Early Breast Cancer Treatment
Read our blog, A Small Lump Is Still a Big Deal.
Early and locally advanced breast cancer
Early and locally advanced breast cancers are invasive breast cancers. However, they have not spread beyond the breast and nearby lymph nodes to other parts of the body (they are not metastatic breast cancer).
Early breast cancer
Early breast cancer is contained in the breast. Or, it has only spread to the lymph nodes in the underarm area (axillary lymph nodes). This term often describes stage I and stage II breast cancers.
In the U.S., most breast cancers are early breast cancers.
Locally advanced breast cancer
Locally advanced breast cancer has spread beyond the breast to the chest wall or the skin of the breast. Or, it has spread to many axillary lymph nodes. Locally advanced breast cancer can also refer to a large tumor.
With treatment, people with early breast cancer usually have a very good prognosis (chance of survival).
For example, from 2012-2018 (most recent data available) [161,303]:
- 5-year relative survival for women diagnosed with breast cancer that had not spread beyond the breast was 99 percent. This means these women were 99 percent as likely to live 5 years beyond diagnosis as women in the general population.
- 5-year relative survival for women diagnosed with breast cancer that had spread to nearby lymph nodes, but not to other parts of the body was 86 percent. This means these women were 86 percent as likely to live 5 years beyond diagnosis as women in the general population.
With recent improvements in treatment, survival for women diagnosed today may be even higher. However, prognosis for breast cancer depends on each person’s diagnosis and treatment.
Treatment for early breast cancer
Treatment for early breast cancer (including invasive ductal carcinoma and invasive lobular carcinoma) includes some combination:
- Radiation therapy
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitor therapy
- PARP inhibitor therapy
Surgery and radiation therapy
Surgery is usually the first step in treating early breast cancer.
You may have mastectomy (the entire breast is removed) or lumpectomy (only the tumor and some surrounding tissue are removed).
With either type of surgery, some lymph nodes in the underarm area (axillary lymph nodes) may be removed to find out if they contain cancer.
Radiation therapy and lumpectomy
People who have lumpectomy usually have radiation therapy to the breast to get rid of any cancer cells that may remain. This lowers the chances of the breast cancer coming back (breast cancer recurrence) .
Radiation therapy and mastectomy
Most people who have mastectomy don’t need radiation therapy if there’s 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.
Treatment after surgery (systemic therapy, adjuvant therapy)
Most people have drug therapies after surgery to lower the risk of breast cancer recurrence.
Some combination of chemotherapy, hormone therapy (with or without the CDK4/6 inhibitor abemaciclib), HER2-targeted therapy, immunotherapy and/or PARP inhibitor therapy almost always follows breast surgery. It’s not common to have surgery as the only treatment.
These drug therapies travel throughout the body to help ensure there’s no more cancer in the body. They may be called systemic therapy or adjuvant therapy.
Some drug therapies are given by vein (through an IV) or injection under the skin, and some are pills.
Which treatments you will need after surgery depends on factors such as:
- Tumor size
- Lymph node status
- Tumor characteristics, such as hormone receptor status and HER2 status
Whether you are premenopausal or postmenopausal can also play a role in your treatment options.
Learn more about factors that affect treatment options.
Tumor profiling and chemotherapy
Some women who have hormone receptor-positive breast cancer should consider getting a tumor profiling test, such as Oncotype DX®, to see if chemotherapy is needed in addition to hormone therapy .
Tumor profiling can be used to help guide chemotherapy for early breast cancers that are all of the following :
- Estrogen receptor-positive (and will be treated with hormone therapy)
- Tumor size smaller than 5 cm
- Lymph node-negative or 1-3 positive lymph nodes
Tumor profiling may also be called genomic testing or molecular profiling.
For a summary of research studies on chemotherapy and early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on tamoxifen in women with hormone receptor-positive early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on aromatase inhibitors in women with hormone receptor-positive early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of studies on trastuzumab (Herceptin) and early breast cancer, visit the Breast Cancer Research Studies section.
Treatment before surgery (neoadjuvant therapy)
Neoadjuvant therapy is treatment given before surgery. Treatment can be chemotherapy, HER2-targeted therapy, immunotherapy or hormone therapy. Neoadjuvant therapy may also be called preoperative therapy.
Some women with early breast cancer may have neoadjuvant therapy as a first treatment. Neoadjuvant therapy may shrink a tumor enough so lumpectomy becomes an option instead of mastectomy.
Treatment for locally advanced breast cancer usually begins with neoadjuvant therapy. Neoadjuvant therapy helps shrink the tumor(s) in the breast and lymph nodes so surgery can more easily remove all the cancer.
Learn more about neoadjuvant therapy.
Neoadjuvant chemotherapy, neoadjuvant HER2-targeted therapy and neoadjuvant immunotherapy
With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery . If the tumor doesn’t 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 (Herceptin) and neoadjuvant pertuzumab (Perjeta), but not at the same time as the chemotherapy drug doxorubicin (Adriamycin) .
If your tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative (triple negative breast cancer) with a high risk of recurrence, you may get neoadjuvant pembrolizumab (Keytruda) . Pembrolizumab is an immunotherapy drug.
Neoadjuvant hormone therapy
Some postmenopausal women with hormone receptor-positive tumors may get neoadjuvant hormone therapy (usually with an aromatase inhibitor) instead of neoadjuvant chemotherapy .
Learn more about chemotherapy.
Learn more about HER2-targeted therapy.
Learn more about immunotherapy.
Learn more about hormone therapy.
For a summary of studies on neoadjuvant chemotherapy, visit the Breast Cancer Research Studies section.
For a summary of studies on neoadjuvant hormone therapy for women with estrogen receptor-positive breast cancer, visit the Breast Cancer Research Studies section.
Although the exact treatment for breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.
The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.
In addition, the National Cancer Institute (NCI) has treatment overviews.
Talk with your health care team about which treatment guidelines they use.
Playing an active role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
Read the full report.
Research is ongoing to improve all areas of treatment for breast cancer.
New therapies are being studied in clinical trials. The results of these studies will decide whether these therapies will become part of the standard of care.
After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
Susan G. Komen® Breast Care Helpline
If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email email@example.com.
The helpline offers breast cancer clinical trial education and support, such as:
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BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service to help find a clinical trial that fits your needs.
Learn what else Komen is doing to help people find and participate in breast cancer clinical trials, including trials supported by Komen.
When to consider joining a clinical trial
If you’re newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesn’t usually start right after diagnosis. So, there’s time to look for a clinical trial that you’re eligible for and fits your needs.
Once you’ve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.
Learn more about clinical trials.
Susan G. Komen® Support Resources