uses a range of drugs to kill and slow the growth of breast cancer cells. These drugs may be delivered at any stage of your breast cancer treatment, from shrinking large tumours before surgery to destroying potential remaining cancer cells after surgery. Chemotherapy plays an important part in reducing the risk of your breast cancer returning in both the breast and the rest of the body.
Chemotherapy treatment for breast cancer takes place over several sessions, given every one to three weeks depending on the type of chemotherapy drugs used. This is known as a cycle. Your care team will walk you through how many cycles you may need for your course of treatment, with most people completing chemotherapy in a period of three to six months.
Radiation therapy for breast cancer Radiation therapy
Radiation therapy treatment is usually used for breast cancer patients who have had breast-conserving surgery (lumpectomy), and sometimes after a mastectomy. If you are scheduled to receive chemotherapy after your surgery, radiation therapy will typically be delivered following chemotherapy.
Although traditionally radiation therapy has been delivered over a period of five to six weeks, with recent advances in radiation therapy technology many patients can now receive their treatment across three to four weeks or even shorter in certain cases.
Radiation therapy can impact the comfort, feel and appearance of breast reconstructions. Your oncologist will speak with you about the timing of your treatments and may encourage you to delay breast reconstruction surgery until after you complete active treatment.
Types of radiation therapy commonly used for people with breast cancer include:
If you have had a lumpectomy, sometimes an extra dose of radiation is given to the region where your tumour has been removed. This can be done using an integrated ‘boost’ as part of a VMAT or IMRT plan or following treatment to the whole breast.
Surface guided radiation therapy
Traditional radiation therapy for breast cancer requires patients to receive very small but permanent tattoos on their chest. These tattoos help the radiation therapist position the patient correctly and deliver treatment to the right location. For some patients, these tattoos are ongoing, unwanted reminders of their cancer treatment.
SGRT uses advanced camera technology to track and monitor patients during set-up and treatment, removing the need for patients to receive permanent tattoos or other temporary markings on the skin. The platform’s auto-pause functionality and high degree of accuracy also support the safe delivery of advanced radiation therapy techniques for breast cancer patients, including Deep Inspiration Breath Hold (DIBH).
SGRT is suitable for all patients undergoing radiation therapy for breast cancer.
Reducing the risk of damage to your heart
Deep Inspiration Breath Hold (DIBH) is a technique for breast cancer patients that reduces the potential impact of radiation on the heart.
The process involves holding your breath for short bursts during treatment which allows the heart to move backwards into the chest and away from the breast while it is exposed to radiation.
Hormone therapy for breast cancerHormone therapy
As hormones can be a source of fuel for breast cancer, hormone therapies can be used to block or lower your body’s natural hormones to stop hormone-sensitive cancers from growing or returning. Hormone therapy treatment is commonly delivered as a tablet or injection, with surgery being used in some cases to remove the ovaries, which are the part of the body that produces the majority of these hormones.
For many women, hormone therapy is used in combination with chemotherapy or surgery and may be delivered over five to ten years.
Common hormone therapy medicines
Hormone therapy treatment for breast cancer typically falls under four categories:
Tamoxifen is a tablet that blocks oestrogen from communicating with your breast cancer cells. This is commonly taken by people who have not experienced menopause, when oestrogen is being created primarily in the ovaries
If your ovaries stop working due to menopause or other causes, your fat tissues will become the body’s main producer of oestrogen. Aromatase inhibitors are tablets that stop this oestrogen from impacting your cancer’s growth and spread.
Ovarian suppression targets oestrogen production in the ovaries, creating a temporary menopause. This is usually achieved with an injection every month.
Fulvestrant is used to treat hormone receptor positive advanced (metastatic) breast cancer in women who have gone through menopause through blocking the effect of oestrogen on cancer cells (known as an oestrogen receptor antagonist). It is given as an injection, typically in two-weekly and monthly intervals.
Targeted therapies for breast cancerTargeted therapies
Targeted therapies use specialised drugs to destroy specific proteins in breast cancer cells. These drugs are particularly effective for HER2 positive breast cancers, where the cancer cells have a higher-than-average amount of HER2 (a growth-promoting protein on the outside of breast cells).
Common targeted therapy medicines
Common targeted therapy treatments for breast cancer include:
Trastuzumab is a targeted therapy which is commonly used in the treatment of both early and advanced stages of HER2 positive breast cancers. Often used in combination with chemotherapy, trastuzumab is delivered every three weeks over six to 12 months, with each infusion lasting up to 60 minutes.
Pertuzumab is a targeted therapy which is used in combination with trastuzumab and chemotherapy to treat people with HER2 positive breast cancer. It is given intravenously every three weeks over 18 to 25 months, with each infusion taking between 40 and 60 minutes.
Trastuzumab emtansine (Kadcyla)
Trastuzumab emtansine is a targeted therapy used in the treatment of HER2 positive breast cancer which has metastasised and previously been treated with trastuzumab and taxane chemotherapy, and after receiving surgery for early-stage HER2 positive breast cancer if there is cancer remaining following treatment with trastuzumab and taxane chemotherapy. It is delivered intravenously every three weeks, with each infusion taking between 30 and 90 minutes.
Lapatinib is a targeted therapy used in the treatment of advanced stages of HER2 positive breast cancers, usually in combination with chemotherapy. It is given by mouth, with five to six tablets taken as a single dose once a day.
