All of the AIs are pills taken daily by mouth. Only women who have gone through menopause or who take medicines to stop the ovaries from making estrogen see "Ovarian suppression," below can take AIs. Treatment with AIs, either as the first hormonal therapy taken or after treatment with tamoxifen, may be more effective than taking only tamoxifen to reduce the risk of recurrence in post-menopausal women.
Post-menopausal women with hormone receptor-positive breast cancer can:. Begin hormone therapy with an AI. Begin hormone therapy with tamoxifen and then after a few years, switch to an AI. When an AI is taken after tamoxifen, the drugs are taken for a combined total of 5 to 10 years. The side effects of AIs may include muscle and joint pain, hot flashes, vaginal dryness, an increased risk of osteoporosis and broken bones, and rarely, increased cholesterol levels and thinning of hair.
Research shows that all AIs work equally well and have similar side effects. However, women who have undesirable side effects while taking one AI medication may have fewer side effects with a different AI for unclear reasons. Women who have not gone through menopause and who are not getting shots to stop the ovaries from working see below should not take AIs, as they do not block the effects of estrogen made by the ovaries.
Often, doctors will monitor blood estrogen levels in women whose menstrual cycles have recently stopped, those whose periods stopped with chemotherapy, or those who have had a hysterectomy but their ovaries are still in place, to be sure that the ovaries are no longer producing estrogen. Ovarian suppression or ablation. Ovarian suppression is the use of drugs to stop the ovaries from producing estrogen.
Ovarian ablation is the use of surgery to remove the ovaries. These options may be used in addition to another type of hormonal therapy for women who have not been through menopause. For ovarian suppression, gonadotropin or luteinizing releasing hormone GnRH or LHRH agonist drugs are used to stop the ovaries from making estrogen, causing temporary menopause. Goserelin Zoladex and leuprolide Eligard, Lupron are types of these drugs.
Since they are not very effective for treating breast cancer on their own, they are typically given in combination with other hormonal therapy. They are given by injection every 4 weeks and stop the ovaries from making estrogen. The effects of GnRH drugs go away if treatment is stopped. For ovarian ablation, surgery to remove the ovaries is used to stop estrogen production. While this is permanent, it can be a good option for women who no longer want to become pregnant, especially since the cost is typically lower over the long term.
Tamoxifen for 5 years, followed by an AI for up to 5 years. This would be a total of 10 years of hormonal therapy. Tamoxifen for 2 to 3 years, followed by 2 to 8 years of an AI for a total of 5 to 10 years of hormonal therapy.
In general, women should expect 5 to 10 years of hormonal therapy. The tumor biomarkers and other features of the cancer may also impact who is recommended to take a longer course of hormonal therapy. As noted above, premenopausal women should not take AI medications without ovarian suppression, as they will not lower estrogen levels.
Options for adjuvant hormonal therapy for premenopausal women include the following:. Tamoxifen for 5 years. Then, treatment is based on their risk of cancer recurrence as well as whether or not they have gone through menopause in those 5 years.
If a woman has not gone through menopause after the first 5 years of treatment and is recommended to continue treatment, they can continue tamoxifen for another 5 years, for a total of 10 years of tamoxifen. Alternatively, a woman could start ovarian suppression and switch to taking an AI for another 5 years.
If a woman goes through menopause during the first 5 years of treatment and is recommended to continue treatment, they can continue tamoxifen for an additional 5 years or switch to an AI for 5 more years. Only women who are clearly post-menopausal should consider taking an AI. However, evidence now suggests benefits independent of the use of chemotherapy as well. For women with stage I or stage II cancer with a higher risk of recurrence who may consider also having chemotherapy.
For women who cannot take tamoxifen for other health reasons, such as having a history of blood clots, so they can take an AI medication.
Ovarian suppression is not recommended in addition to another type of hormonal therapy in the following situations:. This information is based on ASCO recommendations for adjuvant endocrine therapy for women with hormone receptor-positive breast cancer.
