Early Breast Cancer Treatment
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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 axillary lymph nodes (the lymph nodes in the underarm area). 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 refers to a large tumor in the breast and/or a tumor that has spread beyond the breast to the chest wall or the skin of the breast. It can also be a tumor in the breast that has spread to many axillary lymph nodes. This term often describes stage II and stage III breast cancers.
Learn about types of tumors.
The following is a 3D interactive model showing early and locally advanced breast cancer from stages I to III. Click the arrows to move through the model to learn more about breast cancer.
Survival
With treatment, people with early breast cancer usually have a very good chance of survival.
For example, from 2013 to 2019 (most recent data available), the [168]:
- 5-year relative survival for women diagnosed with breast cancer that had not spread beyond the breast was 99%.
- 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%.
This means women diagnosed with breast cancer that had not spread beyond the breast were 99% as likely to live 5 years beyond diagnosis as women in the general population. And women diagnosed with breast cancer that had spread to nearby lymph nodes, but not to other parts of the body, were 86% 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, survival 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 of:
- Surgery
- Radiation therapy
- Chemotherapy
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitor therapy
- Immunotherapy
- PARP inhibitor therapy
Getting a second opinion
It’s always OK to get a second opinion at any point during your care. Your oncologist should never discourage you from getting a second opinion.
Learn more about getting a second opinion.
Surgery and radiation therapy for early breast cancer
Surgery
Surgery is usually the first step in treating early breast cancer.
You may have a mastectomy (the entire breast is removed) or a lumpectomy (only the tumor and some surrounding tissue are removed).
With either type of surgery, some axillary lymph nodes (lymph nodes in the underarm area) may be removed to check if they contain cancer.
Radiation therapy and lumpectomy
People who have a lumpectomy usually have radiation therapy to the breast to kill any cancer cells that may remain in the breast. This lowers the chances of a breast cancer recurrence (the breast cancer coming back) [3].
Sometimes, radiation therapy is also given to the axillary lymph nodes to kill any cancer cells that may remain there.
Radiation therapy and mastectomy
Most people who have a mastectomy don’t need radiation therapy if there’s no cancer in the lymph nodes.
In some cases, radiation therapy is used after a 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 a mastectomy versus a 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 a mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section. |
Treatment after surgery for early breast cancer (systemic therapy, adjuvant therapy)
Most people have drug therapies after surgery to lower the risk of breast cancer recurrence. It’s uncommon to have surgery as the only treatment for early or locally advanced breast cancer.
Drug therapies for early and locally advanced breast cancers include:
- Chemotherapy
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitor therapy
- Immunotherapy
- PARP inhibitor therapy
These drug therapies travel throughout the body to kill or disable cancer cells that may have spread from the breast. They may be called systemic therapy or adjuvant therapy.
Some drug therapies are given through an IV into a vein or by an 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 including biomarkers, such as hormone receptor status and HER2 status
For women, whether you are premenopausal or postmenopausal can also play a role in your treatment options.
For some people, having a BRCA1 or BRCA2 inherited gene mutation can also affect treatment options.
Talk with your health care provider about the benefits and risks of each treatment recommended in your treatment plan.
Learn more about factors that affect treatment options.
Tumor profiling and chemotherapy
Some people who have hormone receptor-positive, HER2-negative breast cancer should ask their health care providers about getting a tumor profiling test, such as Oncotype DX®, to see if chemotherapy is needed in addition to hormone therapy [10].
Tumor profiling can be used to help guide chemotherapy for early breast cancers that are all of the following [10]:
- Estrogen receptor-positive (and will be treated with hormone therapy)
- Tumor size smaller than 5 cm
- HER2-negative
- Lymph node-negative or 1-3 positive lymph nodes
Tumor profiling may also be called genomic testing, molecular profiling or genetic signatures.
Learn more about tumor 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) for early breast cancer
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 people with early breast cancer have neoadjuvant therapy as a first treatment. Neoadjuvant therapy may shrink a tumor enough so a lumpectomy becomes an option instead of a 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.
In some cases, response to neoadjuvant chemotherapy can help guide treatment after breast cancer surgery.
Learn more about neoadjuvant therapy.
Neoadjuvant chemotherapy
With neoadjuvant chemotherapy, usually all the chemotherapy to treat the breast cancer is given before surgery [10]. If the tumor doesn’t get smaller with the first combination of chemotherapy drugs, other combinations can be tried.
Learn more about neoadjuvant chemotherapy.
Learn more about chemotherapy.
| For a summary of studies on neoadjuvant chemotherapy, visit the Breast Cancer Research Studies section. |
Neoadjuvant HER2-targeted therapy
If your tumor is HER2-positive, you may get neoadjuvant trastuzumab (Herceptin) and neoadjuvant pertuzumab (Perjeta) in addition to neoadjuvant chemotherapy [10].
Since trastuzumab and pertuzumab are given for one year, you won’t get all the trastuzumab and pertuzumab before surgery. You’ll get some before surgery and some after surgery.
Whether you will continue to get pertuzumab and trastuzumab after surgery depends on the pathology of the tissue removed.
Learn more about neoadjuvant HER2-targeted therapy.
Learn more about HER2-targeted therapy.
Neoadjuvant immunotherapy
If your tumor is triple negative (estrogen receptor-negative, progesterone receptor-negative and HER2-negative) with a high risk of recurrence, you may get neoadjuvant pembrolizumab (Keytruda) in addition to neoadjuvant chemotherapy [10]. Pembrolizumab is an immunotherapy drug.
