Standard Treatments for Breast Cancer
An Non Exhaustive Intro…
The following information is an ever-evolving and non-exhaustive compilation of the treatments and therapies that are, generally speaking, what is applied as the standard of care in the United States to those diagnosed with the various types of Breast Cancer. Different cancer stages, sizes, and pathologies dictate different approaches and vary based on the genetics and needs of each individual. Use this page to familiarize yourself with the terminology and to learn more about the treatments that your doctor might suggest for your case. Additional reading is available at the in-text, underlined links. Use the table of contents to jump around the page.
*The information on this page is always in flux as standard of care changes and new developments occur
FAQs
Table of Contents (Under Construction)
Immunotherapy
Radiation
Chemotherapy
Genetic Testing
Molecular Testing
Liquid Biopsies
Maintenance Therapies
a. Hormone + Cancer
b. Her2 + Cancer
c. Triple +
d. Triple -
In Development/Research
Supportive Therapies
Ovarian Suppression
Physical Therapy
Meds to Slow Bone Loss
Vaginal Atrophy
*Bolded text highlights key concepts, and underlined text indicates links to further reading
Maintenance Therapies
Hormone+ Cancer
If you have been diagnosed with a hormone-driven breast cancer, you will likely be prescribed one of a number of oral (take at home) and/or injectable (by a nurse) medications. Which one will depend on the stage of your cancer, whether you are already in menopause, and your specific pathology. A few of the most common medications are Selective Estrogen Receptor Modulators (SERMs), which block estrogen receptors, such as the Gold Standard medication, Tamoxifen (used for both pre- and post-menopausal women) and Toremifene, a now rarely used SERM due to its complex drug interactions and cardiac risks (used for postmenopausal women only with ER+, metastatic disease/has strict usage parameters & dosing schedules), and both can pass the blood brain barrier. Aromatase Inhibitors (AIs), which reduce estrogen production in postmenopausal women (e.g., Anastrozole, Letrozole, Exemestane), and Selective Estrogen Receptor Degraders (SERDs). These bind to and destroy estrogen receptors (e.g., the injection; Fulvestrant, and oral versions used in breast cancers with ESR1 Mutations; Imlunestrant (Inluriyo) and elacestrant (Oserdu) (both can pass the blood-brain barrier). Common side effects of SERDs are joint and muscle pain, increased cholesterol and triglycerides, nausea, fatigue, and blood count changes like neutropenia (Low white blood cells) and anemia (Low red blood cells).
SERD’s in particular, but many of the aforementioned drugs are often combined with other drugs like cdk4/6 inhibitorsfor metastatic disease.
CDK4/6 inhibitors are a class of medicines used to treat certain types of (usually metastatic, hormone receptor-positive, HER2-negative) breast cancer that are prescribed along with SERDs, SERMs, tamoxifen, or AIs. These medicines interrupt the process through which hormone-driven breast cancer cells divide and multiply. To do this, they target specific proteins known as the cyclin-dependent kinases 4 and 6, abbreviated as CDK4/6. Currently, there are three types of CDK 4/6 inhibitors: Ibrance(chemical name: palbociclib), Kisquali (chemical name: ribociclib), and Verzenio(chemical name: abemaciclib). At present, Verzenio is the only one of these medications that can pass the blood-brain barrier. All three of these medications have a side effect profile that you can read about at the provided links, but more rare and more serious side effects to look out for are severe neutropenia (very low white blood cell count), severe lung inflammation, recurrent infections, blood clots, (all 3 CDK4/6 inhibitors) heart and liver problems (kisquali), and liver & kidney issues and severe diarrhea (verzinio).
HER2+ Cancer
For HER2+ breast cancer, maintenance therapy often involves continuing HER2-targeted drugs like trastuzumab (Herceptin), given via IV or injection, often for a year post-surgery (adjuvant) or for advanced cancer, sometimes combined with pertuzumab (Perjeta) and chemo; available as a combined subcutaneous injection (Phesgo). Margetuximab (Margenza) Is used for advanced cases, especially in metastatic settings, to prevent recurrence or progression after initial treatment; Using drugs like antibody-drug conjugates (e.g., Kadcyla, Enhertu) or tyrosine kinase inhibitors (e.g., Nerlynx, Tykerb) for later lines. In the case of triple-positive breast cancer, which is when, in addition to being HER2+, the cancer is also positive for estrogen and/or progesterone receptors, they can use any of these lines of treatment depending on the stage, along with endocrine therapy and potentially CDK 4/6 Inhibitors (like palbociclib).
