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Breast Cancer Treatment Early Stage

How Should We Treat Stage 0 Breast Cancer

Treatment Options For Early Stage Breast Cancer
  • Lumpectomy: For small, localized areas of DCIS to prevent recurrence in the same breast.
  • Total mastectomy: In patients with large areas of DCIS or invasive DCIS to stop the spread of cancer to other parts of the body.
  • Radiation or hormonal therapy after surgery: Radiation therapy decreases the risk of recurrence by 50 percent.

Treatment For Early Stage Breast Cancer

If you are diagnosed with early stage breast cancer, the aim of treatment is to remove the breast cancer and any other cancer cells that remain in the breast, armpit or other parts of the body but cannot be detected.

Treatment for early stage breast cancer can vary from person to person. The stage of your breast cancer is an important factor when making decisions about treatment. However, the most suitable treatment for you also depends on other factors, such as where the cancer is in the breast, the cancers grade, and whether the cancer is hormone receptor-positive, HER2 positive or triple-negative. Your doctor will also consider your age, general health and preferences.

Treatment for early breast cancer may involve:

Usually more than one treatment is used. Treatment may be given in different orders and combinations. Learn more about different treatment options here.

Treatment Of Locoregional Recurrent Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of locoregional recurrentbreast cancer , may include the following:

For information about treatment options for breast cancer that has spread to parts of the body outside the breast, chest wall, or nearby lymph nodes, see the Treatment of Metastatic Breast Cancer section.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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Radiation For Breast Cancer

Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments.

Depending on the breast cancers stage and other factors, radiation therapy can be used in several situations:

  • After breast-conserving surgery, to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
  • After amastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.
  • If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.

What Is The Most Important Thing To Know About Breast Cancer

Breast Cancer Staging

Dr. Mayer: One of the most important things to know is what kind of breast cancer is it. The entire treatment plan depends on which category of breast cancer someones diagnosed with. So sitting down with one of the doctors and going through the pathology report to really understand what is the diagnosis and what type of breast cancer is it.

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Neoadjuvant Chemotherapy Neoadjuvant Her2

With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery . If the tumor doesnt get smaller with the first combination of chemotherapy drugs, other combinations can be tried.

If your tumor is HER2-positive, you may get neoadjuvant trastuzumab and neoadjuvant pertuzumab , but not at the same time as the chemotherapy drug doxorubicin .

If your tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative with a high risk of recurrence, you may get neoadjuvant pembrolizumab . Pembrolizumab is an immunotherapy drug.

Starting With Neoadjuvant Therapy

Most often, these cancers are treated with neoadjuvant chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.

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For Patients With Earliest Stage Of Breast Cancer How Much Treatment Is Enough

After a breast biopsy at age 40, Rawan Kajo was given two options: Surgeons could remove one breast, or both.

Kajo, a pharmacist living in Doylestown, Pennsylvania, didn’t like either choice. What had been found in one breast was a calcification, not a tumor essentially a risk factor for future cancer.

“If it was a tumor, I wouldn’t give it a second thought,” she said about the surgery. “But we’re doing this aggressive treatment to eliminate a risk that might never end in a real problem.”

For years, that’s been the challenge for patients diagnosed with ductal carcinoma in situ, what’s sometimes called “Stage zero” breast cancer. DCIS, which is often driven by hormones, is defined as the presence of abnormal cells inside a milk duct.

About 20% to 30% of hormone-positive DCIS has the potential to become invasive cancer, with the remaining 70% to 80% not at risk, said Dr. Laura Esserman, Kajo’s doctor and a surgeon and breast cancer oncology specialist at the UCSF Breast Care Center.

Even with the standard care surgery and radiation, and often hormonal therapy women have about a 15% chance of getting another cancer or DCIS on either side. But because it’s been impossible to identify who was in danger, every DCIS was treated the same.

That’s starting to change.

Recent studies are finding genetic and other differences between harmless calcifications and DCIS that will turn dangerous.

Permission To Use This Summary

Treatment of early stage breast cancer

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .

The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment . Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

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After Breast Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Breast Or To Other Parts Of The Body

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines thestage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnosebreast cancer are also used to stage the disease.

The following tests and procedures also may be used in the staging process:

Breast Cancer Is Sometimes Caused By Inherited Gene Mutations

The genes in cells carry the hereditary information that is received from a persons parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Some mutated genes related to breast cancer are more common in certain ethnic groups.

