Breast Cancer

In addition to surgery, adjuvant therapy ( therapy given in addition to surgery to reduce the chances of the cancer recurring or spreading) may be used to kill any cancer cells that may have spread. In deciding whether adjuvant treatment is necessary, your doctor takes into account the extent (stage) of your disease, your general health and other prognostic factors. The choice of the type of adjuvant therapy that is given depends on many factors, such as whether the cancer cells contain hormone receptors (oestrogen and progesterone), the grade and size of tumour and lymph node involvement.

Most women receive some form of adjuvant therapy, and it usually begins 2-12 weeks after surgery. Two types of systemic adjuvant therapy are used for breast cancer, either alone or in combination:

Chemotherapy involves a combination of anti-cancer drugs, which are powerful and can have many side effects. Anti-cancer drugs are given by mouth or by injection into a blood vessel. Either way, the drugs enter the bloodstream and travel throughout the body. Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most patients receive treatment as an out-patient in hospital, and the therapy usually lasts for three-six months.

The second type of treatment involves hormone therapy, which deprives cancer cells of the female hormone oestrogen that the cancerous cells need to grow. For most women, hormone therapy is treatment with the drug tamoxifen. Some pre-menopausal patients may have surgery to remove their ovaries, which are a woman's main source of oestrogen, or they may be treated with a medication to reduce ovarian function.

Similar to anti-cancer drugs, tamoxifen enters the bloodstream and travels through the body. Recently, two studies confirmed benefits for breast cancer patients taking adjuvant tamoxifen for five years, but saw no added benefit and noted potentially negative effects for patients taking tamoxifen longer than five years.

Radiation therapy is another option, and it should be used as a local adjuvant treatment in patients having a lumpectomy. It is also occasionally used after a mastectomy. Such treatment can help destroy breast cancer cells that have spread to nearby parts of the body, such as the chest wall.