Common Scenarios
Early-Stage (Adjuvant): Chemo + Trastuzumab (for ~1 year); potentially adding Pertuzumab for high-risk cases.
Metastatic (First-Line): Trastuzumab + Pertuzumab + Chemotherapy (e.g., docetaxel).
Metastatic (Later Lines/Progression): Switching to ADCs (Kadcyla, Enhertu) or TKIs (Lapatinib, Neratinib, Tucatinib).
Triple + Cancer
Triple-positive breast cancer is cancer whose growth is fueled by the hormones estrogen and progesterone AND the HER2 protein. This means it has receptors for estrogen and progesterone, making it estrogen and progesterone receptor positive (ER/PR+), AND it possesses high levels of HER2 proteins on the cell that act as receptors (HER2-positive). There are many medicines available to treat triple-positive breast cancer. If you’re one of the 10% of people diagnosed with this type of breast cancer, your doctor will likely recommend hormonal therapies, targeted therapies, and, if called for in your particular case, chemotherapy as part of your treatment plan. Review the sections on both HER2+ and Hormone+ cancer. As treatments for both are often combined and used in the treatments for Triple+.
Triple - Cancer
Maintenance therapy for Triple Negative Breast Cancer is personalized, moving beyond just chemo to include targeted immunotherapy and drugs for specific genetic markers, aiming to prevent or extend the time before cancer returns. Triple-Negative Breast Cancer (TNBC) maintenance therapies focus on preventing recurrence or progression, primarily using Immunotherapy like pembrolizumab (Keytruda) for PD-L1-positive tumors, PARP inhibitors (like olaparib /talazoparib) for BRCA mutations, and sometimes continued chemotherapy or novel antibody-drug conjugates, especially in advanced stages, after initial treatment (chemo/immuno/surgery). These strategies aim to keep the cancer at bay longer, with options tailored to tumor characteristics (PD-L1 status, BRCA mutation) and disease stage (early vs. metastatic).
Immunotherapy
Immunotherapy for breast cancer uses medicines, like checkpoint inhibitors (e.g., Pembrolizumab), to help your own immune system find and destroy cancer cells, working best in aggressive types like triple-negative breast cancer (TNBC) by unblocking immune cells to attack tumors. It involves different approaches, including monoclonal antibodies that block cancer's hiding proteins (PD-L1) and are given as infusions, potentially combined with chemo, but can cause fatigue, rashes, and inflammation.
What it is
Harnesses your immune system: Drugs help your body's own defenses recognize and attack cancer cells more effectively.
Checkpoint Inhibitors: Block proteins (like PD-1/PD-L1) that cancer uses to hide from T-cells, releasing the "brakes" on the immune response
Monoclonal Antibodies: Lab-made antibodies that can target cancer cells or immune checkpoints, sometimes considered targeted therapy too.
Who it's for
Triple-Negative Breast Cancer (TNBC): Has the highest success rates, especially for PD-L1 positive cases, often used with chemotherapy.
HER2-Positive: Some therapies like CAR T-cell trials are exploring targets like HER2.
Common Drugs & Types
Pembrolizumab (Keytruda®): Approved for advanced PD-L1-positive TNBC and early-stage high-risk TNBC.
Dostarlimab (Jemperli): Another FDA-approved immunotherapy for breast cancer.
Bavencio (avelumab), Imfinzi (durvalumab): Also being tested in TNBC.
Side Effects (Due to heightened immune response)
Fatigue, skin rashes, fever, chills, cough, nausea, diarrhea, appetite loss, headaches, and muscle/joint pain.
How it's given
Usually intravenous (IV) infusions, often in cycles (e.g., every 2-6 weeks), and can be given before or after surgery, sometimes with chemotherapy.
In Development/Research
New SERM’s currently In Development/Research are:
Idoxifene and Droloxifene (SERMs that were in development but haven't seen widespread clinical use like Tamoxifen).
Lasofoxifene is a third-generation Selective Estrogen Receptor Modulator (SERM) used in treating postmenopausal osteoporosis, improving vaginal dryness, and as a potential treatment for certain types of breast cancer. It works as an estrogen agonist in bone and vaginal tissue but an antagonist in breast tissue, effectively reducing bone loss and also lowering LDL cholesterol while inhibiting breast cancer growth, especially in resistant forms with ESR1 mutations. Developed by Pfizer and marketed as Fablyn in some regions, it's being studied for its ability to reduce fractures, breast cancer risk, and improve symptoms of vaginal atrophy, showing promising results in clinical trials. It is currently in ongoing clinical trials (like the ELAINE studies) for advanced breast cancer, demonstrating potential to overcome endocrine resistance.
