What is the first-line treatment for breast cancer?

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According to the American Cancer Society, people with breast cancer stages 1–3 may undergo surgery followed by radiation therapy. Many people may also require systemic drug therapy, such as:

• chemotherapy
• immunotherapy
• targeted therapy
• hormone therapy

Some people may undergo systemic therapy before surgery.

For those with metastatic breast cancer that has spread to other areas of the body, the main form of treatment can include systemic drug therapy, such as chemotherapy. Surgery can also be an option.

It is important to note that a person’s treatment plan will depend on many factors and can vary based on a person’s individual situation.

Learn more about the treatment options for breast cancer and treatment options for metastatic breast cancer.

The main types of surgery for breast cancer are lumpectomy and mastectomy. A lumpectomy involves removing the tumor and a small amount of surrounding tissue. This is also called BCS. A mastectomy involves removing the entire breast.

Lymph node biopsies may also help determine if the cancer has spread.

Learn more about the different types of breast cancer surgery.

Hormone receptor-positive breast cancers rely on hormones to grow.

Hormone therapy, which includes tamoxifen and aromatase inhibitors, blocks the effects of hormones such as estrogen and can help prevent cancer recurrence or growth.

Some breast cancers have specific characteristics that certain drugs can target. For example, targeted therapies such as trastuzumab (Herceptin) or pertuzumab (Perjeta) can treat HER2-positive breast cancers.

Some examples of targeted therapies used for hormone receptor-positive breast cancer include:

• CDK4/6 inhibitors: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, such as ribociclib, palbociclib, and abemaciclib, are targeted therapies that work by blocking the activity of specific proteins involved in cell division. These inhibitors can slow down cancer cell growth and delay disease progression.
• Everolimus: This targeted therapy inhibits a protein called mTOR, which regulates cell growth. When combined with an aromatase inhibitor, everolimus can delay disease progression in some instances of hormone receptor-positive, HER2-negative advanced breast cancer.

Learn more about hormone therapy for breast cancer.

Chemotherapy uses drugs to target and kill rapidly dividing cancer cells.

Doctors may administer this before surgery (neoadjuvant chemotherapy) to shrink the tumor or after surgery (adjuvant chemotherapy) to target any remaining cancer cells.

Learn more about chemotherapy for breast cancer.

Radiation therapy, or radiotherapy, is a localized treatment that uses high energy radiation beams to target and damage cancer cells.

The goal is to kill or damage cancer cells in a specific area while minimizing harm to surrounding healthy tissue.

Doctors may use this as a stand-alone curative treatment or to either shrink tumors before surgery (neoadjuvant) or eliminate any remaining cancer cells after surgery (adjuvant).

There are two main types of radiation therapy for breast cancer:

• External beam radiation: This involves aiming radiation beams at the tumor site from outside the body using a machine called a linear accelerator.
• Internal radiation (brachytherapy): In some cases, small radioactive sources are placed inside the body temporarily or permanently to deliver radiation directly to the tumor site.

Learn more about radiation therapy for breast cancer.

Several factors influence the type of treatment a person needs for breast cancer. Oncologists consider these factors to develop an individualized treatment plan tailored to the person’s specific situation.

Here are the key factors that affect treatment decisions:

• Type and stage of breast cancer: Different types and stages of breast cancer require different treatment approaches.
• Tumor characteristics: Tumor characteristics include hormone receptor status, HER2/neu status, and other molecular markers. These characteristics determine whether hormone therapy, targeted therapies, or other treatments are appropriate.
• Lymph node involvement: Whether cancer has spread to nearby lymph nodes is an important consideration. Lymph node involvement can influence decisions about surgery, radiation, and systemic therapies.
• Presence of metastasis: If breast cancer has spread to other parts of the body, the treatment approach shifts to focus on controlling the disease and managing symptoms.

Managing side effects is an essential aspect of breast cancer treatment, as it helps improve a person’s quality of life and overall well-being during and after therapy.

The side effects a person experiences can vary widely based on the specific treatment, the stage of cancer, and individual factors. They may include:

• Pain management: Pain can be a common side effect of surgery, chemotherapy, and radiation therapy. Pain medication, both over-the-counter and prescription, can help manage pain effectively. Alternative therapies such as acupuncture, massage, and relaxation techniques may relieve pain.
• Nausea and vomiting: Chemotherapy can cause nausea and vomiting. Anti-nausea medications, lifestyle adjustments — such as eating small, frequent meals — and dietary changes may help manage these symptoms.
• Fatigue: Cancer treatment often leads to fatigue. Rest and sleep are important, and moderate exercise under medical guidance can help alleviate fatigue. Managing stress and anxiety can contribute to better energy levels.

Choosing the best treatment approach for breast cancer involves carefully considering various factors.

When making treatment decisions, people can consider the following:

• discussing treatment options and their potential outcomes with their healthcare team
• seeking a second opinion from another qualified oncologist to ensure they have explored different perspectives on the treatment plan
• clarifying treatment goals, whether they are focused on curing the cancer, managing symptoms, or prolonging life
• understanding the duration of each treatment option and how it fits into a person’s schedule and responsibilities

Questions to ask the doctor

Some questions people might want to ask their doctor include:

• What is the goal of each treatment option?
• What are the potential risks and side effects of each treatment?
• How likely are these side effects, and how can they be managed?
• What are the potential benefits of each treatment?
• What are the expected outcomes of each treatment option regarding survival and recurrence rates?

First-line treatment for breast cancer will depend on a variety of factors, such as the type and stage of breast cancer and a person’s overall health.

Choosing the best first-line treatment for breast cancer can be challenging. Knowing all of the options empowers people to work with their healthcare team to make the best decision for their situation.