Breast Cancer Treatment
Having explored what breast cancer is, including the different types and subtypes, the next step is understanding how these cancers are treated. Treatment for breast cancer has advanced significantly over recent decades, with more personalised approaches allowing care to be tailored to the individual, their cancer subtype, stage, personal preferences and overall health.
Treatment for breast cancer may involve one or a combination of approaches, including surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy and targeted therapies. Understanding the role of each treatment, and how they may be used together, can help provide a clearer picture of the breast cancer treatment pathway.
Breast cancer treatment is not the same for everyone. A multidisciplinary team works together to develop an individualised treatment plan based on factors including:
- The type of breast cancer
- Cancer stage
- Tumour size and grade
- Lymph node involvement
- Hormone receptor status
- HER2 status
- Genetic factors
- Age and general health
- Individual preferences and goals
The aim of treatment is to remove the cancer, reduce the risk of recurrence, control disease progression, manage symptoms and support quality of life.
Learn more about breast cancer types and subtypes here
The Multidisciplinary Approach to Breast Cancer Care
The most holistic approach to breast cancer care involves a team of healthcare professionals who work together to provide comprehensive treatment and support.
This team can include:
- Breast surgeons
- Medical oncologists
- Radiation oncologists
- Radiologists
- Pathologists
- Breast care nurses
- Genetic counsellors
- Physiotherapists
- Exercise physiologists
- Psychologists
- Dietitians
- Occupational therapists
- Lymphoedema practitioners
This collaborative approach ensures treatment decisions consider the cancer itself as well as the individual’s physical, emotional and functional needs.
Breast Cancer Surgery
For many people diagnosed with early-stage breast cancer, surgery is the first treatment. The goal of surgery is to remove the cancer while preserving as much healthy breast tissue as possible.
The type of surgery recommended depends on:
- The size and location of the tumour
- The type of breast cancer
- Whether there are multiple areas of cancer
- Previous treatments such as neoadjuvant chemotherapy
- Personal preference
The two main surgical approaches are breast-conserving surgery and mastectomy.
Breast-Conserving Surgery (Lumpectomy)
Breast-conserving surgery, also known as lumpectomy, wide local excision or partial mastectomy, involves removing the cancerous tissue along with a margin of healthy surrounding tissue while keeping most of the breast tissue.
Following lumpectomy, radiation therapy is usually recommended to reduce the risk of cancer returning in the breast. For many people with early-stage breast cancer, breast-conserving surgery followed by radiation therapy provides survival outcomes equivalent to mastectomy.
Mastectomy
A mastectomy involves removal of the entire breast. It may be recommended when:
- The tumour is large compared with breast size
- There are multiple areas of cancer within the breast
- Breast-conserving surgery is not suitable
- Previous radiation therapy limits further treatment options
- A person chooses mastectomy based on personal preference
- There is a high genetic risk of developing breast cancer
Different types of mastectomy include:
Total (Simple) Mastectomy removes all breast tissue, including the nipple and areola.
Skin-Sparing Mastectomy removes the breast tissue and nipple but preserves most of the breast skin. This can improve cosmetic outcomes when reconstruction is performed.
Nipple-Sparing Mastectomy preserves the nipple and areola when appropriate. This option can allow for a more natural breast appearance following reconstruction.
Modified Radical Mastectomy involves removal of the breast tissue and all lymph nodes from the axilla. This procedure is less commonly required today due to advances in lymph node assessment.
Lymph Node Surgery
Because breast cancer can spread from its original site in the breast through the lymphatic system, lymph nodes under the arm (axillary lymph nodes) are often assessed during surgery.
Sentinel Lymph Node Biopsy identifies and removes the first lymph nodes that drain fluid from the breast. These nodes are examined to determine whether cancer cells have spread. If the sentinel nodes are clear, further lymph node surgery is often not required.
Axillary Lymph Node Dissection involves removing multiple lymph nodes from the armpit. This may be recommended if the cancer has spread to lymph nodes or in specific clinical situations.
Removal or treatment of lymph nodes can increase the risk of lymphoedema, a condition where swelling develops due to reduced lymphatic drainage capacity.
Breast Reconstruction
Breast reconstruction is a surgical option that restores the shape and appearance of the breast following mastectomy or significant breast tissue removal. Reconstruction is a personal decision. Some people choose reconstruction, while others choose an aesthetic flat closure or use an external breast prosthesis.
There is no right or wrong choice. The best option depends on:
- Personal preference
- Cancer treatment plan
- Body shape and anatomy
- Previous surgeries
- Other planned treatment
- Overall health
- Lifestyle goals
Reconstruction may be performed:
- Immediately: at the same time as breast cancer surgery
- Delayed: months or years after cancer treatment
Types of Breast Reconstruction
Implant-Based Breast Reconstruction – uses a silicone or saline implant to recreate breast shape. This is one of the most common reconstruction approaches.
Tissue Expander Reconstruction -many implant reconstructions occur in two stages. A temporary tissue expander is placed during mastectomy and gradually filled with saline over several weeks. This stretches the skin and tissues before replacement with a permanent implant.