Bazedoxifene is an oral SERM that can pass the blood- brain barrier. It is already in use in the US as Duavee, a prescription medication (for post-menopausal women who still have their uterus), used to treat menopausal symptoms. It combines estrogen and an estrogen antagonist to treat moderate-to-severe hot flashes and prevent osteoporosis, acting like estrogen in bones and the brain's temperature center while protecting the uterus from overgrowth, and is taken as one tablet daily. It currently provides an alternative for women who need estrogen therapy, but have uterine concerns, as bazedoxifene acts like a progestin in the uterus. Current research is looking at its use in invasive breast cancer prevention in those with Ductal Carcinoma in Situ (DCIS), as it offers a dual benefit: breast cancer risk reduction and relief from menopause symptoms, addressing key needs for at-risk women. There is no current projected date for its use as a cancer preventative agent.
andis being studi Arzoxifene. These are being studied for breast cancer prevention and treatment.New SERD’s currently In Development/Research are:
The oral SERDCamizestrant, used with ESR1 mutations in metastatic disease, is a potent, next-generation oral SERD and pure ERα antagonist, that can pass the blood brain barrier and has demonstrated anti-cancer activity across a range of preclinical models, including those with ER-activating mutations. The SERENA-1 Phase I trial demonstrated that camizestrant is well tolerated and has a promising anti-tumour profile when administered alone or in combination with palbociclib, a CDK4/6 inhibitor. It significantly improved progression free survival vs. Faslodex (Fulvestrant) in the Serena II trial in advanced ER+ breast cancer. In the SERENA-06 clinical trial, they studied the use of a biomarker test to look for signs of a cancer genetic change before typical tests (imaging studies) would show that the cancer was growing in people with hormone-receptor positive, HER2-negative advanced breast cancer. Researchers used circulating tumor DNA, or ctDNA, testing to find participants whose cancer had the ESR1 genetic mutation, which affects how estrogen-sensitive cancers grow. If they found an ESR1 mutation, people in the study were randomly assigned to stay on standard treatment or switch to the new drug, camizestrant. Switching to camizestrant kept the cancer from progressing longer than the typical treatment. The study, presented at the annual meeting of the American Society of Clinical Oncology (ASCO) on June 1 2025, and published concurrently in the New England Journal of Medicine, offers promising results for people with advanced breast cancer.6 Camizestrant is still investigational, but FDA approval is anticipated by January 2026.
Other SERD’sIn phase 3 clinical trials are the oral SERD/CERAN palazestrant (OP-1250), an investigational oral drug for ER+/HER2- breast cancer, acting as a complete estrogen receptor antagonist (CERAN) and selective estrogen degrader (SERD) that blocks cancer cell growth, even with resistance mutations like ESR1 mutations, showing promise in trials as a single agent and with CDK4/6 inhibitors, with ongoing Phase 3 studies. It's known for favorable tolerability, strong activity, and good pharmacokinetics, with common side effects including nausea and fatigue. It currently has fast track status with the FDA for advanced/metastatic ER+ breast cancer. Its expected to be available for commercial launch in 2027.
Giredestrant (GDC-9545) is an investigational oral, Selective Estrogen Receptor Degrader (SERD) showing promise as a new standard-of-care for early-stage, HR+/HER2- breast cancer, significantly reducing recurrence risk compared to existing therapies like tamoxifen or AIs in the Phase 3 lidERA trial. Developed by Genentech/Roche, it works by blocking and degrading estrogen receptors, offering a more convenient oral option than injectable SERDs, and while i has the same side effect profile, it had significantly less drop off due to side effects in trials compared to other estrogen therapies like tamoxifen or AIs.Potential as new Standard-of-Care: These early positive results position it as a potential new frontline treatment for HR+ breast cancer. It is also currently in multiple Phase 3 trials for different breast cancer stages (early, metastatic). Expected to become commercially available in 2026.
