Treatment Of Locoregional Recurrent Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
See the Treatment of Metastatic Breast Cancer section 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.
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.
Conditions That Can Raise Your Risk Of Breast Cancer
- Personal history. Women who have , a breast disease that is not cancer, or who have had breast cancer before have an increased risk.
- Family history. A woman’s risk of breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially if they were diagnosed with breast cancer at age 50 or younger.
- A small number of women who have a family history of breast cancer have inherited changes to certain genes, such as BRCA1 or BRCA2, that increase their breast cancer risk.
- are available to find out if you have the genetic mutations long before any cancer appears.
When Is Surgery Needed
Surgery is done when the entire detectable cancer can be removed. Cancers that have spread beyond the breast and lymph nodes are not usually treated with surgery.
Breast-conserving surgery removes the tumor in a way that keeps the normal shape of the breast. It is offered to patients with small tumors that have not spread to any lymph nodes. A mastectomy is surgery that removes the entire breast. This is done for large tumors, cancer that is in more than one part of the breast, or cancer that has spread to any lymph nodes.
Read Also: Does Pain In Your Breast Mean Cancer
Who Treats Breast Cancer
Doctors on your cancer treatment team might include:
- A breast surgeon or surgical oncologist: a doctor who uses surgery to treat breast cancer
- A radiation oncologist: a doctor who uses radiation to treat cancer
- A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer
Many other specialists might be part of your treatment team as well, including physician assistants, nurse practitioners, nurses, psychologists, social workers, nutritionists, genetic counselors, and other health professionals.
Take Advantage Of Patient Navigators
Though intuition would tell us that people who are insured would experience shorter delays before surgery, that doesn’t appear to be true. A large 2019 study in PLoS One looked at over 1.3 million people to see how time to initial treatment affected survival. In this study, they found that with early stage breast cancer, waiting more than 35 days between diagnosis and surgery reduced survival rates. Surprisingly, uninsured people had faster times to initiation of treatment.
While the reasons weren’t certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Difficulty navigating the maze of large treatment centers may also be at play, and the authors made mention of recent clinical trials showing patient navigation could have a beneficial effect on assuring timely cancer care.
Also Check: What Blood Test Can Detect Breast Cancer
Treatment For Breast Cancer May Cause Side Effects
Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.
Late effects of radiation therapy are not common, but may include:
- Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
- Arm lymphedema, especially when radiation therapy is given after lymph node dissection.
- In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.
Late effects of chemotherapy depend on the drugs used, but may include:
Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:
- Heart problems such as heart failure.
Lisa Newman Md Mph Facs Fasco Fsso
Chief, Division of Breast Surgery Director, Interdisciplinary Breast Program Medical Director and Founder, International Center for the Study of Breast Cancer Subtypes Weill Cornell Medicine/New York Presbyterian Hospital Network 2nd Vice President, American College of Surgeons
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What Are The Signs And Symptoms Of Breast Cancer
The signs and symptoms of breast cancer include
- A new lump or thickening in or near the breast or in the armpit
- A change in the size or shape of the breast
- A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
- A nipple turned inward into the breast
- Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
- Scaly, red, or swollen skin in the nipple area or the breast
- Pain in any area of the breast
Reasons To Wait A Short While
While information suggests having surgery within a few weeks and chemotherapy within a month is ideal, there are some very good reasons why you may wish to wait a few days or a few weeks to begin treatment.
Most surgeons and oncologists will reassure you that you have some time, though there are always exceptions to that general rule . Advantages of taking some time include:
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
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What Are The Cosmetic Results Of Breast Conservation Therapy
Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results; that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.
Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.
Systemic Treatments For Breast Cancer
Systemic treatments are intended to kill cancer cells that may have left the original tumor location and be elsewhere in the body. These treatments affect all cells in the body, not just cancer cells. So make sure you discuss possible side effects with your healthcare provider.
Chemotherapy uses powerful drugs to kill all rapidly dividing cells in the body. There are many different chemotherapy drugs that can be used alone or in combination. Chemo may be prescribed adjuvantly or neoadjuvantly . It is typically given intravenously , although some types may be in pill form. Chemo is given on a regular interval, typically once every three weeks or every two weeks . Dose dense is a more aggressive treatment schedule. But it may be recommended for young adults.
Hormonal therapy helps the body fight hormone-receptor-positive breast cancer by reducing or blocking the hormones that help these cancers grow.
- Tamoxifen is typically recommended for five to 10 years for premenopausal women.
- Aromatase inhibitors may be prescribed to postmenopausal women.
- Ovarian suppression is an injection that temporarily stops your ovaries from functioning and simulates menopause.
Recent study results show that taking Tamoxifen or an aromatase inhibitor along with ovarian suppression may be recommended for young women at higher risk of recurrence .
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Top Risk Factors Linked To Breast Cancer
- Aging. Your breast cancer risk increases as you get older. By age group, breast cancer is diagnosed in:
- 4 out of 1,000 women in their 30s.
- 15 out of 1,000 women in their 40s.
- 24 out of 1,000 women in their 50s.