Autologous (Flap) Breast Reconstruction – uses a person’s own tissue to recreate the breast. This approach often provides a more natural appearance and feel because the reconstructed breast consists of living tissue that changes with the body over time. The most appropriate flap option depends on individual anatomy and surgical assessment.
Types of autologous breast reconstruction include:
- DIEP Flap Reconstruction – The Deep Inferior Epigastric Perforator (DIEP) flap is one of the most advanced reconstruction techniques. It uses skin and fat from the lower abdomen while preserving the abdominal muscles.
- TRAM Flap Reconstruction – The Transverse Rectus Abdominis Myocutaneous (TRAM) flap uses tissue from the lower abdomen and includes part of the abdominal muscle. It can provide excellent reconstruction results but may have a greater impact on abdominal strength compared with DIEP flap surgery.
- Latissimus Dorsi Flap – The latissimus dorsi flap uses muscle, skin and fat from the upper back. It may be combined with an implant and can be useful for people who do not have sufficient abdominal tissue or who have had previous abdominal surgery.
- Other Flap Options – In selected cases, tissue may be taken from the thigh, buttock region or other donor sites
Flat Closure
Some people choose not to undergo breast reconstruction following mastectomy. An aesthetic flat closure aims to create a smooth, symmetrical chest wall appearance by carefully managing remaining tissues.
This option may suit for people who:
- Do not wish to undergo further surgery
- Prefer a flat chest appearance
- Want a shorter recovery process
- Prefer to use an external breast prosthesis when desired
Radiation Therapy
Radiation therapy uses high-energy radiation to damage the DNA of cancer cells, preventing them from growing and dividing. It is often used after surgery to destroy microscopic cancer cells that may remain in the surrounding tissue and reduce the risk of the cancer returning. Radiation therapy can be delivered externally or internally.
External beam radiation therapy is the most common form of radiation therapy for breast cancer. A specialised machine called a linear accelerator delivers carefully planned radiation beams to the area requiring treatment. Depending on the individual circumstances, external beam radiation therapy may include:
- Whole-breast radiation therapy – treats the entire breast, commonly following breast-conserving surgery (lumpectomy).
- Partial-breast radiation therapy – focuses radiation on the area around where the tumour was removed and may be suitable for some people with early-stage breast cancer.
- Chest wall radiation therapy – may be recommended following mastectomy when there is a higher risk of cancer remaining or returning in the chest wall.
- Regional nodal radiation therapy – targets nearby lymph node regions, such as the axillary, supraclavicular or internal mammary lymph nodes, when clinically indicated.
Internal radiation therapy (brachytherapy) involves placing a radioactive source, such as a small radioactive seed or implant, inside or close to the area where the tumour was removed. The radiation is delivered directly to the targeted tissue while limiting exposure to surrounding areas. Brachytherapy is used less commonly for breast cancer but may be considered for selected patients.
Modern radiation therapy techniques are carefully targeted to the area being treated, but nearby healthy tissues can also be affected. This can contribute to side effects such as skin changes, fatigue, tissue stiffness, reduced movement and swelling. Over time, radiation can cause changes in tissue elasticity and increase fibrosis (scar tissue), which can contribute to tightness or restricted movement. When lymph nodes are included in the treatment area, radiation can also affect lymphatic function and contribute to the development of lymphoedema.
Read more about radiation therapy for breast cancer here
Chemotherapy
Chemotherapy uses medications to destroy cancer cells or stop them from growing and dividing. It is usually delivered through an intravenous (IV) infusion, allowing the medication to enter the bloodstream and circulate throughout the body. Depending on the specific chemotherapy drugs and treatment plan, some medications may also be taken orally as tablets or capsules. Chemotherapy is commonly given in cycles, with a period of treatment followed by a period of rest to allow the body to recover. The number and timing of cycles varies depending on the individual cancer and treatment plan.
Chemotherapy may be recommended depending on:
- Cancer subtype
- Tumour size
- Lymph node involvement
- Risk of recurrence
- Individual health factors
Chemotherapy may be given:
- Before surgery (neoadjuvant chemotherapy): to shrink a tumour before surgery and assess how it responds to treatment
- After surgery (adjuvant chemotherapy): to destroy any remaining microscopic cancer cells and reduce recurrence risk
- For metastatic breast cancer: to slow disease progression and manage symptoms
Common chemotherapy side effects include:
- Fatigue
- Nausea
- Changes in appetite
- Hair loss
- Reduced immunity
- Peripheral neuropathy (nerve symptoms such as numbness or tingling)
- Reduced exercise tolerance
Many side effects improve after treatment finishes, although some effects can require ongoing management.
Hormone Therapy
Some breast cancers are hormone receptor-positive, meaning they have receptors that allow hormones such as oestrogen and progesterone to contribute to cancer cell growth. Hormone therapy, also called endocrine therapy, works by reducing the effect of these hormones on breast cancer cells. Depending on the treatment, this may involve lowering the amount of hormones available in the body or blocking hormones from attaching to receptors on cancer cells.