Vepdegestrant (ARV-471) is still awaiting licensing), and is another class of drug called a PROTAC (proteolysis-targeting chimera), developed by Arvinas and Pfizer. It is an oral medication not an injection, designed to degrade the estrogen receptor (ER) for treating ER-positive, HER2-negative breast cancer, especially with ESR1 mutations. It works by marking the estrogen receptor for destruction by the cell's own machinery, offering a new approach beyond traditional anti-estrogens, with clinical trials showing promising results. Key Findings & Side Effects (from trials):
Efficacy:
Showed improved progression-free survival (PFS) compared to fulvestrant in patients with ESR1 mutations.
Common Side Effects:
Fatigue, increased liver enzymes (ALT/AST), nausea, anemia, neutropenia, back pain, arthralgia, and decreased appetite.
Safety:
Generally favorable, with low rates of dose reduction or discontinuation due to side effects, similar to fulvestrant.
Status
It received Fast Track designation from the FDA, and a New Drug Application (NDA) is under review, with a decision expected by June 2026. *In September of 2025, both Arvinas and Pfizer stepped back from direct commercialization. They are now actively seeking a 3rd party to handle the drug’s launch and further development, which may impact the drug’s path to market.
Biopsies and Pathology
Once it is determined through imaging scans that cancer is present, needle biopsies are often performed to understand the cancer’s unique pathology. A needle biopsy uses a thin, hollow needle, guided by imaging like ultrasound, to collect small tissue or fluid samples from a suspicious area to check for cancer. There are Fine Needle Aspirations (FNAs) that use a very thin needle to collect cells or fluid, which is good for distinguishing cysts from solid masses, and Core Needle Biopsies (CNB) that use a larger, hollow needle to take several very small tissue samples; this is the standard for diagnosing breast cancer. A local anesthetic is used to numb the skin and breast tissue. You may feel pressure, but should not feel any pain. You’ll hear a clicking sound as samples are taken, and sometimes a small surgical clip or “marker” may be placed at the biopsy site for future reference. It's a common, minimally invasive way to diagnose breast cancer, often done with local anesthetic, causing minor discomfort but generally quick recovery with mild soreness managed by ice and over-the-counter pain relievers. There are also Surgical Biopsies (incisional/excisional), that are used in breast cancer diagnosis when needle biopsies yield unclear results, the suspicious area is hard to access or too large for a needle, or a more definitive diagnosis requires removing the entire lump or a larger tissue sample for detailed analysis. With all biopsies, the
tissue collected will be sent to a lab to be studied by a pathologist. They will determine a number of details about the cancer, e.g., the type of cancer, including what is driving it or the receptor status, the tumor grade, and how fast it’s growing (Ki-67), and a number of other details unique to each person's cancer. Pathology is usually performed again during surgery.
There is so much to say about pathology itself, I could dedicate an entire book to it. But there is a very detailed resource about it on the American Cancer Societies website. See and read more about pathology here…
Surgery
Depending on how extensive your cancer is, you may have one of the following procedures: a lumpectomy, a single or double mastectomy, a lymph node dissection, or removal of part or all of the axilla, and sometimes, removal of any affected skin or muscle, and/or tissue from the chest wall.
A lumpectomy is usually indicated when the cancer is determined to be small and localized in the area of its origin. In this case, the surgeon will remove a smaller portion of tissue, largely leaving the breast intact. How much tissue is actually removed will determine the level of deformity of the breast, if any, that might result. It is important to thoroughly discuss this method with your surgeon to glean ahead of time what the risks are, how your breast will look after surgery, whether it might need reconstruction, and if there will be any long-term deficit in sensation. Usually, with a lumpectomy, these side effects are minimal. When a lumpectomy is performed, depending on how much tissue was removed, the surgeon has many options to reconstruct it. This can involve removal of the cancerous tissue and the rearranging of the remaining breast tissue to recreate the look of a shapely breast, and if necessary a lift on one or both sides for symmetry, but also fat grafting, the use of flap procedures, or even implants can be used depending on what the patient wants and what the surgeon feels is called for in each patients unique situation.
A mastectomyis generally speaking, the removal of the entire breast, or as much of the breast tissue as needed or is possible. It can be performed on one or both breasts and is typically indicated when the cancer is larger in the breast, invasive, or when someone who is high-risk genetically, opts to do it to prevent breast cancer occurrence. There are total/simple mastectomies (removes the entire breast, nipple, areola, skin, fascia, and sometimes lymph nodes), Modified radical mastectomies (all the aforementioned plus most or all of the underarm lymph nodes), Skin sparing mastectomies (removes the internal breast tissue and all aforementioned tissues but leaves the skin itself intact). This can be done with or without a nipple-sparing procedure (preserves the nipple and areola). Then there is the radical mastectomy, which removes the entire breast and its tissue contents, chest muscles, and lymph nodes; this is more rarely used. As with the lumpectomy, surgeons have many options to reconstruct the breast if desired, though it requires different techniques that we discuss below under the heading “Reconstruction”.
