The treatment of breast cancer is individual for each woman. The treatment you have will depend on many factors, including:

• the stage and grade of the cancer
• your age
• whether or not you have had the menopause
• the size of the tumour
• whether the cancer cells have receptors for certain hormones (such as oestrogen) or particular proteins (such as HER2).

Most breast cancers will be treated with surgery to remove the tumour. All or part of the breast tissue may be removed. If the whole breast is removed, breast reconstruction may be carried out, either at the same time as the initial surgery or later.

Sometimes chemotherapy or hormonal therapy may be given to shrink a cancer before surgery. This is known as neo-adjuvant therapy.

After surgery, radiotherapy will be given to any remaining breast tissue, and may be given to the chest wall if the breast has been removed (mastectomy). This is to make sure that any cancer cells that may be left in the area are destroyed.

After surgery, the doctors can tell the stage and the grade of the cancer, and they can look at several other factors to predict how likely the cancer is to come back or spread. Factors which affect the chance of the cancer coming back include:

• the size of the tumour
• whether the lymph nodes in the armpit were affected
• the grade of the tumour
• whether the cancer cells have spread into lymph or blood vessels close to the tumour (the pathologist checks for this)
• whether the cells have receptors for oestrogen or particular proteins (such as HER2) on their surface. Cancers with oestrogen receptors are less likely to recur in the short term, whereas those with HER2 receptors are more likely to come back unless Herceptin is given.

If the chance of the cancer spreading or coming back is very low, you won’t need to have any further treatment. However, if there is a risk of recurrence many women who have oestrogen receptor negative (ER-) breast cancer will be advised to have treatment with chemotherapy, and those with oestrogen receptor positive (ER+) breast cancer are usually advised to have hormonal therapy. This is known as adjuvant therapy. Many women who are oestrogen receptor positive will have both treatments, but not at the same time.

Some women have a large number of HER2 protein receptors on the surface of their cancer cells. This is known as being HER2 positive. In this situation, treatment with trastuzumab (Herceptin®) may be helpful. Your cancer specialist can discuss this with you.

Doctors can use various methods of calculating the chance of the cancer having spread or coming back. These are only a rough guide and cannot predict what will happen to an individual woman with breast cancer. However, they can give some idea of how effective treatment is likely to be.

These methods use the following information:

• stage of the cancer
• grade of the cancer
• and whether the cells have oestrogen or HER2 receptors.

One of the most commonly used methods in the UK is the Nottingham Prognostic Index.

Another method is Adjuvant! Online. This is a website that uses the factors above and results from clinical trials in breast cancer. The information helps to predict a woman’s chance of being alive ten years after diagnosis, if she has particular treatments after surgery and radiotherapy. It can help to show which of these treatments are likely to reduce the chance of the cancer coming back or spreading, and by how much. Many women with early breast cancer will live for much longer than ten years.

These figures are often used because if someone has no sign of the cancer returning for ten years after their treatment, it is unlikely to come back and they have a good chance of being cured.

This section discusses the treatments for stage 1–3 breast cancer. Our section on secondary breast cancer, discusses the treatments for secondary breast cancer.

If you have any questions about your treatment, ask your doctor or nurse. You may like to take a relative or friend with you to remind you of questions at the time or the answers afterwards.

If you have been diagnosed with breast cancer, you will be looked after by a breast care team. This is a team of staff who specialise in treating breast cancer and in giving information and support. It is known as a multidisciplinary team, and will normally include:

• Surgeons who are experienced in breast surgery.
• Breast care nurses who give information and support.
• Oncologists – doctors who have experience in breast cancer treatment using chemotherapy, radiotherapy, hormonal therapy and biological therapy.
• Radiologists who help to read mammograms.
• Pathologists who advise on the type and extent of the cancer.

Other staff will also be available to help you if necessary, such as:

• physiotherapists
• counsellors and psychologists
• social workers.

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should be given full information about:

• The type and extent of the treatment you are advised to have.
• The advantages and disadvantages of the treatment.
• Any other treatments that may be available.
• Any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations. It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

Patients often feel that hospital staff seem to be too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is essential to tell your doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can help to let the staff know your concerns so that they can give you the best advice.

Usually a number of cancer specialists work together as a team and use national treatment guidelines to decide on the most suitable treatment for a patient. Even so, you may want to have another medical opinion. Either your specialist, or your GP, should be willing to refer you to another specialist for a second opinion if you feel it will be helpful.

Getting a second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready so that you can make sure your concerns are covered during the discussion.