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Local treatments are used to remove or destroy the cancer cells in a specific area. Surgery and Radiation therapy are examples of local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormonal therapy examples of systemic treatments. The right treatment method, however, depends on the size and location of the breast tumor; the results of the pathologist’ s review of the tumor specimen, the woman's age, menopausal status, and general health; and the stage of the disease.

Surgery is the most common treatment for breast cancer. There are two types: breast-sparing surgery and mastectomy.

Breast-sparing surgery, also known as lumpectomy or partial mastectomy, removes the cancerous lump but not the entire breast. This is generally accompanied by a sampling of the under arm lymph nodes to see if the cancer has spread to this area. This sampling can either by achieved by removing all of the lymph nodes (known as full lymph node dissection) or a new procedure known as a sentinel node dissection. In this procedure, the surgeon injects a radioactive dye and/or a blue dye in the area around the tumor or around the nipple. The surgeon then finds the lymph nodes to which this dye travels and removes only those nodes. If there is cancer in one of these nodes with dye in it, then the rest of the nodes are removed. Otherwise, the nodes are left in place, which lowers the likelihood of developing complications such as arm swelling or pain after surgery. Studies have shown that women who have breast-sparing surgery require radiation therapy after surgery in order to reduce the risk that the cancer will come back in the breast.

The other type of surgery that is commonly performed in breast cancer is called a mastectomy. In this procedure, the entire breast is removed. This is usually done if the tumor is too large to remove without removing the entire breast, if the cancer is present in the skin of the breast (inflammatory breast cancer), or if the patient prefers this type of surgery. Again, the lymph nodes are sampled at the time of the mastectomy. Either a full axillary dissection may be performed or a sentinel lymph node dissection.

Radiation therapy (also called x-ray therapy, radiotherapy, or irradiation) uses high-energy rays to damage cancer cells and stop them from growing. Radiation is used after breast-conserving surgery to reduce the risk of the cancer returning in the breast. It may also be used after mastectomy if the cancer had spread to the lymph nodes. Radiation may come from an outside source or from radioactive materials placed directly in the breast. The patient receives external radiation treatments as an outpatient, usually five days a week for five or six weeks. At the end of that time, an extra "boost" of radiation is usually given to the treatment site. The boost may be either external (using electron beam therapy) or internal (using an implant). A short hospital stay may be required for implant radiation.

Local treatments remove cancerous cells from the breast and under arm lymph nodes. However, cancerous cells may have left the breast before the surgery and be present in other parts of the body. These cells can grow into a tumor in one of these other body locations months to years later in what is called a breast cancer recurrence. Unfortunately, if this occurs, the cancer is said to be “metastatic” and although it is treatable, it is no longer curable. In order to reduce the chance of this happening, systemic or whole body treatments are often used after surgery to try to kill any cancer cells that may have escaped from the breast prior to surgery. There are two primary kinds of adjuvant systemic treatments:

Chemotherapy drugs are medications that kill rapidly growing cells such as cancer cells. These drugs can be given either by mouth or intravenously. Chemotherapy medications are very powerful and can have many side effects. In general, chemotherapy is used for large tumors or for cancers that have spread to the under arm lymph nodes. Some types of cancer are also not sensitive to hormonal therapy and chemotherapy is usually used in these situations. Finally, younger women appear to benefit more from chemotherapy than older women. It is important to speak to a medical oncologist to find out if chemotherapy is recommended.

There are many different types of chemotherapy drugs used in the treatment of breast cancer. The most commonly used drugs are adriamycin, cytoxan and paclitaxel (Taxol), or docetaxel (Taxotere). Chemotherapy is usually given in “cycles”. One cycle of chemotherapy usually involves going to the oncologist’s office and receiving intravenous chemotherapy once every two to three weeks. This is usually repeated four to eight times, depending on the size of the tumor and lymph node status.

In recent years, new types of chemotherapy drugs have been developed that are targeted to special types of breast cancer. The most important of these so far is known as trastuzumab or Herceptin. This medication was developed specifically to treat cancers that have too much of a growth protein known as HER-2/neu. About 20 - 30 percent of breast cancers fall into this category, and treatment with this new medication has been shown to greatly reduce the risk of dying from this type of breast cancer. Many new medications are under development for other types of breast cancer.

Hormone therapy is used to prevent cancer cells from getting the hormones they need to grow. Hormonal therapy is only useful in treating tumors that have either estrogen receptors or progesterone receptors. These types of cancer are said to be hormone receptor positive or hormone responsive.

In post-menopausal women, the ovaries are no longer producing female hormones. However, these women still do have estrogen in their bodies. It comes from the adrenal glands, which are small glands that sit above the kidneys. The adrenals make male hormones that are transformed into female hormones in fat cells. This is one of the reasons that women with more fatty tissue have higher estrogen levels.

In women who have gone through menopause, there are two types of medicine which can prevent estrogen from getting to any cancer cells that may have escaped the breast before surgery. The medication tamoxifen is an estrogen receptor blocker, meaning that it prevents estrogen in the body from getting to the cancer cells. The other type of medications are called aromatase inhibitors (including Arimidex, Femara, and Aromasin). These medications stop the transformation of male hormones into female hormones. Both of these types of medications work well to prevent breast cancer from returning.

In pre-menopausal women, most of the estrogen in the body comes from the ovaries. The most common type of hormonal therapy in this group is tamoxifen, since this works to block estrogen no matter where it comes from. At times, the ovaries might also be removed to decrease the amount of estrogen in the body. However, given the increased side effects from this type of procedure, this is usually not recommended outside of a clinical trial.

Choice of treatment is often a complicated issue and must be individualized for each patient, with the consultation of a medication oncologist, a radiation oncologist and a surgeon.