Lymph Node Removal
During surgery, a sentinel node biopsy (Biopsy of the first lymph nodes in the breast) is performed. This is done to see if the cancer has spread to the lymph nodes. If it has, your surgeon will check the next lymph nodes in line to determine how extensive the cancer is in the axilla (armpit). If they find cancer in the sentinel node and subsequent nodes, and depending on the extent of the spread, they will commonly perform an axillary lymph node dissection.
An axillary lymph node dissection (ALND) is the surgical removal of part or all of the axilla (fat pad or fatty tissue in the armpit) that contains the axillary lymph nodes. Usually performed after the sentinel node biopsy has confirmed cancer in the 1st lymph node in the breast (the sentinel node). You have between 20 and 40 axillary lymph nodes, located in several groups within each of your armpits. When you have breast cancer, your armpit (axillary) lymph nodes are generally the first place that cancer spreads (metastasizes). ALND can remove lymph nodes located above, below, or directly underneath a muscle that runs along the side of the upper chest. This muscle is known as the pectoralis minor muscle. There are three levels of excision.
Level I — The Low Axilla; Nodes lateral to the pectoralis minor muscle, considered the lowest and least extensive. (removes all the tissue below the muscle)
Level II — The Mid Axilla; Nodes located under the pectoralis minor muscle, deeper than Level I (removes the tissue directly underneath the muscle)
Level III — The High Axilla; Nodes above or medial to the pectoralis minor muscle, near the collarbone, representing the deepest and most aggressive level to clear. It removes the tissue that is above the muscle (this is the most aggressive surgery).
What's typically removed: A traditional ALND usually includes removing nodes from Levels I and II, which contain the majority of the lymph nodes draining the breast. Removing any lymph nodes can predispose a patient to lymphedema, but removing Level III nodes is more complex and carries a higher risk of complications like lymphedema or infections, so it's often done only if cancer is suspected to have spread to these deeper nodes. If there is a possibility that you will have lymph nodes removed, ask your surgeon about Immediate Lymphatic Reconstruction (ILR) Proceduresto help prevent lymphedema.
With all methods of surgery, the excised tissue will be sent to the lab, and another pathology workup will be done. During this second lab visit, all the same procedures as before are checked, but in addition, they dissect the axilla to determine the extent of the lymph node involvement, assess the margin status, and if there was any lymphovascular invasion. They will often also do genetic and molecular workups of the cancer. Confirm the procedures and tests that you will have with your surgeon.
Lymphedema
Lymphedema or secondary lymphedema is a complication that can develop from breast cancer treatments like surgical excision of any lymph nodes and all or part of the axilla and radiation to the armpit. Signs of Lymphedema are swelling in the affected limb, feelings of heaviness, weakness, fullness, or tightness in the limb, restricted range of movement or stiffness in the limb at the joints, skin changes like thickening, hardening, itching, and burning, or recurrent infections in the area. Lymphedema is one of the most frustrating side effects of cancer treatment insofar as that once you have it, it’s a chronic condition that requires regular management and daily attention with wraps, compression garments, daily massage to drain fluid, and skin care. It is not curable. Though there are now some micro-surgical techniques that can help alleviate swelling, there is no technique that works 100% of the time in 100% of cases, and for best results, it is better to get treatment before swelling gets too bad. Many surgeons are now offering Immediate Lymphatic Reconstruction at the time of lymph node removal. Prioritize a discussion with your breast surgeon before your mastectomy or node removal to prepare for this in advance.
Recognizing lymphedema is harder in those who are overweight, and being overweight significantly increases the risk of developing it. Have a conversation about this complication with your oncologist and surgeon before your cancer treatment, and be on the lookout for this complication to address any signs of it as immediately as possible to avoid severe swelling or infections. We discuss lymphedema in more detail in the symptom management section of this site. But here is a quick overview of the surgical procedures available to help manage it…
There are two physiologic procedure once someone has lymphedema: a Lymphovenous Bypass (LVA)(connecting lymphatics to veins) andVascularized Lymph Node Transfer (VLNT) (moving healthy nodes from elsewhere in the body), to restore drainage, and there are two ablative or debulking procedures like liposuction or the more invasive tissue removal(e.g., Charles Procedure) to reduce excess fat and fibrous tissue, typically for severe cases, with lifelong compression usually required afterward.
