Treating Early Breast Cancer

Treatment of early stage HR+/HER2- breast cancer generally involves surgery and endocrine therapy, which can last 5-10 years. Several factors, such as tumor size, genes, and age will determine treatment options. Learning more about early stage breast cancer can help you make informed decisions about care.

Breast cancer treatment is a different experience for each person. The stage of your cancer, the size of your tumor, the presence of certain genes and proteins, your age, and more are several factors your doctor will consider when determining the best treatment options. 

For example, a large subset of U.S. women with breast cancer will be diagnosed with hormone receptor-positive/human growth factor receptor2-negative (HR+/HER2-) early breast cancer. This article explains how treatment for this type of breast cancer will typically occur. 

Early stage breast cancer means the cancer has not spread beyond your breast or nearby lymph nodes. Surgery is often the first form of treatment. This can be done using breast-conserving surgery to remove the tumor, sometimes referred to as a lumpectomy, or as a mastectomy, removing the entire breast.

Lymph nodes in your armpit on that side may also be biopsied or removed at the same time. 

If you have breast-conserving surgery, you’ll likely be treated with radiation therapy afterward to destroy any remaining cancer cells and prevent it from returning. 

In some cases, if your tumor was large or if cancer is found in a few lymph nodes, radiation may be recommended after a mastectomy. 

Estrogen and progesterone are two hormones produced by your body. If testing of your cancer cells indicates you have HR+ breast cancer, these hormones can fuel your cancer to grow and spread. 

After surgery, you’ll be treated with endocrine therapy to lower the amount of estrogen in your body or block it from having an effect on your cancer cells. This is called “adjuvant therapy” and it lowers the risk of breast cancer returning or spreading.

There are a few types of endocrine therapy for early stage breast cancer:

• Ovarian suppression: Before menopause, your ovaries are your primary source of estrogen. An ovarian ablation, which is surgery to remove your ovaries, or medications to stop your ovaries from functioning can lower your estrogen levels. 
• Tamoxifen: This daily pill can be taken whether you’re pre-menopausal or post-menopausal. It blocks estrogen from attaching to hormone receptors on your breast cancer cells, stopping them from growing. 
• Aromatase inhibitors: These medications, including anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin), decrease the production of estrogen. They may be prescribed to post-menopausal women or pre-menopausal women who’ve had their ovaries suppressed. 

Endocrine therapy is given for 5-10 years. The choice of endocrine therapy and duration of treatment will depend on whether you’ve gone through menopause and the risk of breast cancer recurring. Some treatment plans may have you switch between tamoxifen and an aromatase inhibitor after a few years.

Even among individuals who have this same type of early stage breast cancer, there may be additional differences in treatment. 

Some women would prefer breast-conserving surgery over a mastectomy, but either the size or location of the tumor makes this difficult. Neoadjuvant treatment, meaning treatment with chemotherapy or endocrine therapy before surgery, may be used to shrink the tumor first, making it easier to remove. 

The goal of early breast cancer treatment is to produce the best outcomes with the fewest negative effects. Researchers are learning to identify who may be at high risk of breast cancer returning and may benefit from additional treatment. These may include:

• Chemotherapy: Genetic tests of your cancer cells can help determine whether you’d benefit from chemotherapy in addition to endocrine therapy.  
• Bisphosphonates: These medications may lower the risk of breast cancer spreading to the bone in postmenopausal women. 
• Abemaciclib (Verzenio): If testing indicates you’re at high risk and your breast cancer has spread to your lymph nodes, you may be a candidate for this medication. 
• Olaparib (Lynparza): If your breast cancer has the BRCA gene mutation, this treatment may increase your cancer-free time. 

The bottom line? If you’re being treated for hormone-sensitive breast cancer, talk with your doctor about options. The more you learn and understand about your cancer, the better you can make informed decisions about your care and treatment.