If you have early HR+/HER2- breast cancer, including stages II and III, you’ll likely have several treatment options. Your doctor may suggest a combination of approaches – maybe one after the other – to make sure they get all the cancer out and to lower the risk that it comes back.
Your treatment options may depend on the specific features of your tumor, as well as your genes, family history, menopause status, overall health, and personal preferences.
Things That Guide Your Doctor’s Treatment Recommendations
Cancer stage. Cancer stage describes the size of the tumor and whether cancer cells have reached nearby lymph nodes. Some people with stage II cancers may be able to have surgery alone or surgery plus radiation. With stage III cancers, you’ll usually get a round of chemotherapy before surgery.
The size of your tumor may also help your care team figure out which surgery options are available to you. Lumpectomy, or “breast-conserving surgery,” for example, might not be right for some people with larger tumors.
Tumor size can also dictate how many lymph nodes the surgeon takes during your breast surgery. With smaller tumors, it may only be necessary to take the few nodes closest to the breast through a procedure called a sentinel node dissection. Larger tumors might require taking all the nodes from the armpit through an axillary node dissection.
Nodal status. Your breast surgery includes removal of lymph nodes so that doctors can check to see whether cancer has spread to them. The results of this biopsy – your nodal status – will determine the next steps in your treatment. (For example, whether you need radiation and systemic therapy, such as chemotherapy or targeted medication.)
Hormone receptor status of the tumor. If you have hormone receptor-positive (HR+) breast cancer, the tumor thrives on the female hormones estrogen and progesterone. Only people who have this type of breast cancer will benefit from hormone therapies, such as tamoxifen or aromatase inhibitors, that stop the body’s production of these hormones or interfere with the hormones’ effects on breast tumors.
Menopausal status. When you have HR+ breast cancer, the choice of hormone therapy to help keep your cancer from coming back depends on your menopause status.
Tamoxifen, the most common hormone therapy for breast cancer, is given to women pre- and post-menopause. It doesn’t stop estrogen production. Rather, it blocks the estrogen receptors on cancer cells so that they can no longer feed on estrogen.
Aromatase inhibitors only work on postmenopausal women. These stop the remaining production of estrogen in the body. Before menopause, your ovaries make estrogen. Aromatase inhibitors don’t work on the ovaries. But after menopause, fat cells still put out a bit of this hormone. Aromatase inhibitors shut that down. If you are postmenopausal, you might get one of these alone or along with tamoxifen.
Premenopausal women with HR+ cancer might also get treatment called ovarian suppression to stop their ovaries from making estrogen, which might be followed by an aromatase inhibitor.
Your genes. A test that looks at your DNA can tell doctors about your genetic risk of cancer and a recurrence. The results may influence their treatment suggestions. For example, if you have HR+/HER2- breast cancer at stage II or III, a risk-raising BRCA gene mutation, and some remaining cancer cells after surgery and chemotherapy, you might be prescribed a targeted drug called olaparib.
The tumor’s genes. Doctors may also run tests that analyze the genes in your tumor. This tells them which genes in the tumor are driving its growth and survival. That can help them predict the risk that your cancer comes back. Depending on the test results, your doctor may recommend drugs that target and shut down those genes and lower your risk of recurrence.
Your overall health. If you have other health problems, this might figure into your doctor’s treatment advice. For example, other illnesses might make you unable to tolerate the risks or side effects of a certain drug.
Your personal preferences. Your wishes may influence many parts of your treatment plan. For example, you may choose to do breast reconstruction at a different time from your cancer surgery, or not at all, depending on how much time you are willing to spend in recovery. You might also be able to schedule radiation or chemotherapy around important life events so that you are not out of commission for things you don't want to miss. When there are choices between two or more drugs or treatment plans, you may be able to make the final call based on the risks and side effects of each of your options.
Learn More on Your Own
It’s not just a breast cancer diagnosis that determines your treatment plan. Your doctor may need many more tests to help decide what course of action might be best for you. While you wait for test results and advice, it’s a good chance to study up on breast cancer treatment. You can:
Double-check conflicting info with your care team. Remember that your doctor knows your situation best. When you read something on the internet or hear opinions from friends that go against your doctor's suggestions, don’t change course. Simply write down your concerns and ask your doctor about them.
Look for trustworthy, credible information sources. Rather than reading whatever Google offers up, ask a member of your care team for good online sources of information about breast cancer treatment.
Some examples include:
- American Cancer Society’s website www.cancer.org
- The American Society of Clinical Oncology’s patient-facing website www.cancer.net
- The national nonprofit organization breastcancer.org
- Susan G. Komen’s website www.komen.org
- The National Cancer Institute’s website www.cancer.gov
Look at social media through a critical lens. Breast cancer-focused groups on social media can be great places to meet other people who’ve been where you are and who can tell you what to expect and how to prepare. But they can also be fertile ground for misinformation and offers of miracle cures that take advantage of scared or desperate people. Keep this in mind as you scroll.
Questions for Your Doctor About Your Treatment Plan
When your doctor is ready to recommend treatments, be ready with questions. You might consider asking:
- How did you decide that these were the best options for me?
- What are the risks and side effects of each of these options?
- How much downtime or recovery time will I need?
- Will I need to arrange for someone to take care of me or my children?
- Will these treatments interfere with my other health conditions or medications?
- If I have treatment options, what things should guide my choice?
- Which treatment plan would you choose and why?
- Should I get a second opinion?
- When do I need to start treatment?
Show Sources
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SOURCES:
Cancer.net: “Breast cancer: Types of treatment.”
American Cancer Society: “Treatment of Breast Cancer Stages I-III,” “Aromatase inhibitors for lowering breast cancer risk,” “Understanding your options and making treatment decisions.”
Breastcancer.org: “Sentinel lymph node dissection,” “What is genomic testing for breast cancer?”
Susan G. Komen: “Breast Cancer & Lymph Node Status.”
National Cancer Institute: “Hormone therapy for breast cancer.”
Cancer Research UK: “Hormone therapy for breast cancer.”
MD Anderson: “Diagnosed with breast cancer after menopause? Aromatase inhibitors can help.”
