After you receive a breast cancer diagnosis, your oncologist (cancer specialist) will recommend a treatment plan tailored to your situation. Their advice will be based on the type and stage of your breast cancer, as well as other details about your diagnosis. They’ll also consider your overall health, age (including whether you’ve been through menopause), and any other medical conditions.

Your oncology team will help you understand the benefits and risks of different options, and you should share your treatment goals and preferences with them. Ultimately, the choice of your breast cancer treatment is a decision between you and your cancer care team. You can also get a second opinion from a different doctor or ask about joining a clinical trial, a research study that tests new treatments to explore more options.

Breast cancer treatments fall into six main categories: surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, and hormone therapy. Most breast cancer is managed with a combination of these treatment options.

Here are some of the main types of treatment options currently used for breast cancer that you can discuss further with your oncologist.

1. Surgery for Breast Cancer

For many people with breast cancer, surgery is the first step. Others may undergo chemotherapy or other therapies first to shrink the tumor before surgery. Treatment given before surgery is called neoadjuvant therapy.

Surgeries To Diagnose Breast Cancer

Some surgeries are done to help diagnose breast cancer by identifying its location, checking if it’s spreading, and collecting a biopsy (tissue sample) for analyzing the cancer cells. The results are described in your pathology report, which helps shape your treatment plan.

These surgeries involve examining lymph nodes, bean-shaped structures that are part of the body’s lymphatic system and play a role in the immune system. Two common types of diagnostic surgeries for lymph node evaluation in breast cancer are:

• Sentinel lymph node biopsy — The surgical removal of one to three lymph nodes nearest the tumor for testing
• Axillary lymph node dissection — The surgical removal of several lymph nodes, usually fewer than 20, from the underarm area

Surgeries To Remove Breast Cancer

A lumpectomy is known as a breast-conserving surgery, a wide local excision, or a partial mastectomy. This surgery removes a breast cancer tumor along with some of the normal breast tissue that surrounds it. Surgeons may also remove one or more lymph nodes near the tumor or in the armpit during a lumpectomy. Unlike mastectomy (total removal of breast tissue), lumpectomy removes only part of the breast.

For many people with breast cancer, surgery is the first treatment recommended by doctors.

Your doctor may recommend a lumpectomy if your tumor is relatively small in early-stage breast cancer. It’s typically followed by radiation therapy to lower the risk of breast cancer returning.

Mastectomy is surgery that removes all breast tissue. Mastectomies may be unilateral (removing one breast) or bilateral (removing both). There are several different procedures used for mastectomy, some of which spare the breast skin, nipple, or areola.

Reconstructive Surgery After Breast Cancer Treatment

After undergoing a mastectomy, some people choose breast reconstruction to restore the appearance and feel of their breasts. Others decide not to reconstruct. If you choose reconstruction, there are several reconstructive options to discuss with your surgeon. Sometimes, a person undergoes reconstructive surgery during or immediately after surgery to remove their breast cancer. Other times, it happens well after breast cancer treatment has ended.

Risks of Breast Cancer Surgery

Like all breast cancer treatments, breast cancer surgery comes with risks. Breast cancer surgery can have complications like:

• Excessive bleeding
• Infections
• Scarring
• Breathing or heart-related problems related to anesthesia

After breast cancer surgery, some people develop lymphedema, which is swelling due to the buildup of lymph fluid on the side that was treated.

2. Radiation Therapy for Breast Cancer

Radiation therapy (also known as radiotherapy) may be used as a treatment to prevent breast cancer recurrence or spread. It may be used after surgery, especially lumpectomy. If surgery isn’t an option because breast cancer has spread too far, radiation therapy may be used to help shrink tumor size or reduce bone pain.

There are two basic types of radiation therapy:

• External beam radiation — This is the most common type. Beams of energy — a special type of X-ray — are projected from a machine into your body, targeting specific areas such as the whole breast, lymph nodes, or other areas affected by cancer.
• Internal radiation — Known as brachytherapy, this involves placing small radioactive pellets through a catheter or device directly into the treatment area.