Reconstructive Surgery
After having a lumpectomy or a mastectomy, there are many different types of interventions to reconstruct damaged or missing breasts. There are immediate vs delayed reconstruction options, which are dictated by a patient’s specific needs and desires, and nipple sparing options for those who are candidates. Reconstructive procedures are broadly categorized as implant-based or autologous (using a patient’s own tissue) reconstruction, and often a combination of both is used to create the best result. Implant-based reconstruction can include tissue expanders and/or either immediate or delayed implant placement in a reconstructed internal pocket created during a mastectomy, where as autologous procedures include fat transfers, and many different types of flap procedures. Fat transfers involve using liposuction to take fat from another part of the body and transfer it in the breast. The most common flap procedures are the abdominal flap procedures and are the DIEP flap, using skin and fat from the lower abdomen and the TRAM flap which uses a portion of the abdominal muscle, skin, and fat. The Latissimus Dorsi flap is also common, and uses skin and fat from the back. The less common flap procedures use tissue from the buttockse.g. the IGAP flap; lower buttocks and the SGAP flap; upper buttocks. There are also the Thigh flap procedures e.g. PAP; inner thigh and TUG; upper thigh). In the case where a patient can not preserve the nipple and/or areola, there are also reconstruction techniques to recreate the look of this tissue that can include but is not limited to tissue grafting and 3D tattooing.
Its also important to ask your surgeon about the loss of sensation in the breast after any breast surgery, but particularly after a mastectomy. Inquire if you are a candidate for an innovative procedure called “Resensation”, which can help restore lost feeling in the breast by preserving the nerve tissue during or after surgery. Surgeons use allografted (using donor nerve tissue) or autografted (using patients own nerve tissue) to do this. Neurotization using Nerve Conduits or Nerve Transfers are also an option in some cases. At the time of this writing these procedures are still novel and at best can restore only up to 82% of sensation, but usually significantly less. Early intervention here is key, and it’s important to understand that most likely these procedures can improve touch, temperature, and other sensations but are unlikely to restore full natural feeling. Either way, some feeling is usually better than no feeling. Especially with regard to arousal and intimacy mechanisms. But ask your surgeon.
Radiation
Radiation for breast cancer is a common treatment modality that targets the DNA of cancer cells, preventing them from multiplying and causing them to die. It may be used at any stage of treatment, depending on the patient's unique circumstances, in both early and late-stage breast cancers, to both destroy cancer cells and also to reduce symptoms and pain in advanced breast cancer.
There are two main radiation therapies for breast cancer, External Beam Radiation Therapy (EBRT) and Brachytherapy (internal radiation); both of these have several types, and which is appropriate for someone depends on many factors and is a conversation to be had between the patient and their surgical oncologist.
Common side effects can include skin changes like redness/blistering, skin darkening, swelling in the treated area, tenderness, and/or the area feeling hot and tight. Skin changes often heal within 6-12 months but can take longer. Fatigue is also common, and shrinkage, firming or tightening of tissue, permanent darkening, damage to nerves or the skin’s healing ability, and increased risk of lymphedema can linger and can require physical therapy. In rare cases damage to the ribs, lungs, or heart can occur. In very rare instances, a secondary cancer called an angiosarcoma can develop.
In all cases of radiation, it is critically important that the recipient stays OUT OF THE SUN during and after treatment until treatment is completely concluded, and uses appropriate creams, sunscreens, and moisturizers. Patients must keep the area clean and dry but moisturized daily during and for several months after treatment to ensure proper healing of the area and to minimize any permanent damage to both the epidermal and dermal skin and tissue. Radiated skin and tissue that is severely damaged can prevent reconstruction from being possible, so it is very important to take care of the affected area.
Read more about radiation here…
Chemotherapy
Chemotherapy is often used in combination with other treatments like surgery and radiation, and can be administered before (neoadjuvent) or after surgery (adjuvent), and for advanced stages of the disease. Neoadjuvent therapy is used to shrink tumors before surgery to make them easier to remove, whereas adjuvent treatment is primarily used to target any remaining cancer cells after surgery to reduce risk of recurrence.
