Treatment options

Non-drug treatment

Surgery

Surgery could be a lumpectomy, mastectomy or a treatment to remove axillary lymph nodes depending on the stage and type of breast cancer. In a lumpectomy (removal of a lump), the cancer is removed whilst as much of the breast as possible is preserved. When this is not possible, a mastectomy (removal of the breast) will be carried out. After mastectomy reconstruction may be offered. When the cancer has spread to the lymph nodes (or glands) in the armpit, these nodes may also be removed.

All women should be considered for adjuvant (post surgery) therapy following the removal of the tumour as this therapy aims to reduce the risk of recurrence.

Radiotherapy

Radiotherapy is a treatment that uses high-energy x-rays, gamma rays and other similar rays to kill cancer cells. Quite often women are given radiotherapy following a lumpectomy and sometimes after a mastectomy in order to destroy any cancerous cells that might still be present. It can also be given to shrink a cancer before surgery, to complement chemotherapy, or to control symptoms and improve quality of life if the cancer is too advanced to cure. Radiotherapy is most often delivered by external means.1

Drug treatment

The three categories of drugs used to treat breast cancer are antibody therapy, chemotherapy and hormonal therapy. Chemotherapy and hormonal therapy are used to treat the majority of breast cancers.

Chemotherapy

Chemotherapy is treatment with one or more anti-cancer drugs which aims to destroy any cancer cells that may have spread beyond the breast or axillary lymph nodes. Chemotherapy affects healthy cells as well as cancerous cells and this may cause side-effects such as hair loss and nausea. It is administered either by injection, infusion or mouth and can be administered before or after breast surgery. Chemotherapy drugs are often used in combination with one another, and those used to treat breast cancer include anthracyclines and taxanes (e.g. docetaxel and paclitaxel).

Antibody therapy

Antibody therapy aims to prevent cancer cells from accessing growth factors that they need to multiply and spread. All cells need growth factors from the blood to help them multiply, and the growth factors must bind to proteins on the cells in order to work. By blocking these proteins on cancer cells with antibodies, growth factors can be prevented from getting to them, and therefore the cancer cells cannot multiply.

In breast cancer, the most effective protein to block is human epidermal growth factor receptor (HER2). Twenty five per cent of women with breast cancer have unusually high levels of HER2 and can therefore benefit from antibody treatment4. At present, the only antibody treatment available for early and advanced breast cancer is Herceptin® (trastuzumab).

Hormone/endocrine therapy

The female hormones, oestrogen and progesterone, can promote the growth of breast cancer cells. Certain tumours, especially in postmenopausal women, depend on these growth hormones and therefore make good targets for hormone therapy.

Hormone/endocrine therapies are aimed at inhibiting the growth of breast cancer cells by depriving the tumour of the hormones on which it is dependent (e.g. depriving the oestrogen-dependent tumour of oestrogen). Since the majority of breast cancer tumours in postmenopausal women are hormone-dependent for growth, they will respond to endocrine/hormone therapy.

The current standard of care for adjuvant treatment for women with postmenopausal breast cancer following surgical removal of their primary tumour is the hormone treatment, tamoxifen. Women are routinely prescribed up to five years of treatment with tamoxifen. Studies have shown that women gain no additional benefit from taking tamoxifen for longer than five years and indeed, taking tamoxifen for longer than this period results in increased risk of rare serious adverse events including endometrial cancer, pulmonary embolism and stroke5. Until now, there was no treatment to continue preventing breast cancer from returning after five years of tamoxifen therapy.

Hormone treatments have played a major part in improving the prognosis of women with breast cancer, over 60 percent of whom have oestrogen sensitive cancer6. Research shows that the widespread use of tamoxifen has saved the lives of thousands of women. Further research into the dependence of breast cancer tumours on hormones resulted in the identification of new classes of anti-hormone treatments, the most promising of which is the aromatase inhibitor class.

What are aromatase inhibitors?

The primary source of oestrogen in postmenopausal women is fat, liver, muscle and breast tissue, through a process that converts adrenal androgens (such as testosterone and androstenedione) into oestrogen. The oestrogen produced in this process stimulates the growth of hormone-dependent cancer cells in the tumour. A breast tumour itself may also generate oestrogen. Aromatase inhibitors (Femara® (letrozole), Arimidex® (anastrozole) and Aromasin® (exemestane)) bind to the enzyme aromatase and block it from converting adrenal androgens to oestrogen in these tissues. As the aromatase enzyme acts at the last step in the generation of steroidal compounds, the production of other important steroids in the body is not affected.

Staying healthy and positive

It is perfectly normal to be concerned about your breast cancer treatment. It is therefore important to discuss the options available to you with your breast care nurse or doctor. Alternatively, you could speak to one of the patient groups listed on this website.

Continuing to eat well and remain active is a good way of improving your general health and boosting your immune system. Some women seek support activities such as yoga, acupuncture and massage to maintain a feeling of wellbeing although there is no evidence that alternative therapies can reduce the risk of breast cancer returning. Please check with your healthcare team before you start any of these activities.