Breast Cancer Treatments

Breast cancer treatment aims to remove the cancer and reduce the risk of it returning or spreading to other parts of the body.

There are two parts to breast cancer treatment: locoregional therapy and systemic therapy.

The goal of locoregional therapy is to control the disease in the breast and nearby lymph nodes. Locoregional therapies include surgery (breast-conserving surgery or mastectomy) and radiotherapy. These therapies are sometimes offered in combination with each other; other times, surgery alone is adequate. In most cases, breast-conserving surgery and radiotherapy go together.

The goal of systemic therapy is to get rid of the very tiny cancer cells that may have escaped from the primary breast tumour to other sites, such as the lymph nodes, bones, liver, lungs or brain. All invasive breast cancers have the potential to travel from the primary tumour to another part of the body. These cancer cells may initially be too small to be detected on imaging. Systemic therapies include chemotherapy, endocrine therapy and targeted therapy.

Just as no two people are alike, no two breast cancers are the same. Dr Mousina works together with the local multidisciplinary team to develop treatment plans that address the unique nature of each breast cancer case.

Who is Suitable for Breast Cancer Treatments?

The suitability for specific breast cancer treatments depends on several factors:

Type of Breast Cancer: Some treatments are specific to the type of breast cancer, such as hormone receptor-positive, HER2-positive, or triple-negative breast cancer.
Stage of Cancer: Early-stage cancers might be treated effectively with surgery and radiation, while advanced cancer may require systemic treatments like chemotherapy or targeted therapy.
Biological Age and Overall Health: Health conditions can influence the treatment choice, as some treatments might be too harsh for patients with certain health issues.
Genetic Factors: Genetic mutations like BRCA1 or BRCA2 can influence treatment choices, particularly the consideration of preventative surgeries.

Benefits of Breast Cancer Treatments

The primary benefit of breast cancer treatment is the potential to cure the cancer or significantly extend the patient’s life. Other benefits include:

Control of Cancer: Treatments like chemotherapy, hormone therapy, and targeted therapy can control the spread of cancer and reduce the risk of recurrence.
Symptom Relief: Treatments help alleviate symptoms caused by cancer, improving quality of life.
Preventive Care: For individuals with a high risk of breast cancer (such as those with certain genetic predispositions), some treatments can serve as preventive measures to reduce risk.

Types of Breast Cancer Treatments

Surgery

Surgery is one of the most common treatments for breast cancer, aiming to remove cancerous tissue from the breast. There are several types of surgeries depending on the extent of cancer and patient preference:

Lumpectomy: Also known as breast-conserving surgery, it involves removing the tumour along with a margin of surrounding tissue while leaving the rest of the breast intact.
Mastectomy: This involves the removal of the entire breast. Depending on how much of the breast and surrounding tissues need to be removed, there are several types of mastectomies (simple, total, radical, and modified radical).
Sentinel Node Biopsy: Removing a few lymph nodes to see if cancer has spread beyond the breast.
Axillary Lymph Node Dissection: Removing several lymph nodes to check for cancer spread if the sentinel nodes are positive.

Radiation Therapy

This treatment uses high-energy rays to target and kill cancer cells. Types of radiation therapy include:

External Beam Radiation: The most common form, where radiation is directed at the breast from a machine outside the body.
Intraoperative Radiation: Delivered during surgery directly to the area where the tumour was before the incision is closed.
Brachytherapy: Involves placing radioactive seeds inside the breast close to where the cancer is located.

Chemotherapy

Chemotherapy involves the use of drugs to kill rapidly dividing cells, including cancer cells. It can be given:

Before Surgery (Neoadjuvant Chemotherapy): To shrink a tumour too large to be surgically removed at diagnosis.
After Surgery (Adjuvant Chemotherapy): To kill any remaining cancer cells that surgery could not remove.