After surgery, you will continue to get pembrolizumab to complete one year of treatment.
Learn more about neoadjuvant immunotherapy.
Learn more about immunotherapy.
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 [10].
Since hormone therapy is given over a long period of time, you won’t get all the hormone therapy before surgery. You’ll get some before surgery and some after surgery.
Learn more about neoadjuvant hormone therapy.
Learn more about hormone therapy.
| For a summary of studies on neoadjuvant hormone therapy for women with estrogen receptor-positive breast cancer, visit the Breast Cancer Research Studies section. |
Your health care team
Throughout your treatment and beyond, you’ll get care from many health care providers. Your health care team may include:
- Doctors involved in cancer treatment (medical oncologists, surgeons, radiation oncologists)
- Doctors involved in other care for people with breast cancer (radiologists, pathologists, palliative care or pain specialists, and others)
- Your primary care doctor
- Nurses
- Genetic counselors
- Patient navigators
- Social workers
- Mental health providers (counselors, clinical social workers, psychologists and others)
- Dietitians
- Physical therapists
- Pharmacists
- Integrative care specialists
- Other health care providers
These health care providers may be involved in your care throughout diagnosis, treatment and beyond.
If you’re not happy with your care or you’re not connecting with your doctor, consider getting a second opinion. It’s always OK to get a second opinion at any point during your care. Your doctor should never discourage you from getting a second opinion.
Learn about choosing a doctor.
Learn about choosing a hospital.
Learn more about getting a second opinion.
Online access to your medical information
Most hospitals and doctor offices now allow you access to your medical information online. You set up an account with a login name and password. This provides security to protect your privacy.
An online account gives you access to your test results, pathology and radiology reports, prescription drug information, medical appointments, doctors’ notes and more. It also gives you another way to communicate with your health care team.
Staying organized |
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It may be helpful to use a notebook or 3-ring binder with pockets, or other organizer to keep track of your breast cancer treatments and health care team. You may want to include:
Susan G. Komen® has interactive Questions to Ask Your Doctor resources that you can download and may be helpful to include. |
Questions you may want to ask your health care provider
- How will the status of my lymph nodes affect my treatment plan? Will a sentinel node biopsy be done?
- Is my tumor estrogen/progesterone receptor-positive or estrogen/progesterone receptor-negative? How does this affect my treatment plan? If my tumor is estrogen receptor-positive, will my tumor be tested with Oncotype DX or another tumor profiling test to help decide if I need chemotherapy?
- Is my tumor HER2-positive or HER2-negative? How does this affect my treatment plan?
- If my tumor is estrogen receptor-positive and HER2-negative, will my tumor be tested with Oncotype DX or another tumor profiling test to help decide if I need chemotherapy?
- If I have triple negative breast cancer, how does this affect my treatment plan?
- What are my treatment options? Which treatments do you recommend for me and why?
- What are my chances for survival with treatment? What are my chances for survival without treatment?
- Is there a clinical trial I can join?
- How long do I have to make treatment decisions?
- Can I choose the days and times of treatments?
- Should I have genetic testing (for inherited gene mutations) done? Should I meet with a genetic counselor?
- Can I have a lumpectomy (breast-conserving surgery) plus radiation therapy? Will chemotherapy or hormone therapy before surgery improve my chances of being able to have a lumpectomy?
- If I have a lumpectomy, when will I meet with a radiation oncologist to discuss radiation therapy?
- If I have a lumpectomy plus radiation therapy now and the breast cancer returns in the future, will I need to have a mastectomy at that time?
- Can breast reconstruction be done at the time of the surgery, as well as later? How much later can it be done? Can you refer me to a plastic surgeon?
- If I choose not to have breast reconstruction, what types of prostheses are available? Where can I find them? Will my insurance cover the cost? What if I’d like to “go flat”?
- Were my tumor margins negative (clean, not involved, clear)? If not, will I need more surgery?
- Will you give me a copy of my pathology report and other test results?
- What is my follow-up care? Which health care provider will manage my follow-up care?
- How will treatment affect my bone health?
- What do I need to consider before treatment begins if I would like to have a child after being treated for breast cancer?
- Who can talk with me about the cost of my treatment, including the expenses covered by my insurance and the costs I should expect to pay out-of-pocket?
- Will part of my tumor be stored? Where will it be stored? For how long? How can it be accessed in the future?
Learn more about talking with your health care team.
If you have been diagnosed with early breast cancer or feel too overwhelmed to know where to begin to gather information, it may be helpful to download and print some of Susan G. Komen®‘s resources. For example, we have Questions to Ask Your Doctor About Breast Cancer Surgery and Questions to Ask Your Doctor About Hormone Therapy.
You can download and print resources to take with you to your next doctor’s appointment or you can save them on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write or type the answers to the questions.
There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.
Treatment guidelines
Although the exact treatment for breast cancer varies from person to person, evidence-based guidelines help make sure high-quality care is given. 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 follow.
After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment has risks and benefits to consider along with your own values and lifestyle.
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. This is called shared decision-making.
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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. |
Clinical trials
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® Patient Care Center |
If you or a loved one needs information or resources about clinical trials, the Patient Care Center can help. Contact the Komen Breast Care Helpline at 1-877-465-6636 or email clinicaltrialinfo@komen.org. Se habla español. |
BreastCancerTrials.org in collaboration with Komen offers a custom matching service to help find a clinical trial that fits your needs.
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 |
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Updated 04/12/24