Please note this link takes you to another ASCO website. These treatments are very focused and work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells. Not all tumors have the same targets.
To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. The first approved targeted therapies for breast cancer were hormonal therapies. Trastuzumab FDA-approved biosimilar forms are available.
This drug is approved as a therapy for non-metastatic HER2-positive breast cancer. It is given either as an infusion into a vein every 1 to 3 weeks or as an injection into the skin every 3 weeks. Currently, patients with stage I to stage III breast cancer see Stages should receive a trastuzumab-based regimen, often including a combination of trastuzumab with chemotherapy, followed by a total of 1 year of adjuvant trastuzumab.
This risk is increased if a patient has other risk factors for heart disease or receives chemotherapy that also increases the risk of heart problems at the same time. These heart problems may go away and can be treated with medication. Pertuzumab Perjeta. This drug is approved for stage II and stage III breast cancer in combination with trastuzumab and chemotherapy. It is given as an infusion into a vein every 3 weeks. Pertuzumab, trastuzumab, and hyaluronidase—zzxf Phesgo.
This combination drug, which contains pertuzumab, trastuzumab, and hyaluronidase-zzxf in a single dose, is approved for people with early-stage HER2-positive breast cancer. It may be given in combination with chemotherapy. It is given by injection under the skin and can be administered either at a treatment center or at home by a health care professional. Neratinib Nerlynx. This oral drug is approved as a treatment for higher-risk HER2-positive, early-stage breast cancer.
It is taken for a year, starting after patients have finished 1 year of trastuzumab. Ado-trastuzumab emtansine or T-DM1 Kadcyla. This is approved for patients with early-stage breast cancer who have had treatment with trastuzumab and chemotherapy with either paclitaxel or docetaxel followed by surgery, and who had cancer remaining or present at the time of surgery. T-DM1 is a combination of trastuzumab linked to a very small amount of a strong chemotherapy.
This allows the drug to deliver chemotherapy into the cancer cell while lessening the chemotherapy received by healthy cells, which usually means that it causes fewer side effects than standard chemotherapy. T-DM1 is given by vein every 3 weeks.
Talk with your doctor about possible side effects of specific medications and how they can be managed. Bone modifying drugs block bone destruction and help strengthen the bone. They may be used to prevent cancer from recurring in the bone or to treat cancer that has spread to the bone. Certain types are also used in low doses to prevent and treat osteoporosis.
Osteoporosis is the thinning of the bones. Denosumab Prolia, Xgeva. An osteoclast-targeted therapy called a RANK ligand inhibitor. The use of denosumab to lower the risk of breast cancer recurrence is under study. For people with breast cancer that has not spread, receiving bisphosphonates after breast cancer treatment may help to prevent a recurrence. ASCO recommends zoledronic acid Reclast, Zometa or clodronate multiple brand names as options to help prevent a bone recurrence for women who have been through menopause.
Clodronate is only available outside of the United States. You may have other targeted therapy options for breast cancer treatment, depending on several factors. The following drug is used for the treatment of non-metastatic breast cancer.
Olaparib Lynparza. This is a type of oral drug called a PARP inhibitor, which destroys cancer cells by preventing them from fixing damage to the cells. Adjuvant olaparib should be given for 1 year following the completion of chemotherapy, surgery, and radiation therapy if needed. Abemaciclib Verzenio. It is approved as treatment in combination with hormonal therapy tamoxifen or an AI to treat people with hormone receptor-positive, HER2-negative, early breast cancer that has spread to the lymph nodes and has a high risk of recurrence.
Abemaciclib is given twice a day by mouth for up to 2 years. Many of the following drugs are used for advanced or metastatic breast cancer. Alpelisib Piqray. Alpelisib is an option along with the hormonal therapy fulvestrant for people with hormone receptor-positive, HER2-negative metastatic breast cancer that has a PIK3CA gene mutation and has worsened during or after hormonal therapy.
These drugs include abemaciclib Verzenio , palbociclib Ibrance , and ribociclib Kisqali. They are approved for women with ER-positive, HER2-negative advanced or metastatic breast cancer and may be combined with some types of hormonal therapy. They may also be used in conjunction with fulvestrant in endocrine-resistant second-line disease.