- 36 out of 1,000 women in their 60s.
- 38 out of 1,000 women in their 70s.
Classes Of Breast Cancer Drugs
Medication-based treatment options for breast cancer mainly depend on the stage and the tumors characteristics. Your doctor will run tests to check the type of breast cancer and if the cancer has spreador metastasized. The test results will help your doctor decide on the best treatment recommendation for you. Doctors follow expert guidelines when choosing which medicines to use in treating breast cancer.
Classes of breast cancer drugs include:
There are various ways to receive cancer medication. Typically, you will get injection medicines in an outpatient clinic or hospital setting. You can usually take hormone therapy and other tablet medications at home. Your doctor will monitor you closely during your treatment cycles. It may be necessary to adjust your doses as you go through cancer treatment.
How Is Breast Cancer Stage Determined
The breast cancer staging process helps doctors determine how much cancer there is and where its located. The higher the breast cancer stage number, the more advanced the disease.
Breast cancer staging is so important because it provides cancer care teams which include breast surgeons, oncologists, pathologists, radiologists and many others an agreed upon way to talk about the disease. This makes it easier for them to understand diagnoses and collaborate on treatment plans.
Testing Genes To See If Your Breast Cancer Is Likely To Come Back
Gene activity tests are also called tumour profiling tests, genetic expression profiling tests or gene assays. They look at groups of cancer genes to find out how active they are.;The activity of particular genes helps doctors work out;whether a cancer is likely to come back
Your doctor may suggest you have a;tumour profiling test when the benefit of having chemotherapy is not clear.;This gives them more detailed information on whether or not you should have chemotherapy to lower the risk of the cancer coming back.;
Some of these tumour profiling tests;are available for breast cancer, depending on your situation. Your doctor can explain;whether this;testing is an option for you. Examples include;EndoPredict , Oncotype DX Breast Recurrence Score, and Prosigna.
Doctors do this test using a sample of the;cancer taken during your surgery. This means that you will not need any extra tests or examinations.
These tests should not be confused with tests that look for an inherited faulty gene that increases a persons risk of getting cancer.
Can Exercise Help Reduce My Risk Of Developing Breast Cancer
Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.
The type of exercise you do can vary the main goal is get your heart rate up as you exercise. Its recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.
Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:
Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:
Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
What Are The Types Of Breast Cancer
The most common types of breast cancer are:
- Infiltrating ductal carcinoma. This cancer starts in the milk ducts of the breast. It then breaks through the wall of the duct and invades the surrounding tissue in the breast. This is the most common form of breast cancer, accounting for 80% of cases.
- Ductal carcinoma in situ is ductal carcinoma in its earliest stage, or precancerous . In situ refers to the fact that the cancer hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.
- Infiltrating lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues in the breast. It accounts for 10 to 15% of breast cancers. This cancer can be more difficult to diagnose with mammograms.
- Lobular carcinoma in situ is a marker for cancer that is only in the lobules of the breast. It isn’t a true cancer, but serves as a marker for the increased risk of developing breast cancer later, possibly in both or either breasts. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
Dealing With Visible Side Effects Of Treatment
You may be able to see some of the side effects of breast cancer treatment, and this can take an emotional toll. But thereâs a lot you can do to overcome them, and that can help you feel better.
If you’ve had a mastectomy, you can use an external prosthesis instead of, or before, breast reconstruction surgery. You tuck it into a bra or attach it to your skin with double-sided tape.
If you chose to get one:
- Ask your doctor for a prescription for an external prosthesis. Then, it can usually be covered by insurance.
- Ask your oncologist for referral to a specialized store that sells external prostheses. You may also find them in some lingerie departments.
- Make an appointment with a breast prosthesis consultant and allow yourself about an hour to get fitted.
- Try a variety of them to see which feels and looks the best on you.
Some chemotherapy kills fast-growing cells like hair follicles, whether those cells are cancer or not. Hair loss is different for everyone, and it depends on the type of chemo you’re taking. Radiation and hormonal treatments may also cause this side effect.
If you lose hair from chemo, it’s likely to fall out within 1 to 2 weeks of starting treatment. It may thin or fall out almost all at once. It’s common to lose hair over your whole body, not just on your head. This means you may lose eyelashes and eyebrows as well as arm, leg, and pubic hair.
Here are some other tips that may help:
Weight gain or loss
Getting A Second Opinion
Treatment decisions can;be complicated and confusing. You can ask for a second opinion if you would like to get another doctor’s view about your treatment. This means going to see another specialist. They will need to see all your test results and x-rays.;
Having a second opinion doesn’t usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which is the best treatment approach to take.
If you want to get a second opinion, your doctor will usually be happy to arrange it for you. It can take time to arrange though and it might mean that your treatment is delayed for a while.
It is worth discussing your treatment again with your current specialist first. Once you have heard why they are suggesting particular treatments for you, you might feel that you don’t need a second opinion.
It is always a good idea to jot down a few questions before you go to the hospital for an appointment with your specialist.;It can be difficult to remember everything you want to ask once you get there. Writing down your questions beforehand can help you to feel more confident during the discussion.