Breast Cancer Treatment Is Personal: How Your Care Team Builds a Treatment Plan

Two people can both be diagnosed with breast cancer and receive very different treatment recommendations. 

One may need surgery followed by radiation. Another may receive chemotherapy before surgery. Some patients benefit from hormone therapy taken for several years, while others may be candidates for targeted therapy or immunotherapy. 

Why so many different approaches? 

Because breast cancer isn't just one disease. Understanding the specific characteristics of a patient's cancer helps the care team develop a treatment plan designed for that individual diagnosis. 

Amanda D. May, MD, FACP, a medical oncologist at Archbold Cancer Center, works with patients throughout South Georgia to understand their diagnosis and determine which breast cancer treatments may offer the most benefit. 

"Patients sometimes compare their treatment plan to someone else they know who has had breast cancer," Dr. May said. "But there are many different types of breast cancer. Our goal is to understand the individual cancer as thoroughly as possible so we can recommend treatment based on each patient's specific diagnosis."

Why Isn't Breast Cancer Treatment the Same for Everyone? 

When a biopsy confirms breast cancer, the diagnosis provides much more information than whether cancer is simply present or absent. 

Doctors examine the cancer cells and perform testing to learn more about how the tumor behaves and what may be driving its growth. They also evaluate how large the cancer is an whether it has spread beyond the breast. 

Together, these details help determine which treatments are most likely to be effective. 

Some of the factors your breast cancer care team may consider include: 

• They type of breast cancer
• The size and location of the tumor
• The stage of the cancer
• Whether cancer has spread to nearby lymph nodes or other areas of the body
• Hormone receptor status
• HER2 status
• Certain genetic or genomic test results, when appropriate
• Whether the patient has gone through menopause
• The patient's age, overall health and other medical conditions
• Previous treatments and the patient's individual preferences

Treatment plans can also change as new information becomes available. 

"Breast cancer treatment is very individualized," Dr. May said. "We're looking at the whole picture—not one test result—to determine which combination and sequence of treatments makes the most sense." 

Understanding Hormone Receptor Status in Breast Cancer

One important characteristic doctors evaluate is whether the cancer has hormone receptors. 

Breast cancer cells may have receptors that allow hormones such as estrogen or progesterone to encourage their growth. These cancers are described as hormone receptor-positive, which may include estrogen receptor-positive (ER-positive) or progesterone receptor-positive (PR-positive) breast cancer. 

Knowing whether a tumor is hormone receptor-positive is important because these cancers may respond to hormone therapy, also called endocrine therapy. 

Hormone therapy works be lowering certain hormone levels or preventing hormones from stimulating breast cancer cells. Depending on the patient's circumstances, doctors may recommend medications such as tamoxifen or aromatase inhibitors. 

Unlike chemotherapy, which is generally given for a defined period, hormone therapy may be taken for several years to help reduce the risk of breast cancer returning. 

What Does HER2-Positive Breast Cancer Mean? 

Doctors also routinely evaluate breast cancer cells for a protein called HER2, or human epidermal growth factor receptor 2. 

Some breast cancers have higher-than-normal levels of HER2, which can cause cancer cells to grow more quickly. These are known as HER2-positive breast cancers. 

While HER2-positive breast cancer can behave more aggressively than some other types, identifying HER2 also provides an important treatment opportunity. Targeted medications can specifically interfere with the HER2 protein and the signals that encourage cancer growth. 

"Testing gives us information about what may be fueling a particular cancer," Dr. May said. "In some cases, that allows us to use therapies designed to target a specific feature of those cancer cells."

HER2-targeted therapy may be used along with chemotherapy or other treatments, depending on the patient's diagnoses and stage of disease. 

What Is Triple-Negative Breast Cancer?

If a breast cancer does not have estrogen receptors or progesterone receptors and does not have elevated HER2, it is known as triple-negative breast cancer. 

Because triple-negative breast cancer doesn't have these three common treatment targets, hormone therapy and HER2-targeted treatments are not effective against it. 

Chemotherapy is often an important part of treatment for triple-negative breast cancer. For some patients, doctors may also recommend immunotherapy. 

