For a patient diagnosed with early-stage breast cancer, the old treatment approach was to immediately refer the patient to a surgeon, who typically performed a total mastectomy to remove the entire breast. Years later, total mastectomy was replaced by a more limited operation, where only the cancer was removed. This breast conserving surgery is often referred to as lumpectomy.
Whichever operation was chosen, surgery was traditionally the first treatment for a patient with early-stage breast cancer. After surgery, the patient would be referred to another doctor for radiation therapy and chemotherapy. This approach is outdated.
The modern approach to treating early breast cancer requires an oncologist to answer one important question before treatment: “What kind of breast cancer are we dealing with?” Breast cancer is not one disease, but represents a spectrum of diseases of different biologic types.
The principles of treatment for each biologic type are the same:
- Destroy all visible disease in the breast and regional lymph nodes (in the armpit)
- Use additional drug treatment to prevent disease recurrence
However, the treatment plan is different for each biologic type. Each requires a different drug treatment, and the sequencing of treatment may be different, as well. For example, patients whose cancer is HER2-positive frequently benefit from drug treatment before surgery. Modern drug treatment can possibly destroy all cancer cells in HER2-positive disease, so only limited surgery would be needed.
We are now living in an era of personalized cancer treatment. The basic forms of treatment—surgery, radiation and chemotherapy—remain the same but the type of treatment and its sequencing is different for every patient.
A simple needle biopsy can help uncover the appropriate treatment for a woman with early-stage breast cancer. Every woman diagnosed with breast cancer should see a breast surgeon and a medical oncologist before any treatment is started. Doing so ensures she will be treated according to the biologic type of breast cancer she has.
The new paradigm of treating early breast cancer is this:
- Identify the important biological characteristics that impact prognosis
- Help determine the most appropriate systemic (drug) treatment
- Develop a treatment plan that will eliminate all visible disease
- Minimize the risk of recurrence, while maintaining as much healthy tissue as possible
See our infographic to learn more about breast cancer as a spectrum of diseases.