Lapatinib Tykerb. It may be combined with the chemotherapy capecitabine, the hormonal therapy letrozole, or the HER2 targeted therapy trastuzumab. Tucatinib Tukysa. Tucatinib, when added to capecitabine chemotherapy and trastuzumab, is approved for the treatment of advanced unresectable or metastatic HER2-positive breast cancer, including cancer that has spread to the brain, in those who have already received 1 or more HER2-targeted therapy.
Unresectable means surgery is not an option. Tucatinib is a tyrosine kinase inhibitor designed to turn off HER2. It is an oral medication that is given twice daily. Sacituzumab govitecan-hziy Trodelvy.
The FDA has approved the use of sacituzumab govitecan-hziy for the treatment of people with metastatic triple-negative breast cancer who have already received at least 2 treatments, including 1 treatment for metastatic disease. It is also approved for people with locally advanced triple-negative breast cancer that cannot be treated with surgery. Sacituzumab govitecan-hziy is an antibody-drug conjugate, which means the antibody attaches to a cancer cell and then delivers the anticancer drug it carries to start destroying the cancer cell.
Sacituzumab govitecan-hziy is given by vein, or intravenously, on days 1 and 8 of every day cycle. Entrectinib Rozyltrek and larotrectinib Vitrakvi. These may be used for breast cancer with an NTRK fusion that is metastatic or cannot be removed with surgery and has worsened with other treatments see Diagnosis.
It is a type of drug called a PARP inhibitor, which destroys cancer cells by preventing them from fixing damage to the cells. Talazoparib Talzenna. It is a PARP inhibitor. Chemotherapy, immunotherapy, hormonal therapy, and targeted therapy may all be given as neoadjuvant treatments for people with certain types of breast cancer. Neoadjuvant chemotherapy, for example, is the treatment usually recommended for people with inflammatory breast cancer. The doctor will consider several factors including the type of breast cancer that you have, including its grade, stage, and estrogen, progesterone, and HER2 status to guide the decision around whether neoadjuvant chemotherapy should be part of your treatment plan.
ASCO recommends that neoadjuvant systemic therapy be offered to people with high-risk HER2-positive breast cancer or to people with triple-negative breast cancer who would then receive additional drug therapy after surgery, called adjuvant therapy, if cancer still remains. Neoadjuvant therapy may also be offered to reduce the amount of surgery that needs to be performed and allow someone who would otherwise require a mastectomy, for example, to consider having a lumpectomy.
In situations where delaying surgery is unavoidable or preferred such as waiting for genetic test results to guide further treatment options or to allow time for deciding on breast reconstruction options , neoadjuvant systemic therapy may be offered. Your doctor will likely suggest breast imaging after treatment for surgical planning as well as if they believe that the cancer may have progressed despite treatment.
Your doctor will likely use the same type of imaging test in your follow-up care that was most helpful at the time your breast cancer was originally diagnosis. In general, it is not recommended that blood tests or biopsies be used to monitor response to therapy for people receiving neoadjuvant chemotherapy. Additional drugs, including the chemotherapy drug carboplatin and the immunotherapy drug pembrolizumab see below , may also be recommended in addition to usual chemotherapy drugs to increase the likelihood of having a complete response.
A complete response is when there is no cancer found in the tissue when it is removed during surgery. Talk with your doctor about the potential benefits and risks of receiving carboplatin and pembrolizumab before surgery. People with early-stage 1 cm or less, and no lymph nodes that look abnormal triple-negative breast cancer should not routinely be offered neoadjuvant therapy unless they are participating in a clinical trial.
In cases where a recommendation for chemotherapy can be made without having all the information that is obtained from surgery, such as the actual size of the tumor or the number of involved lymph nodes, any person with HER2-negative, hormone receptor-positive breast cancer can receive neoadjuvant chemotherapy instead of adjuvant chemotherapy. Meanwhile, for postmenopausal women with large tumors or other reasons why surgery may not be a good option at the time of diagnosis of the cancer, hormonal therapy with an aromatase inhibitor may be offered to reduce the size of the tumor.