Hormone therapy is often used as part of treatment after surgery and may be recommended alongside other treatments such as chemotherapy or radiation therapy. Unlike some breast cancer treatments that are given over a shorter period, hormone therapy is commonly taken for between 5–10 years, depending on factors such as the characteristics of the cancer and the individual’s risk of recurrence.
Because treatment can continue for many years, side effects can have an ongoing impact on energy levels, movement, physical comfort, mood and overall quality of life. Possible side effects include:
- Hot flushes
- Joint stiffness and aches
- Fatigue
- Muscle or joint pain
- Mood changes
- Changes in bone density
- Changes in sleep and concentration
Immunotherapy
Immunotherapy is a type of cancer treatment that helps the body’s immune system recognise and attack cancer cells. Cancer cells can sometimes avoid detection by the immune system or interfere with the immune response. Immunotherapy works by helping to remove some of these barriers, allowing the immune system to respond more effectively to the cancer.
Immunotherapy is not suitable for everyone with breast cancer and is currently used most commonly in selected people with triple-negative breast cancer or metastatic breast cancer. It may be given alongside other treatments, particularly chemotherapy, depending on the characteristics of the cancer and the individual’s treatment plan.
As immunotherapy changes how the immune system functions, it can cause side effects that are different from those associated with chemotherapy. Some people may experience fatigue, skin changes, joint or muscle aches, or inflammation affecting different organs. Side effects vary between individuals and are monitored throughout treatment.
Targeted Therapy
Targeted therapies are medicines designed to identify and interfere with specific features of cancer cells that help them grow and survive. Because they focus on particular characteristics of the cancer, they work differently from treatments such as chemotherapy, which generally targets rapidly dividing cells throughout the body.
Targeted therapies are particularly important in HER2-positive breast cancer, where cancer cells have higher levels of a protein called HER2 that can promote cancer cell growth. HER2-targeted treatments work by blocking signals from HER2 or helping the immune system identify and destroy HER2-positive cancer cells.
Examples of HER2-targeted therapies include:
- Trastuzumab
- Pertuzumab
Treatment may continue for an extended period, including after surgery, to reduce the risk of the cancer returning. Like all cancer treatments, targeted therapies can cause side effects. These vary depending on the specific medication but may include fatigue, muscle or joint aches and changes in heart function, which are monitored throughout treatment.
Clinical Trials
Clinical trials play an important role in advancing breast cancer treatment and improving the way people are supported throughout diagnosis, treatment and survivorship. They are carefully designed research studies that investigate whether a new treatment, combination of treatments or approach is safe and effective, or whether an existing treatment can be delivered in a better way.
Clinical trials investigate:
- New medications or treatments – including new chemotherapy, targeted therapies, immunotherapies or hormone therapies.
- New combinations of treatments – investigating whether different treatments work more effectively when used together or in a different sequence.
- Different ways of delivering treatment – such as changes to the dose, timing or duration of treatment.
- Less invasive or more personalised treatment approaches – including approaches that may reduce unnecessary treatment while maintaining effective cancer control.
- New approaches to surgery or radiation therapy – including techniques designed to improve outcomes or reduce side effects.
- Supportive care and rehabilitation – investigating better ways to manage treatment side effects, improve physical function, reduce symptoms and support quality of life.
- Follow-up and survivorship care – exploring ways to monitor people after treatment and support longer-term health and wellbeing.
Clinical trials can occur at different stages of cancer treatment and may compare a new approach with the current standard treatment. Not every trial involves an experimental treatment; some investigate ways to improve existing treatments or supportive care.
Participation in a clinical trial is voluntary, and each trial has specific eligibility criteria. Suitability may depend on factors such as the type and stage of breast cancer, previous or planned treatments, overall health and other individual circumstances. Before deciding whether to participate, people should be provided with information about the purpose of the trial, potential benefits and risks, what participation involves and the alternatives available to them.
Key Takeaways
Breast cancer treatment has become increasingly personalised, with advances in research and treatment approaches providing more options than ever before. Treatment may involve one approach or a combination of therapies, depending on many different individual factors.
The treatment pathway can involve several stages, from initial treatment and surgery through to ongoing therapies and follow-up care. Understanding what each treatment involves and why it may be recommended can help people know what to expect and have meaningful conversations with their healthcare team throughout their care journey.
References
Breast Cancer Network Australia. (n.d.). Hormone-blocking therapy. BCNA
Breast Cancer Network Australia. (n.d.). Targeted therapies. BCNA
Breast Cancer Network Australia. (n.d.). Treatments for early breast cancer. BCNA
Cancer Institute NSW. (n.d.). Planning treatment. Cancer Institute NSW
Cancer Institute NSW. (n.d.). Understanding your diagnosis. Cancer Institute NSW
Healthdirect. (n.d.). Breast cancer. Healthdirect
Disclaimer
This content is general in nature and provided for educational purposes only. It is not a substitute for individualised advice, diagnosis, or treatment. If you have concerns about your symptoms or health, consult a qualified healthcare professional.