The choice of drugs and treatment plan depends on various factors, including the cancer's stage, molecular characteristics, and overall health of the patient. The main types of chemotherapy for breast cancer are anthracyclines like doxorubicin (also called adriamycin or doxil) and epirubicin (ellence), taxanes such as paclitaxel (taxol), docetaxel (taxotere), and abraxane (nab-paclitaxel), anti-metabolite drugs such as 5-flourouracil (5-fu), alkylating agents like cyclophosphamide (cytoxan), and antibody-drug-conjugates (ADC’s) like sacituzumab govitecan (trodelvy). Which one or which combination you receive will be different depending on whether your cancer is hormone driven, HER+, triple-negative or gene driven.
Most of the side effects from taking chemotherapy are temporary and many of the effects that happen during treatment can be mediated by other medications, diet adjustments alternative and supportive therapies, extra rest, and physical therapy (PT), but some can linger for months or even years after treatment, and others can appear after treatment e.g., chronic inflammation and its issues like tendonitis or more of a tendency to get ovarian cysts, and because of the inflammation in the joints and tendons… ganglion cysts. There are still others that can be permanent, such as infertility.
Side effects generally include but are not limited to hair loss, fatigue, nausea, mouth sores, increased risk of infection, acid reflux, diarrhea, neuropathy, tendonitis, allergic reactions like swelling in the face, hands or feet, nails turning black and falling off or nail clubbing, skin changes, permanent infertility, vaginal dryness, sun sensitivity, mood changes, olfactory and taste changes, bone pain, dry eyes, and nose bleeds. Depending on the type of chemo used, there also exists an increased risk of Myelodysplastic Syndromes (MDS) and secondary cancers, particularly lymphoid and myeloid leukemias such as Acute Myelogenous leukemia (AML) and Acute lymphocytic leukemia (ALL), and even secondary breast cancers.
Genetic Testing
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Molecular Testing
Molecular tests (also known as gene expression profiling or genomic tests) are special tests that look at the activity of many different genes at once. Examples of these tests include:
Oncotype DX
Mamma Print
Prosigna
Breast Cancer Index
Germline Mutation Tests
Invitae Common Hereditary Cancers Panel: Analyzes 47 genes linked to multiple cancers, including breast, ovarian, uterine, and pancreatic, for pathogenic variants.
Invitae Hereditary Breast Cancer STAT Panel: A rapid test (average 7 days) for genes significantly increasing breast cancer risk, designed for patients with urgent treatment decisions.
BRCA1 and BRCA2 Panel: A focused test for mutations in these key genes, vital for hereditary breast and ovarian cancer syndromes (HBOC).
Hereditary Breast & Gyn Cancers Panel: A broader panel covering numerous genes beyond BRCA, including ATM, CHEK2, PALB2, and TP53, to assess risk for breast and gynecologic cancers.
These tests might be done in some situations to help predict the prognosis (outlook) for people with breast cancer or to determine if certain treatments are likely to be helpful, but not everyone needs these tests.
If one of these tests is done on your biopsy specimen, ask your doctor to explain what the results mean. The results will not affect your diagnosis, but they might affect your treatment options.
https://www.cancer.org/cancer/diagnosis-staging/tests/biopsy-and-cytology-tests/understanding-your-pathology-report/breast-pathology/breast-cancer-pathology.html
Liquid Biopsies; Circulating Tumor Dna Tests (ctDNA)
Signatera
The Signatera test is a personalized liquid biopsy blood test that detects molecular residual disease (MRD) by finding circulating tumor DNA (ctDNA), tiny DNA fragments from cancer cells, to monitor for recurrence or treatment response in solid tumors. It's a tumor-informed assay, meaning it's custom-built to a patient's specific tumor mutations, allowing for highly sensitive detection of microscopic cancer traces, often earlier than imaging.
Guardant360
The Signatera test is a personalized liquid biopsy blood test that detects molecular residual disease (MRD) by finding circulating tumor DNA (ctDNA), tiny DNA fragments from cancer cells, to monitor for recurrence or treatment response in solid tumors. It's a tumor-informed assay, meaning it's custom-built to a patient's specific tumor mutations, allowing for highly sensitive detection of microscopic cancer traces, often earlier than imaging.
FoundationOne Liquid CDx
FoundationOne Liquid CDx is widely used in breast cancer care, especially for advanced or metastatic HR+/HER2- breast cancer, as an FDA-approved companion diagnostic (CDx) test to identify patients who might benefit from specific targeted therapies like alpelisib (for PIK3CA mutations) and others, guiding personalized treatment decisions with a minimally invasive blood test.