It may also be used to control the cancer if there is no role for surgery. However, hormonal therapy should not be routinely offered in this situation outside of a clinical trial for premenopausal women with early-stage HER2-negative, hormone receptor-positive breast cancer.
For people with HER2-positive breast cancer that has spread to the lymph nodes or is more than 2 cm in size, neoadjuvant therapy with chemotherapy in combination with the targeted therapy drug trastuzumab should be offered. Another targeted therapy drug against HER2, pertuzumab, may also be used with trastuzumab when given before surgery. However, people with early stage 1 cm or smaller and no abnormal appearing lymph nodes , HER2-positive cancer should not be routinely offered neoadjuvant chemotherapy or drugs that target HER2 such as trastuzumab and pertuzumab outside of a clinical trial.
Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. The following drugs, which are a type of immunotherapy called immune checkpoint inhibitors, are used for recurrent and advanced or metastatic breast cancer. Pembrolizumab is also used for high-risk, early-stage disease. Pembrolizumab Keytruda. This is a type of immunotherapy that is approved by the FDA to treat both high-risk, early-stage, triple-negative breast cancer and metastatic cancer or cancer that cannot be treated with surgery.
Pembrolizumab is approved to treat people with high-risk, early-stage, triple-negative breast cancer in combination with chemotherapy before surgery. It could then continue to be given alone following surgery. For people with metastatic breast cancer, pembrolizumab is approved in combination with a few different chemotherapy drugs to treat metastatic or locally recurrent triple-negative breast cancer that cannot be treated with surgery and that tests positive for PD-L1.
In addition, pembrolizumab can be used to treat people with metastatic breast cancer whose tumors have a molecular alteration called microsatellite instability-high MSI-H or DNA mismatch repair deficiency dMMR see Diagnosis. Dostarlimab Jemperli. This type of immunotherapy is approved by the FDA to treat recurrent or metastatic breast cancers that have dMMR and have progressed during or after previous treatment.
Different types of immunotherapy can cause different side effects. Common side effects include skin rashes, flu-like symptoms, diarrhea, and weight changes. Other severe but less common side effects can also occur. Talk with your doctor about possible side effects of the immunotherapy recommended for you. Learn more about the basics of immunotherapy. Age should never be the only factor used to determine treatment options.
Systemic treatments, such as chemotherapy, often work as well for older patients as they do for younger patients. However, older patients may be more likely to have side effects that impact their quality of life. For example, older patients may have a higher risk of developing heart problems from trastuzumab. This is more common for patients who already have heart disease and for those who receive certain combinations of chemotherapy. They should also ask about potential side effects and how they can be managed.
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs.
Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy. Research has shown that some integrative or complementary therapies may be helpful to manage symptoms and side effects.
However, most natural products are unregulated, so the risk of them interacting with your treatment and causing harm is uncertain. ASCO agrees with recommendations from the Society for Integrative Oncology on several complementary options to help manage side effects during and after breast cancer treatment. These include:. Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.
Learn more about recommendations on integrative therapy for managing the side effects of breast cancer and its treatment, found on a different ASCO website.
People may have concerns about if or how their treatment may affect their sexual health and their ability to have children in the future. People are encouraged to talk with their health care team about these topics prior to starting treatment. Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan.
You should also talk about the possible side effects of the specific treatment plan and palliative care options. During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem.
This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide.
Learn more about palliative care in a separate section of this website. If the cancer returns after treatment for early-stage disease, it is called recurrent cancer. When breast cancer recurs, it may come back in the following parts of the body:.
The chest wall or lymph nodes under the arm or in the chest on the same side as the original cancer. This is called a regional recurrence. Another place, including distant organs such as the bones, lungs, liver, and brain. This is called a distant recurrence or a metastatic recurrence. For more information on a metastatic recurrence, see the Guide to Metastatic Breast Cancer.