Endocrine (Hormone) Therapy

Some breast cancers are hormone receptor-positive, meaning they grow in response to estrogen or progesterone. Endocrine therapy is used to block or lower these hormones, reducing the chance of recurrence. The main types of endocrine therapy include:

Tamoxifen: A selective estrogen receptor modulator (SERM) that blocks estrogen receptors on breast cancer cells, stopping their growth. It is used in both premenopausal and postmenopausal women.
Aromatase Inhibitors (AIs): Drugs like anastrozole, letrozole, and exemestane lower estrogen levels by blocking the enzyme aromatase, which converts other hormones into estrogen. These drugs are mainly used in postmenopausal women.
Ovarian Suppression: In premenopausal women, drugs like goserelin or surgery to remove the ovaries can be used to lower estrogen levels, making the breast cancer less likely to grow.

Anti-HER2 Therapy

About 15-20% of breast cancers overproduce a protein called HER2, which promotes cancer growth. Anti-HER2 therapies target this protein and can significantly improve outcomes for patients with HER2-positive breast cancer. The main anti-HER2 drugs are:

Trastuzumab (Herceptin): A monoclonal antibody that attaches to HER2 receptors on cancer cells, blocking their growth and alerting the immune system to attack.
Pertuzumab (Perjeta): Another HER2-blocking drug that is often used in combination with trastuzumab for more aggressive HER2-positive cancers.
T-DM1 (Kadcyla): A combination of trastuzumab and a chemotherapy drug, used in cases where the cancer has not responded to initial HER2 therapies.

Immunotherapy

This is a relatively new area in breast cancer treatment, utilising the body's immune system to fight the cancer. It’s usually reserved for certain types of advanced breast cancer that exhibit specific markers such as PD-L1 or are triple-negative and have a high mutation burden.

Bone-directed Therapy

For patients whose breast cancer has spread to the bone, treatments might include drugs to help protect the bones against the effects of cancer.

Nutrition

Maintaining a healthy diet during and after breast cancer treatment is crucial for recovery and overall well-being. Some dietary strategies that may help during treatment include:

Balanced Diet: Eating a variety of nutrient-dense foods, including fruits, vegetables, whole grains, and lean proteins, supports immune function and provides the body with essential vitamins and minerals.
Low Sugar and Fat Intake: Studies suggest that high sugar and fat intake may increase the risk of cancer recurrence. A diet low in processed foods and saturated fats is generally recommended.
Stay Hydrated: Adequate hydration can help manage treatment side effects, like fatigue and dry mouth.

Exercise

Regular physical activity is associated with better outcomes during breast cancer treatment and recovery. Benefits of exercise include:

Improved Energy Levels: Exercise helps reduce fatigue, a common side effect of cancer treatments.
Weight Management: Maintaining a healthy weight can lower the risk of recurrence and improve overall health.
Enhanced Mental Health: Physical activity is known to reduce symptoms of anxiety and depression, which are common during cancer treatment.

Emotional Support

A breast cancer diagnosis can have a significant emotional and psychological impact. Emotional support is a key part of comprehensive cancer care. Support can come in various forms:

Counseling and Therapy: Professional counseling or psychotherapy can help patients cope with the emotional challenges of cancer diagnosis and treatment.
Support Groups: Many women find it helpful to join breast cancer support groups, where they can share experiences and receive encouragement from others going through similar situations.
Mind-Body Practices: Techniques such as mindfulness, meditation, and yoga can help reduce stress and improve emotional well-being.

Breast Procedures

Breast procedures encompass a range of surgical operations designed to alter or restore the shape, size, and general appearance of the breast. These can be broadly categorised into cosmetic procedures, done primarily for aesthetic reasons, and reconstructive procedures, performed to restore the appearance after surgical procedures such as mastectomies.

Breast Reduction (Reduction Mammaplasty)

What is Breast Reduction?

Breast reduction, or reduction mammaplasty, is a surgical procedure for reducing the size of large breasts. The surgery involves removing excess breast fat, glandular tissue, and skin to achieve a breast size in proportion to the body and to alleviate the discomfort associated with overly large breasts.