Women who have certain gene mutations, such as a BRCA1 or BRCA2 mutation, have an increased risk of breast cancer. These women also have an increased risk of ovarian cancer, and may have an increased risk of other cancers. Men who have a mutated gene related to breast cancer also have an increased risk of breast cancer. For more information, seeMale Breast Cancer Treatment.

There are tests that can detect mutated genes. Thesegenetic tests are sometimes done for members of families with a high risk of cancer. For more information, see Genetics of Breast and Gynecologic Cancers.

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Progression Of Early Stage Breast Cancer

Left untreated, early stage breast cancer can continue to grow and eventually spread to other areas of the body. Early detection and treatment can help prevent the cancer from progressing, and, in many cases, cure or get rid of it entirely.

Once breast cancer has spread to distant parts of the body, doctors can no longer cure it. Instead, treatment focuses on extending a personâs life, reducing symptoms, and improving quality of life.

Ovarian Ablation Or Suppression

HER2

In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.

Ovarian ablation or suppression stops the ovaries working and producing oestrogen.

Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.

Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .

Your periods will stop while you’re taking it, although they should start again once your treatment is complete.

If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.

Goserelin comes as an injection you have once a month.

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Treating Stage Iii Breast Cancer

In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.

If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment of Inflammatory Breast Cancer.

There are two main approaches to treating stage III breast cancer:

Breast Cancer: Types Of Treatment

Have questions about breast cancer? Ask here.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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Radiation Therapy And Mastectomy

Most people who have mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.

In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.

For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section.

For a summary of research studies on radiation therapy following mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section.

What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment

New Treatment for Early-stage Breast Cancer Available at Emory Healthcare

Even though Stage 0 breast cancer is considered non-invasive, it does require treatment, typically surgery or radiation, or a combination of the two. Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer.

Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer.

Material on this page courtesy of National Cancer Institute

Medically Reviewed on April 15, 2020

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The Grading System Is Used To Describe How Quickly A Breast Tumor Is Likely To Grow And Spread

The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:

  • How much of the tumor tissue has normal breast ducts.
  • The size and shape of the nuclei in the tumor cells.
  • How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.

For each feature, the pathologist assigns a score of 1 to 3 a score of 1 means the cells and tumor tissue look the most like normal cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.

Three grades are possible:

  • Total score of 3 to 5: G1 .
  • Total score of 6 to 7: G2 .
  • Total score of 8 to 9: G3 .

Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

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Types Of Stage 1 And 2 Breast Cancer

The most common types of invasive breast cancers are named after the area of the breast where they begin. Types of early breast cancers include:

  • Invasive ductal carcinoma IDC means that the cancer originated in the milk ducts of the breast, and has spread into the surrounding breast tissue. IDC is the most common type of breast cancer, accounting for 80% of all breast cancers.
  • Invasive lobular carcinoma ILC means that the cancer originated in the milk-producing lobules of the breast, and has spread into the surrounding breast tissue. ILC is the second most common type of breast cancer, and accounts for 10% of breast cancers.
  • There are also other less common forms of invasive breast cancer, such as inflammatory breast cancer and Pagets disease of the nipple. For more information on the various types of invasive breast cancer, including the less common forms, please visit Types of Breast Cancer page.

Screening For Breast Cancer

Radiation Therapy for Early

Women aged between 50 and 74 are invited to access free screening mammograms every two years via the BreastScreen Australia Program.

Women aged 40-49 and 75 and over are also eligible to receive free mammograms, however they do not receive an invitation to attend.

It is recommended that women with a strong family history of breast or ovarian cancer, aged between 40 and 49 or over 75 discuss options with their GP, or contact BreastScreen Australia on 13 20 50.

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Sequence Of Adjuvant Therapy For Early Stage Breast Cancer

Adjuvant therapy is typically administered after surgery and before radiation because this sequence produces superior survival when compared to giving radiation first. It is much easier to treat a local recurrence of cancer than a systemic recurrence and this may explain why patients treated with chemotherapy followed by radiation have improved survival compared to patients treated with radiation followed by chemotherapy. An additional explanation is that delivering radiation therapy before chemotherapy treatment of systemic disease may adversely affect the doctorâs ability to deliver the chemotherapy treatment. Hormone therapy can begin during or following radiation therapy. One notable exception to this sequence is patients with locally advanced breast cancer. In these patients, administration of chemotherapy prior to surgery may allow for greater breast conservation.

The optimal time to initiate adjuvant systemic therapy is uncertain however a retrospective, observational study has reported that delays in initiation of adjuvant chemotherapy do adversely affected survival outcomes.20

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