Immunotherapy works differently from traditional chemotherapy. Rather than directly attacking cancer cells it helps the body's immune system better recognize and fight cancer. 

Whether immunotherapy is appropriate depends on several factors, including the stage and characteristics of the cancer. 

When Is Chemotherapy Used for Breast Cancer? 

Not everyone diagnosed with breast cancer will need chemotherapy. 

Chemotherapy uses medications that travel throughout the body to destroy rapidly growing cancer cells. It may be recommended based on factors such as the type and stage of breast cancer, tumor characteristics, lymph node involvement, and the estimated risk of the cancer returning. 

The timing can vary as well. 

Neoadjuvant chemotherapy is commonly given before surgery. It may be used to shrink a tumor, potentially make surgery less extensive, and allow the care team to see how the cancer responds to treatment. 

Adjuvant chemotherapy is often given after surgery. Its purpose is to destroy cancer cells that may remain elsewhere in the body but are too small to detect with imaging or other tests. 

For some patients with early-stage hormone receptor-positive, HER2-negative breast cancer, additional testing of the tumor may help doctors estimate the likelihood that chemotherapy will provide meaningful benefit. 

"We don't want to give a patient treatment simply because it's available," Dr. May said. "We want to recommend treatments when the expected benefit makes sense for that individual patient." 

How Does Radiation Therapy Fit Into Breast Cancer Treatment? 

Radiation therapy uses high-energy radiation to destroy cancer cells in a specific area of the body. 

It is commonly recommend after breast-conserving surgery, such as a lumpectomy, to reduce the chance of cancer returning in the breast. Radiation may also be recommended after a mastectomy for some patients, particularly when certain risk factors are present. 

The decision depends on factors such as tumor size, lymph node involvement, surgical findings, and other characteristics of the cancer. 

A radiation oncologist works with the rest of the breast cancer care team to determine whether radiation is appropriate and develop a treatment plan for the patient. 

Does the Order of Breast Cancer Treatment Matter? 

Yes. One of the most important decisions the breast cancer care team makes is not only which treatments a patient needs, but also when the treatment should happen. 

For some patients, surgery comes first, followed by treatments such as radiation, chemotherapy, or hormone therapy. 

For others, chemotherapy, targeted therapy or immunotherapy may be recommended before surgery. Treating the cancer first can sometimes shrink the tumor and provide valuable information about how well it responds to a particular therapy. 

This is one reason coordination among specialists is so important. 

A patient's breast cancer treatment may involve a general surgeon, medical oncologist, radiation oncologist, radiologist, pathologist, physical therapist, and other healthcare professionals. Each specialist brings a different perspective to the treatment plan. 

Multidisciplinary Breast Cancer Care at Archbold Cancer Center

A breast cancer diagnosis can quickly lead to multiple appointments, specialists, and decisions. Having those providers working together helps create continuity throughout the patient's care. 

At the Archbold Cancer Center, patients have access to comprehensive cancer care close to home in South Georgia. Medical oncologists and radiation oncologists work alongside surgeons, diagnostic imaging specialists, pathologists, and rehabilitation professionals to help coordinate each patient's treatment. 

Archbold's Breast Cancer Navigator can also help guide patients through the process following a diagnosis, providing support, helping coordinate care, and connecting patients with resources as they move through treatment. 

"Cancer care truly is a team effort," Dr. May said. "Communication among the different specialists involved allows us to look at the entire treatment plan and make recommendations based on what's best for the individual patient." 

Your Breast Cancer Treatment Plan Should Be as Individual as Your Diagnosis

Learning that you have breast cancer naturally brings questions what comes next. But you don't have to understand every test result or treatment option on the day you're diagnosed. 

Your care team will gather information about your cancer, explain what those findings mean, and help you understand the treatment options available to you. 

The important thing to remember is that a treatment plan that looks different from someone else isn't necessarily better or worse. It reflects the fact that breast cancer treatment is personal. 

Facing a cancer diagnosis? Learn more about Amanda D. May, MD, FACP, and the comprehensive cancer services available at Archbold Cancer Center.