Indications for Breast Reduction

The procedure is considered for both physical and emotional reasons. Common indications include:

Physical discomfort: Large breasts can cause neck, shoulder, and back pain due to the extra weight.
Skin irritation: Constant rubbing and sweating under the breastfold can lead to skin rashes and other irritations.
Limited activity: Some individuals may find it difficult to participate in physical activities due to the size and weight of their breasts.
Psychological distress: Large breasts can also lead to self-image issues and discomfort in social situations.

Benefits of Breast Reduction

The benefits of breast reduction surgery are numerous:

Pain Relief: Reduction in neck, back, and shoulder pain.
Improved Mobility: Increased ability to participate in physical activities.
Enhanced Appearance: A more proportionate and aesthetically pleasing breast shape.
Better Fit for Clothing: Easier fitting into bras and clothing.
Improved Self-Image and Confidence: Helps alleviate emotional discomfort and boost self-confidence.

Breast Reduction Procedure

Breast reduction surgery is usually performed under general anaesthesia and can take about 2 to 5 hours, depending on the extent of the reduction. The typical steps include:

Incision: One of several incision patterns may be used. Common patterns include a circular pattern around the areola, a keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease, or an inverted T or anchor-shaped pattern.
Removal and Reshaping: Excess breast tissue, fat, and skin are removed, and the remaining tissue and nipples are repositioned to a higher, more youthful location.
Suturing: The incisions are brought together to reshape the now smaller breast. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts.

Recovery after Breast Reduction

Patients typically experience soreness, swelling, and bruising post-surgery for several weeks. Recovery guidelines include:

Rest: Adequate rest is crucial for recovery. Heavy lifting and strenuous activities should be avoided for at least a month.
Support Garments: Wearing a support bra or compression garment can help reduce swelling and support the breasts as they heal.
Follow-up Visits: Regular follow-up visits are necessary to monitor the healing process and manage potential complications.

Breast Reduction Risks

Scarring: Although scars are permanent, they will fade over time.
Changes in nipple or breast sensation may be temporary or permanent.
Complications related to anaesthesia.
Inability to breastfeed: Depending on the amount of tissue removed and the surgery technique.

Breast Cancer Treatment Prognosis

Early-stage breast cancers have a higher survival rate compared to advanced stages. For instance, localised breast cancers have a 5-year survival rate of nearly 99%, while cancers that have spread extensively have lower survival rates.

Hormone receptor-positive breast cancers generally have a better prognosis due to more treatment options like hormone therapy. HER2-positive cancers, once among the most aggressive, now also have improved outcomes due to effective targeted therapies.

Age, overall health, and genetic factors like BRCA1 or BRCA2 mutations also influence prognosis.

Breast Cancer Treatment Risks

Every treatment carries potential risks and side effects. Common risks associated with breast cancer treatments include:

Surgery: Risks include infection, bleeding, and anaesthesia-related complications. There might also be a change in breast sensation or shape.
Radiation Therapy: Possible side effects are skin irritation, fatigue, and a slight increase in the risk of developing other cancers.
Chemotherapy: This can cause hair loss, nausea, fatigue, and increased risk of infection and may sometimes lead to long-term cardiovascular issues or secondary cancers.
Hormone Therapy: Risks include menopausal symptoms, bone thinning, and possibly increased risk of blood clots.
Targeted Therapy and Immunotherapy: Depending on the specific medication used, these can lead to skin reactions, diarrhoea, liver problems, and heart issues.

What if Breast Cancer Treatment is Delayed?

Delaying breast cancer treatment can allow the cancer to progress to a more advanced stage, potentially spreading beyond the original site (metastasis) and reducing the likelihood of a full cure. Studies have shown that even a short delay (e.g., a month or more) in starting treatment can statistically decrease survival rates.

More advanced cancer often requires more extensive and aggressive treatment, which can bring about more severe side effects and complications. Delaying treatment can also lead to increased anxiety and stress, impacting the patient’s mental health and potentially their physiological response to treatment.