Early Stage Breast Cancer -- An Introduction

Last Updated: May 15, 2019

Dr. Erica Mayer discusses what is important for patients to know about early stage breast cancer following a diagnosis. Beginning with types of breast cancer, Dr. Mayer guides patients through understanding their treatment plan and health care team, recent advancements in research and treatments, and questions to ask.

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Cancer.Net®: Doctor-Approved Patient Information from ASCO®

Early Stage Breast Cancer: An Introduction

Erica L. Mayer, MD, MPH, Member, American Society of Clinical Oncology: Breast cancer is a cancer that originates in the breast. What's important to know about breast cancer is that even though all breast cancer comes out of one part of the body, it's actually three different diseases. The three main categories are defined by the receptors on the outside of the cancer cells.

Types of Early Stage Breast Cancer

Dr. Mayer: One of the most important things to know is what kind of breast cancer is it. The entire treatment plan depends on which category of breast cancer someone's diagnosed with. So sitting down with one of the doctors and going through the pathology report to really understand what is the diagnosis and what type of breast cancer is it.

The largest category of breast cancer is hormone receptor positive breast cancer. That means breast cancer that has estrogen and/or progesterone receptors on the outside.

The second most common type has a different kind of receptor called HER2. The third type of breast cancer, which is the smallest category, lacks the receptors for estrogen and progesterone and lacks the HER2 receptor. Therefore, it has none of those three receptors. We call it triple negative breast cancer.

The Treatment Team

Dr. Mayer: There usually are at least three doctors who are on the breast cancer treatment team. This includes a surgeon who does breast surgery, a radiation oncologist who may or may not be necessary on the team, and then a medical oncologist who provides what's called systemic therapy, so therapy that goes throughout the body. It's very important for someone newly diagnosed with breast cancer to have a treatment team that she or he feels comfortable with and who communicate well together and can work as a team to make the best treatment plan.

Making a Treatment Plan

Dr. Mayer: There are many factors that the treatment team needs to consider. The three main categories that I think about include the anatomy of the cancer. This is the stage of breast cancer. How large is the cancer? And is there any evidence the cancer could have gotten into the lymph nodes under the arm, what we consider the regional lymph nodes. The next category is the biology of the cancer, like the personality. This has to do with those categories of breast cancer, hormone receptor positive, HER2 positive, or triple negative and some other features about the growth pattern of the cancer.

And then the third category is who is the person with the breast cancer diagnosis. What is their health like? Are there other important health issues that the treatment team needs to consider? And also, what are someone's preferences? What do they want to do in terms of their treatment decisions? All of those features come together to make a treatment plan.

Treatment Options

Dr. Mayer:  So for someone who is newly diagnosed with early stage breast cancer, meaning cancer limited to the breast and/or regional lymph nodes, there are typically two main parts of treatment, what we call local therapy and systemic therapy. Local therapy means treatments that are focused and directed on specific parts of the body such as on the breast and lymph nodes. And this includes surgery and can also include radiation treatments.

In a woman who has had a lumpectomy, meaning that the breast is preserved, often radiation treatment is included in the program as well. If someone's had a mastectomy, most of the time radiation is not necessary, but occasionally it will be recommended as well. Systemic therapy means whole body treatment, so something that someone will take by mouth or vein that travels everywhere in the body, not just breast and lymph node areas. And this is the type of treatment that a medical oncologist provides.

There are three main categories of systemic treatment that a medical oncologist can select from. We have what's called hormone therapies, also known as endocrine therapies. And these are the medicines that block the body's hormones from stimulating cancer cells. This includes pill medicines such as tamoxifen or the aromatase inhibitors. The second category is the chemotherapy category. Most of the time that's intravenous treatment. And then the third category, what we sometimes think of as the most exciting category in breast cancer, is what we call targeted or biologic therapy.

That means treatments that are very specific for cancers and very precise for cancers but are not chemotherapy treatments and are really designed to go after the cancer but not harm or touch any other tissues in the body.

When a person who's newly diagnosed with breast cancer sits down with their medical oncologist, they can review each of these categories and see which medicines, if any, from any of these categories would be appropriate to treat the cancer.

Recent Progress in Breast Cancer Treatment

Dr. Mayer: There's kind of two large arenas of progress that we've seen over the past several years for breast cancer. The first one has to do with how much treatment is appropriate for someone with a breast cancer diagnosis. If we look at the history of how we've developed our successful breast cancer treatments, it's usually by adding more and more treatments to the program. More surgery. More radiation. More chemotherapy.

The newest trend, though, is realizing that not every person needs the same treatment. Treatment should not be homogenous. Instead, it should be highly personalized to a person and to his or her situation. And so the newest research is actually looking at ways to pull back and to give exactly what's needed to best treat the cancer but not expose somebody to a treatment that's unnecessary or unhelpful. So we actually now see situations where we're able to pull back and not have to offer chemotherapy in the ways we might have in the past or not have to do excessive surgery if that's not necessary for the treatment program.

The other main area where we've seen great progress is in this category of targeted therapies. There's a wealth of targeted therapies that have been evaluated in clinical trials, and every year we are seeing these medicines emerge out of trials, become FDA approved, and become part of our standard treatment program.

Where to Get More Information

Dr. Mayer: Cancer.net is a wonderful website that provides terrific information, easy to understand information about all kinds of cancer, especially breast cancer. And there are links on that website that can take you to other places that also have high quality information.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical OncologyConquerCancerFoundation.org.

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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