CDK4/6 inhibitors such as abemaciclib (Verzenio), palbociclib (Ibrance) and ribociclib (Kisqali) are used to treat advanced (metastatic) hormone receptor positive, HER2 negative breast cancers. They are usually taken by mouth at varying frequencies, depending on the type of CDK4/6 inhibitor you are being treated with.
Bone therapy drugs are used to treat advanced breast cancer when the cancer has spread (metastasised) to the bones. They are used to help protect and strengthen your bones, and to reduce the risk of the cancer continuing to spread to the bones.
- Denosumab – Denosumab is a monoclonal antibody drug. It helps strengthen bones by preventing the breakdown and loss of bone cells. It is given by injection into the skin (subcutaneous injection) every 28 days
- Zoledronic acid – Zoledronic acid is a type of drug called a bisphosphonate. It helps protect the bones by slowing the loss of bone cells and by increasing bone density. It is given by intravenous infusion every three to four weeks
Immunotherapy for breast cancerImmunotherapy
Immunotherapy trains your body’s own immune system to recognise and fight breast cancer cells. In Australia, there are no approved immunotherapies for breast cancer.
However, immunotherapies are currently being tested through clinical trials in Australia to assess their safety and effectiveness in treating breast cancer.
Icon offers a wide-range of clinical trials providing patients with access to new and evolving treatments. Clinical trials offer hope and opportunity and contribute to breakthroughs in treatment for future cancer patients.
You may also like to consider visiting the Breast Cancer Trials website for more information on breast cancer research in Australia and New Zealand.
When you are diagnosed with breast cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.
Common treatment options for each stage of breast cancer include:
Early breast cancer (Stage I and II)
In Stage I and II breast cancer, the cancer is confined to the breast and may or may not have spread to nearby lymph nodes. Surgery to the breast and axilla is typically the first treatment option for early-stage breast cancer. Following breast conservation surgery, most patients will receive radiation therapy to the breast afterwards to reduce the risk of their cancer returning. In some cases, further treatments may be recommended including chemotherapy, radiation therapy to the lymph node areas, targeted therapy (such as Herceptin) and hormone therapy (for hormone-positive patients)
Locally advanced breast cancer (Stage III)
In Stage III breast cancer, the breast cancer is either large, has spread to multiple lymph nodes or has spread to the surrounding tissues such as the skin and muscle. Locally advanced breast cancer requires a combination of treatments, which usually begins with surgery and chemotherapy. The chemotherapy may be given prior to surgery to help shrink the cancer. After surgery it is likely that you will receive radiation therapy to the breast and lymph node areas. Hormone therapy will be included as part of your treatment if you have hormone receptor positive breast cancer, alongside targeted therapies if you have HER2 positive breast cancer.
Metastatic or advanced breast cancer (Stage IV)
In Stage IV breast cancer, the cancer has spread outside the breast and nearby lymph node regions to other parts of the body. Treatments commonly used are hormone therapy (if hormone receptor positive), targeted therapy (if HER2 positive) and chemotherapy. Hormone therapies may include fulvestrant and CDK4/6 inhibitors. Radiation therapy may also be used for metastatic breast cancer to help reduce symptoms caused by breast tumours (such as pain).
- American Cancer Society. (2019). Treatment of breast cancer by stage. Retrieved on 6 December 2021 from https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html
- National Breast Cancer Foundation. (2021). Breast cancer treatment. Retrieved on 6 December 2021 from https://nbcf.org.au/about-breast-cancer/treatment/
- American Cancer Society. (2016). Surgery for breast cancer. Retrieved on 18th December 2018 from https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html
- American Cancer Society. (2017). Chemotherapy for breast cancer. Retrieved on 18th December 2018 from https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html
- American Cancer Society. (2019). Chemotherapy for Breast Cancer. Retrieved on 7 September 2021 from https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html
- American Cancer Society. (2019). Hormone Therapy for Breast Cancer. Retrieved on 8 September 2021 from https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html
- American Cancer Society. (2019). Targeted Drug Therapy for Breast Cancer. Retrieved on 7 September 2021 from https://www.cancer.org/cancer/breast-cancer/treatment/targeted-therapy-for-breast-cancer.html
- Breast Cancer. (2021). Who Gets Chemotherapy? Retrieved on 7 September 2021 from https://www.breastcancer.org/treatment/chemotherapy/who_gets_it
- Breast Cancer Network Australia. (n.d.). Targeted therapy. Retrieved on 7 September 2021 from https://www.bcna.org.au/understanding-breast-cancer/treatment/targeted-therapy/
- Cancer Council. (2020). Targeted therapy for breast cancer. Retrieved on 7 September 2021 from https://www.cancercouncil.com.au/breast-cancer/cancer-treatment/targeted-therapy/
- Cancer Council. (2021). Treatment methods: Chemotherapy. Retrieved on 7 September 2021 from https://www.cancercouncil.com.au/breast-cancer/cancer-treatment/chemotherapy/
- Cancer Council. (2021). Treatment methods: Hormone therapy. Retrieved on 8 September 2021 from https://www.cancer.org.au/cancer-information/treatment/hormone-therapy
- National Cancer Institute. (2021). Hormone Therapy for Breast Cancer. Retrieved on 8 September 2021 from https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet
- National Cancer Institute. (2021). Targeted Cancer Therapies. Retrieved on 7 September 2021 from https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet
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