Treatment of Early, Localized, or Operable Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of early, localized, or operable breast cancer may include:

Surgery

• Breast-conserving surgery and sentinel lymph node biopsy. If cancer is found in the lymph nodes, a lymph node dissection may be done.
• Modified radical mastectomy. Breast reconstruction may also be done.

Postoperative radiation therapy

For women who had breast-conserving surgery, radiation therapy is given to the whole breast to lessen the chance the cancer will come back. Radiation therapy may also be given to lymph nodes in the area.

For women who had a modified radical mastectomy, radiation therapy may be given to lessen the chance the cancer will come back if any of the following are true:

• Cancer was found in 4 or more lymph nodes.
• Cancer had spread to tissue around the lymph nodes.
• The tumor was large.
• There is tumor close to or remaining in the tissue near the edges of where the tumor was removed.

Postoperative systemic therapy

Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to lessen the chance the cancer will come back after surgery to remove the tumor.

Postoperative systemic therapy is given depending on whether:

• The tumor is hormone receptor negative or positive.
• The tumor is HER2 negative or positive.
• The tumor is hormone receptor negative and HER2 negative (triple-negative).
• The size of the tumor.

In premenopausal women with hormone receptor positive tumors, no more treatment may be needed, or postoperative therapy may include:

• Tamoxifen  therapy with or without chemotherapy.
• Tamoxifen therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.
• Aromatase inhibitor therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used.

In postmenopausal women with hormone receptor positive tumors, no more treatment may be needed, or postoperative therapy may include:

• Aromatase inhibitor therapy with or without chemotherapy.
• Tamoxifen followed by aromatase inhibitor therapy, with or without chemotherapy.

In women with hormone receptor negative tumors, no more treatment may be needed, or postoperative therapy may include chemotherapy.

In women with HER2 negative tumors, postoperative therapy may include chemotherapy.

In women with small, HER2 positive tumors, and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes, or the tumor is large, postoperative therapy may include:

• Chemotherapy and targeted therapy (trastuzumab).
• Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for tumors that are also hormone receptor positive.

In women with small, hormone receptor negative and HER2 negative tumors (triple-negative) and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes or the tumor is large, postoperative therapy may include:

• Chemotherapy.
• Radiation therapy.
• PARP inhibitor therapy for women with an inherited BRCA1 or BRCA2 mutation.
• A clinical trial of a new chemotherapy regimen.

Preoperative systemic therapy

Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Preoperative systemic therapy is given to shrink the tumor before surgery.

Preoperative chemotherapy may make breast-sparing surgery possible in patients who are not eligible otherwise. Preoperative chemotherapy may also lessen the need for lymph node dissection in patients with disease that has spread to the lymph nodes.

In postmenopausal women with hormone receptor positive tumors, preoperative therapy may include:

• Chemotherapy.
• Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for women who cannot have chemotherapy.

In premenopausal women with hormone receptor positive tumors, preoperative therapy may include a clinical trial of hormone therapy, such as tamoxifen or aromatase inhibitor therapy.

In women with HER2-positive tumors, preoperative therapy may include:

• Chemotherapy and targeted therapy (trastuzumab).
• Targeted therapy (pertuzumab).

In women with HER2-negative tumors or triple-negative tumors, preoperative therapy may include chemotherapy.

For patients with triple-negative or HER2-positive disease, the response to preoperative therapy may be used as a guide in choosing the best treatment after surgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.