Breast Cancer Treatment Options

How is my treatment plan decided?

A multidisciplinary team (MDT) brings together specialists such as a surgeon, oncologist, radiologist, pathologist and breast care nurse. They review the stage, grade, hormone receptors and HER2 results, alongside your health. The team recommends options; you should have a chance to discuss benefits, side effects and alternatives before agreeing to treatment.

Ask for a copy of your treatment plan and a named contact. Request an interpreter, accessible information or another conversation if you need one. Your preferences, other illnesses, caring responsibilities and future family plans matter.

Will I have surgery or medicines first?

For many people with primary breast cancer, surgery is a main part of treatment. Breast-conserving surgery removes the cancer with surrounding tissue; a mastectomy removes the breast. Lymph nodes may also be checked or removed. Reconstruction can sometimes be done at the same operation or later; choosing no reconstruction is also an option.

Some people have medicines before surgery to shrink the cancer. This is called neoadjuvant treatment. Treatment after surgery is called adjuvant treatment and aims to reduce the chance of cancer returning. A different order does not by itself mean that your care is less effective.

When is radiotherapy used?

Radiotherapy is usually offered after breast-conserving surgery. After a mastectomy, it is offered in certain circumstances, such as a higher risk of cancer remaining or returning. Some people at very low risk may discuss leaving out radiotherapy after breast-conserving surgery. Your team should explain your own balance of benefit and harm.

Many suitable patients now have five radiotherapy sessions over one week. Other schedules are needed in some circumstances, including when particular lymph-node areas are treated. Ask which areas will be treated, how many visits you need and why that schedule is recommended.

Will I need chemotherapy?

Chemotherapy uses medicines that kill cancer cells. It may be given before or after surgery, or to control secondary breast cancer. Not everyone benefits enough to need it. In selected early breast cancers, a tumour gene-expression test can help inform the discussion about chemotherapy benefit.

What are hormone therapy and ovarian suppression?

Hormone (endocrine) therapy can help when the cancer is sensitive to hormones. Examples include tamoxifen and aromatase inhibitors such as letrozole. The choice depends partly on whether the ovaries are still producing oestrogen. Aromatase inhibitors may be used before menopause when combined with treatment that suppresses ovarian function; they are not used alone while the ovaries remain active.

Hormone therapy after primary breast cancer commonly continues for several years. Ask about bone health, menopause symptoms and support for side effects. Contact your team before changing or stopping a prescribed medicine.

What about targeted therapy or immunotherapy?

Targeted medicines act on particular features of the cancer. Immunotherapy helps the immune system act against cancer. Both are used only in suitable situations, based on test results, previous treatment and other factors. A medicine mentioned online is not necessarily suitable or available for your diagnosis. Ask which tests guide the recommendation and which current NHS access criteria apply where you live.

How is treatment different for secondary breast cancer?

For cancer that has spread to distant parts of the body, treatment usually aims to control the cancer, relieve symptoms and help you live longer and as well as possible. The plan may change over time. Supportive and palliative care can help alongside cancer treatment, including with pain and emotional concerns.

What should I discuss before treatment starts?

• Ask about fertility preservation before treatment if having children in the future might matter to you, even if you are unsure.
• Bring a list of medicines, vitamins and supplements, and discuss contraception or any possibility of pregnancy.
• Ask for the 24-hour treatment advice number and written instructions about urgent side effects.
• Ask what follow-up will involve and whom to contact about a new symptom between appointments.