Radiation can cause short-term and long-term side effects including:

• Swelling
• Skin changes
• Changes to the shape or texture of the breast

It may also lead to lymphedema, weakened ribs, or damage to organs of the chest.

3. Chemotherapy for Breast Cancer

Chemotherapy is the treatment of cancer with medications. Chemotherapy agents may be given intravenously (through a vein) or orally, depending on the medication. People may receive chemotherapy before surgery, after surgery (referred to as adjuvant therapy or adjuvant chemotherapy), or when they have advanced breast cancer. The goal of chemotherapy is always to shrink tumors by killing cancer cells and preventing or slowing the spread of cancer.

Many different classes of chemotherapy are often given in combination. For example, gemcitabine (Gemzar, Infugem) is a type of chemotherapy that may be used with paclitaxel (Abraxane), another chemotherapy, as a first-line treatment for metastatic breast cancer (cancer that has spread). This is used for those who have not benefited from previous chemotherapy with an anthracycline, a type of drug that targets cancer cells by damaging their DNA.

Your doctor may need to make changes to your treatment plan, depending on how your breast cancer is responding. Chemotherapy is usually given in cycles with some treatment days and some recovery days in between treatments. Your chemotherapy schedule will depend on many factors. Chemotherapy can cause a wide array of side effects.

4. Targeted Therapy for Breast Cancer

Targeted therapies are designed to zero in on specific proteins or other targets on breast cancer cells. Your oncologist will recommend these therapies depending on the details found when your cancer cells from the biopsy were analyzed in the lab. For example, if your cancer cells test positive for biomarkers for certain proteins or genes, your tumors may respond well to targeted therapy.

Targeted therapies are designed to zero in on specific proteins or other targets on breast cancer cells.

There are several types of targeted therapies. All of them are designed to identify and damage cancer cells. Side effects depend on the type of targeted treatment.

Tyrosine Kinase Inhibitors

Tyrosine kinase is a protein found in some breast cancer cells that signals cancer cells to grow. Tyrosine kinase inhibitors (TKIs) block these signals. TKIs approved by the U.S. Food and Drug Administration (FDA) to treat breast cancer include:

• Lapatinib (Tykerb)
• Neratinib (Nerlynx)
• Tucatinib (Tukysa)

Cyclin-Dependent Kinase Inhibitors

Cyclin-dependent kinase (CDK) is another type of protein found on some breast cancer cells that encourages them to grow. CDK inhibitors may be recommended along with hormonal therapy. Drugs in this category approved to treat breast cancer include:

• Abemaciclib (Verzenio)
• Alpelisib (Piqray) — Used to target mutations (changes) in the PIK3CA gene
• Inavolisib (Itovebi) — Also targets PIK3CA mutations and is often used with palbociclib and fulvestrant
• Palbociclib (Ibrance)
• Ribociclib (Kisqali)

Poly (ADP-Ribose) Polymerase Inhibitors

Poly (ADP-ribose) polymerase (PARP) inhibitors prevent cancer cells from repairing themselves once damaged by chemotherapy. Examples of PARP inhibitors approved to treat breast cancer include:

• Olaparib (Lynparza)
• Talazoparib (Talzenna)

Mammalian Target of Rapamycin Inhibitors

Yet another kinase, mammalian target of rapamycin (mTOR) is a protein that promotes the growth of cancer cells and new blood vessels to feed them. Everolimus (Afinitor) is an mTOR inhibitor that blocks this protein.

5. Immunotherapies for Breast Cancer

Immunotherapy is also targeted to breast cancer cells, but immunotherapies work by helping your immune system find breast cancer cells and kill them. Several different types of immunotherapies have been developed for breast cancer. Most immunotherapies need to be injected under the skin or given as an intravenous infusion to work.

Several types of immunotherapies have been developed to fight breast cancer.

