Breast cancer treatment

Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient. Treatment types can be classified into local therapy (surgery and radiotherapy) and systemic treatment (chemo-, endocrine, and targeted therapies). Local therapy is most efficacious in early stage breast cancer, while systemic therapy is generally justified in advanced and metastatic disease, or in diseases with specific phenotypes.

Historically, breast cancer was treated with radical surgery alone. Advances in the understanding of the natural course of breast cancer as well as the development of systemic therapies allowed for the use of breast-conserving surgeries, however, the nomenclature of viewing non-surgical management from the viewpoint of the definitive surgery lends to two adjectives connected with treatment timelines: adjuvant (after surgery) and neoadjuvant (before surgery).

The mainstay of breast cancer management is surgery for the local and regional tumor, followed (or preceded) by a combination of chemotherapy, radiotherapy, endocrine (hormone) therapy, and targeted therapy. Research is ongoing for the use of immunotherapy in breast cancer management.

Management of breast cancer is undertaken by a multidisciplinary team, including medical-, radiation-, and surgical- oncologists, and is guided by national and international guidelines.

Staging breast cancer is the initial step to help physicians determine the most appropriate course of treatment. As of 2016, guidelines incorporated biologic factors, such as tumor grade, cellular proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression profiling into the staging system. Cancer that has spread beyond the breast and the lymph nodes is classified as Stage 4, or metastatic cancer, and requires mostly systemic treatment.

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