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 common breast cancer treatment options you may want to discuss 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.

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

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 — Removal of one to three lymph nodes nearest the tumor for testing
• Axillary lymph node dissection — 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 surrounding it. Surgeons may also remove one or more lymph nodes near the tumor or in the armpit. Unlike mastectomy, lumpectomy removes only part of the breast.

Your doctor may recommend a lumpectomy if your tumor is relatively small in early-stage breast cancer. The procedure is 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). Several procedures are 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, you can discuss several options with your surgeon. For some people, reconstruction is done during or immediately after surgery to remove breast cancer. For others, reconstructive surgery is done well after breast cancer treatment has ended.

Risks of Breast Cancer Surgery

Like all breast cancer treatments, breast cancer surgery comes with risks, including complications such as:

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

After breast cancer surgery, some people develop lymphedema — 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 to prevent breast cancer recurrence or spread. This treatment may be used after surgery, especially lumpectomy. If surgery isn’t an option because breast cancer has spread too far, radiation therapy may 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 the whole breast, lymph nodes, or other specific 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.

Short-term and long-term side effects include swelling and changes to the skin or to the breast’s shape or texture. Radiation 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 classes of chemotherapy are often given in combination. For example, gemcitabine (Gemzar, Infugem) may be used with paclitaxel protein-bound (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 treatments based on the results of lab tests done on your biopsy. 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) — Targets 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 after they’ve been damaged by chemotherapy. Examples of PARP inhibitors approved to treat breast cancer include:

• Olaparib (Lynparza)
• Talazoparib (Talzenna)

Mammalian Target of Rapamycin Inhibitors

The mammalian target of rapamycin (mTOR) protein helps cancer cells grow and form new blood vessels to support that growth. Everolimus (Afinitor), an mTOR inhibitor, blocks this protein.

5. Immunotherapies for Breast Cancer

Immunotherapy is also targeted to breast cancer cells, but these drugs work by helping the immune system find and destroy breast cancer cells. Most immunotherapies need to be injected under the skin or given as an intravenous infusion. Several types 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, Keytruda Qlex) — 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 trastuzumab biosimilars (highly similar drugs) 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 — that work together to deliver the drug directly to the cancer cells. Antibody-drug conjugates approved to treat breast cancer include:

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

Scientists are 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, which the cells need 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 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 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. Elacestrant (Orserdu), fulvestrant (Faslodex), and imlunestrant (Inluriyo) 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 combined with other therapies such as tamoxifen.

One GnRH agonist, Zoladex, is a goserelin implant that’s given 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 experience symptoms of anxiety or depression, talk with your breast cancer care team or family physician. They can refer you to counselors and other mental healthcare resources that 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, people share their experiences with breast cancer, get advice, and find support from others who understand.

What treatments have you tried? Let others know in the comments below.