When breast cancer recurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. Testing may include imaging tests, such as those discussed in the Diagnosis section.
In addition, another biopsy will likely be needed to confirm the breast cancer recurrence and learn about the features of the cancer. After this testing is done, you and your doctor will talk about the treatment options. The treatment plan may include the treatments described above, such as surgery, radiation therapy, chemotherapy, targeted therapy, and hormonal therapy. They may be used in a different combination or given at a different pace. The treatment options for recurrent breast cancer depend on the following factors:.
People with recurrent breast cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence. A local or regional recurrence is often manageable and may be curable.
The treatment options are explained below:. For women with a local recurrence in the breast after initial treatment with lumpectomy and adjuvant radiation therapy, the recommended treatment is usually a mastectomy. The cancer is usually completely removed with this treatment. For women with a local or regional recurrence in the chest wall after an initial mastectomy, surgical removal of the recurrence followed by radiation therapy to the chest wall and lymph nodes is the recommended treatment.
However, if radiation therapy has already been given for the initial cancer, this may not be an option. Radiation therapy cannot usually be given at full dose to the same area more than once.
Doctors will shield normal tissues close to the area from radiation exposure. The type of radiation treatment you get depends on the stage of breast cancer. People with early to stage 3 breast cancer will benefit most from radiation treatment.
Radiation can also help ease side effects in people with advanced breast cancer. Not everyone can have intraoperative radiation or internal beam radiation.
Whether you can have these procedures depends on:. Radiation for breast cancer is a common treatment that kills or slows the growth of cancer cells. It can be used alone or with other treatments like…. My breast cancer diagnosis taught me to protect my energy so I can enjoy time doing what's really important — without the added stress.
Papillary breast cancer is a rare and slow-growing type of breast cancer. Learn about symptoms, risk factors, treatment, and more. Learn about the characteristics of metaplastic breast cancer along with causes and risk factors, diagnosis, treatment, and more. A mammogram is an X-ray of the breast that can detect tumors or abnormalities in the breast tissue. Learn more about who should get one and how they…. Learn what researchers say about the link between deodorant and breast cancer.
We'll also cover ingredients to avoid and tips to manage excessive…. Hormone therapy for breast cancer works to stop or slow the production of hormones that fuel tumors. Read more on the pros and cons of this treatment. Learn what being at a high risk for breast cancer means, what factors put you at high risk, and the recommendations for early cancer detection in high-. There are several tumor markers associated with breast cancer.
Testing for tumor markers can help your doctor get an idea of cancer activity in your…. A breast cancer diagnosis can seem daunting at first, but getting the help you need can ease the burden of treatment and survivorship. Health Conditions Discover Plan Connect. Breast Cancer. The death of healthy cells can lead to side effects. These side effects depend on the dose of radiation and how often you have the therapy.
Side effects can develop early during treatment within a few weeks and be short-lived, or they may be more lasting long-term side effects. Late side effects can happen months or years later. Your provider will explain care at home during and after radiation treatment.
Wholebreast radiation therapy following breast-conserving surgery reduces the risk of cancer coming back and reduces the risk of death from breast cancer.
Breast cancer - radiation therapy; Carcinoma of the breast - radiation therapy; External beam radiation - breast; Intensity-modulated radiation therapy - breast cancer; Radiation - whole breast; WBRT; Breast radiation - adjuvant; Breast radiation. Alluri P, Jagsi R. Postmastectomy radiotherapy.
Philadelphia, PA: Elsevier; chap National Cancer Institute website. Breast cancer treatment Adult PDQ - health professional version. Updated September 2, Accessed October 5, Radiation therapy and you: support for people who have cancer. Updated October Review provided by VeriMed Healthcare Network. Editorial team. Whole breast radiation therapy. Some centers use ink tattoos. These marks are permanent, but are most often smaller than a mole.
These cannot be washed off, and you can bathe and shower normally. After treatment, if you want the marks removed, laser or surgery can be used.
Some centers use marks that can be washed off.
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