When a woman is diagnosed with breast cancer, she typically meets the surgical oncologist first. Surgery is often the most visible part of treatment. But the medical oncology component, what I manage, is equally important and in some cases begins before surgery.
Neoadjuvant chemotherapy before surgery can shrink a tumour significantly, creating options that did not exist at diagnosis. HER2 targeted therapy for HER2 positive breast cancer has transformed outcomes in one of the most common breast cancer subtypes. Hormone therapy for ER positive cancers given for 5 to 10 years after surgery prevents recurrence more effectively than any other single intervention. Immunotherapy has recently entered the picture for certain triple negative breast cancers.
I also specifically address delayed presentations in women who come to me months or years after first noticing something. The reasons for this delay are real and varied. I do not judge them. I treat what is in front of me with whatever options remain, and I explain everything clearly in the patient's language.
"The medical oncology component of breast cancer treatment is as important as the surgery. In some cases it begins before surgery."
Dr. Owais Mohammed, Medical Oncologist, MRCP UK, Tata Memorial TrainedGiven before surgery to shrink tumours. Particularly used for locally advanced disease, HER2 positive cancers, and triple negative breast cancers. Response to neoadjuvant treatment also provides important prognostic information about cancer behaviour.
Chemotherapy given after surgery to eliminate any remaining cancer cells that surgery could not remove. Whether adjuvant chemotherapy is needed depends on cancer stage, receptor status, grade, and lymph node involvement.
For HER2 positive breast cancers, targeted therapy with trastuzumab (Herceptin) and related agents is standard of care. It has significantly improved outcomes in this subtype. HER2 testing must be done on every breast cancer biopsy.
For ER positive or PR positive breast cancers, hormone therapy (tamoxifen or aromatase inhibitors) given for 5 to 10 years after surgery substantially reduces recurrence risk. This is oral medication, not chemotherapy. Side effects are different and generally much milder.
If you have already been given a breast cancer treatment plan and want to verify it is the right approach for your specific receptor status and stage, I review complete treatment plans. Molecular testing done or not is the first thing I check.
Not necessarily. Whether adjuvant chemotherapy is needed depends on cancer stage, receptor status, grade and lymph node involvement. For early stage, low grade, ER positive, HER2 negative breast cancers, hormone therapy alone may be sufficient. For higher risk cancers, chemotherapy is typically recommended. The pathology report from surgery provides the information needed to make this decision.
HER2 positive means the cancer cells have excess HER2 protein on their surface. This subtype tends to be more aggressive but responds well to HER2 targeted therapy. Trastuzumab (Herceptin) and related targeted drugs are standard of care for HER2 positive breast cancer. They have significantly improved outcomes in this group over the last twenty years. HER2 testing should be done on every breast cancer biopsy.
Hormone therapy for breast cancer, typically tamoxifen or aromatase inhibitors, is given for 5 to 10 years and has a well-established safety profile at that duration. Side effects vary by drug. Tamoxifen can cause hot flushes and joint pains in some patients. Aromatase inhibitors can affect bone density and require monitoring. The benefit in preventing recurrence substantially outweighs the manageable side effects for most patients.
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