Monoclonal Antibodies

Also known as biologics, monoclonal antibodies are synthetic versions of immune proteins. They work by identifying breast cancer cells and encouraging the immune system to destroy them. Monoclonal antibodies approved to treat breast cancer include:

• Margetuximab-cmkb (Margenza) — This treatment may be used to treat advanced HER2-positive breast cancer.
• Pembrolizumab (Keytruda) — This is a checkpoint inhibitor, which works by unleashing the full power of the immune system. It’s used for triple-negative breast cancer, which lacks hormone receptors and human epidermal growth factor receptor 2 (HER2) targets.
• Pertuzumab (Perjeta) — This drug targets cells that contain HER2.
• Trastuzumab (Herceptin) — This drug is also given for HER2-positive breast cancer. Several biosimilars of trastuzumab — drugs that are highly similar to trastuzumab — are also available.

Some immunotherapies are combination drugs. For instance, Phesgo is a combination of trastuzumab, pertuzumab, and hyaluronidase used to treat HER2-positive breast cancer.

Antibody-Drug Conjugates

Antibody-drug conjugates have two parts: an antibody that identifies breast cancer cells and a chemotherapy drug designed to kill them. These two parts work together to deliver the drug directly to the cancer cells.

Antibody-drug conjugates approved to treat breast cancer include:

• Ado-trastuzumab emtansine (Kadcyla)
• Fam-trastuzumab-deruxtecan-nxki (Enhertu)
• Sacituzumab govitecan-hziy (Trodelvy)

Scientists are currently studying many more targeted therapies and immunotherapies in clinical trials for different types of breast cancer.

6. Hormone Therapy

About two-thirds of breast cancer tumors have receptors on the cells for hormones like estrogen or progesterone. These cells need these hormones to grow. Hormone therapy (also called endocrine therapy) is a category of breast cancer treatment that may help slow or stop the growth of hormone receptor-positive breast cancer. The American Cancer Society recommends taking hormone therapy for at least five years — perhaps longer if your breast cancer has a high risk of returning.

Hormone therapy may help slow or stop the growth of hormone receptor-positive breast cancer.

There are several different types of hormone therapy drugs.

Aromatase Inhibitors

Aromatase inhibitors work by blocking the enzyme that helps produce estrogen, lowering the body’s estrogen levels. Aromatase inhibitors include:

• Anastrozole (Arimidex)
• Exemestane (Aromasin)
• Letrozole (Femara)

Selective Estrogen Receptor Modulators

Tamoxifen (Soltamox) and toremifene (Fareston) are selective estrogen receptor modulators (SERMs). SERMs work by blocking estrogen from attaching to receptors on breast cancer cells.

Selective Estrogen Receptor Degraders

Selective estrogen receptor degraders (SERDs) tightly bind to estrogen receptors on breast cancer cells, causing the receptors to break down. Fulvestrant (Faslodex) and elacestrant (Orserdu) are SERDs used to treat breast cancer.

Gonadotropin-Releasing Hormone Agonists

GnRH agonists lower estrogen levels by temporarily suppressing ovarian function, creating a “chemical menopause” that can help slow the growth of hormone-sensitive breast cancer. These drugs are often used in combination with other therapies like tamoxifen.

One GnRH agonist, Zoladex, is a goserelin implant that’s administered subcutaneously (under the skin) every 28 days.

Managing Common Side Effects of Breast Cancer Treatment

Your quality of life matters. Be sure to follow up with your doctor and report any side effects of breast cancer treatment to your cancer care team. If they can’t recommend ways to help, they can refer you to a palliative care specialist. Palliative care (also called supportive care or symptom management) is available to people with any stage of cancer. The focus of palliative care is to relieve pain and other symptoms and help you feel your best as you fight cancer.

Taking Care of Your Mental Health

Your mental health is just as important as your physical health. Before, during, and after treatment, it’s important to reach out for support. If you notice symptoms of anxiety or depression, talk to your breast cancer care team or family physician. They can refer you to counselors and other mental health care resources who can help.

Don’t be afraid to ask for and accept support from friends, relatives, or your spiritual community. You can also get involved in support groups either in person or online, like MyBCTeam, where you can find others who know what it’s like to be in your shoes.

Find Your Team

On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 73,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

What treatments have you tried? Share your experience in the comments below, or start a conversation by posting on your Activities page.