Pathlight
Cellsearch CTC
Oncodetect
Supportive Therapies
Ovarian Suppression
In some cases, your doctor might recommend Ovarian Suppression/Ablations to stop the ovaries from producing estrogen (using surgery to remove the ovaries or LHRH agonists like Goserelin (zoladex), Leuprolide (lupron), Triptorelin (trelstar)). These medications are often paired with an AI or Tamoxifen.
Physical Therapy
Physical therapy for breast cancer patients focuses on restoring movement, strength, and function through gentle stretching, massage (manual therapy), posture training, and targeted strengthening exercises, alongside specialized lymphedema management (like Manual Lymphatic Drainage and compression) and energy conservation education to combat fatigue and side effects from surgery, radiation, or chemotherapy.
Key Types of Physical Therapy Interventions:
Manual Therapy: Gentle massage and joint mobilization to reduce stiffness, break down scar tissue, improve circulation, and restore shoulder/upper body mobility.
Stretching & Flexibility: Essential for regaining range of motion in the shoulder, arm, and chest, preventing tightness and "frozen shoulder".
Strengthening: Resistance exercises (using bands, weights) to rebuild muscle strength lost from inactivity or treatment.
Postural Training: Correcting poor posture that develops from protecting the surgical area, reducing neck and back pain.
Breathing Exercises: Deep breathing to maintain chest wall mobility and lung function.
Aerobic Conditioning: Activities like walking or swimming to boost energy, reduce fatigue, and improve heart health.
Lymphedema Management: Techniques such as Manual Lymphatic Drainage (MLD), compression bandaging, and specific exercises to manage swelling in the arm or chest.
Vaginal and Pelvic Floor PT: Common Pelvic physical therapy for breast cancer patients includes pelvic floor muscle training (Kegels, relaxation), manual therapy (reducing scar tissue), vaginal dilator therapy for tightness/pain, biofeedback, electrical stimulation, and education on lubricants/moisturizers to manage side effects like dryness, pain, and sexual dysfunction from treatment. Therapists focus on improving tissue health, blood flow, and the brain-body connection for overall pelvic and sexual wellness.
Education: Guidance on energy conservation, proper movement, and home exercise programs.
Why It's Used:
Physical therapy addresses common issues like limited mobility, pain, muscle weakness, fatigue, and swelling (lymphedema) resulting from breast cancer treatments, helping patients regain independence and improve their quality of life. Treatment starts early to prevent complications and is customized to the individual's recovery stage.
Medications to help slow bone loss or metastasis to the bone.
Why it's Needed…
Aromatase Inhibitors (like anastrozole, letrozole, and exemestane) lower estrogen, which can significantly accelerate bone loss and increase fracture risk in breast cancer survivors. The primary injection given to women at risk for osteoporosis due to breast cancer treatment (especially those using Aromatase Inhibitors) is denosumab (brand names Prolia or Xgeva). It is a monoclonal antibody that prevents bone breakdown by targeting RANKL and is administered as a subcutaneous shot every 4-6 months to maintain bone density and reduce fracture risk in women who are in treatment for hormone-driven breast cancer. Other Treatments like Bisphosphonates, (zoledronic Acid; IV infusion) and Raloxifene (an oral medication for osteoporosis prevention in only postmenopausal women after breast cancer treatment) can also be used to protect bones in these situations. It’s essential to consult your doctor about a serious complication that can develop from denosumab, known as osteonecrosis of the jaw (ONJ). This is when part of the jawbone dies. Low blood calcium and phosphate can also occur (In RANK Ligand Inhibitors), as can kidney problems (Bisphosphonates), or stroke, deep vein thrombosis, and pulmonary embolism (Raloxifene).
Vaginal Atrophy
Ospemifene (also called Senshio or Osphena) is FDA-approved for Genitourinary Syndrome of Menopause (GSM) in postmenopausal women with a history of breast cancer after all treatment concludes, but its use, especially in hormone-positive cases, requires careful consideration due to its selective estrogen receptor modulator (SERM) action. It is not for women with known/active or metastatic disease, those suspected to have a high risk for breast cancer, or during other treatments. For those with ER+ breast cancer, it's generally considered only after you've finished all other therapies (chemo, tamoxifen, aromatase inhibitors), iAFTER treatment concludes, n those who are deemed to be in remission, and its use should always be under strict medical guidance as its long term effects for patients with ER+ cancers are still being studied.