Should I use chemotherapy for early-stage breast cancer?

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Early-stage breast cancer is usually treated with surgery to remove the breast (mastectomy) or surgery to remove just the cancer (breast-conserving surgery) followed by radiation therapy. Breast-conserving surgery is called local treatment, because both the surgery and radiation only treat cancer cells in the specific location.

Depending on information about your breast cancer, your health professional may talk to you about additional treatment after your surgery. Chemotherapy is often used to treat early-stage breast cancer. Some people think of additional treatment as an insurance policy designed to destroy any cancer cells that may still be in your body. But it is not possible to predict exactly which women will benefit from additional treatment. The potential benefits depend on each situation. Keep in mind that chemotherapy has both short- and long-term side effects. Different women will have different attitudes about each.

This is an overview of important issues to think about as you make decisions about early-stage breast cancer. The following facts related to your breast cancer may help guide your decision.

• How old are you? Women younger than 35 usually have a more aggressive type of breast cancer than women who are older. Younger women may benefit more from additional treatment.
• How big is your breast cancer? If your breast cancer is smaller than 1 cm (0.4 in.), your chances that the cancer will come back (recur) are less than if your cancer were larger. Additional treatment may not be needed.
• Has your breast cancer spread to the lymph nodes under your arm (axillary lymph nodes)? If breast cancer cells have spread to your lymph nodes, there is a greater risk that they may also have spread to other places in your body. Additional treatment may help destroy cancer cells in your body.
• What do your cancer cells look like under a microscope? This is called classification. It tells your doctor how rapidly the cancer cells are growing and dividing and where they may have started in the breast tissue. If your cancer cells are growing and dividing rapidly, you may benefit from chemotherapy.
• Do your breast cancer cells respond to hormones? If so, you may be better helped by hormone therapy than chemotherapy. Many breast cancer cells use the hormones estrogen and progesterone to grow and divide (estrogen receptor-positive and progesterone receptor-positive breast cancer, or ER/PR+). This type of breast cancer tends to grow more slowly and behave less aggressively than breast cancer that does not use hormones (estrogen receptor-negative and progesterone receptor-negative breast cancer, or ER/PR–). If your breast cancer is ER/PR+, you may be able to use hormone therapy, such as tamoxifen, or an aromatase inhibitor, which will reduce the chances that your cancer will come back. Depending on your other risk factors, your doctor may discuss chemotherapy followed by hormone therapy.
• Does your breast cancer contain human epidermal growth factor (HER-2)? This protein is partly responsible for how certain cancer cells grow, divide, and repair themselves. Some women have cells with more than the normal two copies of the gene (HER-2) that produces this protein. Breast cancer that produces this protein grows and spreads quickly, and more aggressive treatment may be needed. Your doctor may recommend surgery and chemotherapy, and then trastuzumab (Herceptin) if your breast cancer tests positive for HER-2.
• Some medical centers are beginning to use a "molecular profiling" test that looks for certain breast cancer genes. Experts don't yet know how well this genetic test can predict which women should have both chemotherapy and hormone therapy. A large study, the TAILORx Breast Cancer Trial, is under way in Canada and the United States to learn how well it works. Talk to your doctor if you think you might like to be in this trial.

What is breast cancer?

Breast cancer is a rapid, uncontrolled growth of abnormal cells in one or both breasts. It is the most common type of cancer in women, but it is highly curable when found early.¹

How is breast cancer treated?

Breast cancer is usually treated with a combination of surgery, medicines, and radiation therapy. Which combination of treatments you have depends on your unique situation. Because of improved screening methods, diagnosis at an early stage, and improved treatment techniques, the number of deaths from breast cancer has been steadily declining over the past few years. Decisions about how to treat breast cancer are based on information about the cancer, your preferences, your age, and your health.²

What will help me determine which type of treatment is appropriate for my breast cancer?

Breast cancer is classified according to what the breast cancer cells look like under a microscope. Tests for hormone receptors and other markers are also done to determine how your cancer will respond to hormone therapy and other treatments.

How far the cancer has spread within your breast and whether it has spread to nearby tissues or other organs is called the stage. Your doctor will determine the stage of your breast cancer by gathering information from other tests, such as lymph node biopsies, blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important factors in selecting the treatment option that is right for you.

What are the risks of chemotherapy?

Chemotherapy is medicine that travels through your bloodstream. It affects rapidly growing cells in your body, which include the cancer cells as well as blood cells, hair cells, and the cells that line your digestive tract.

Common short-term side effects include nausea and vomiting, hair thinning or hair loss, mouth sores, diarrhea, and an increased chance of bleeding and infection. Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women have a great deal of difficulty. If you have problems, your health professional can use other medicines to help relieve some of these side effects.³

You may feel very stressed while you are being treated for breast cancer. Chemotherapy can also cause memory loss and make it harder for you to concentrate. Support groups can help, but often women continue to feel frightened, even after their treatment is finished. You may find that staying active and involved helps you handle this stress.⁴

Long-term side effects of chemotherapy include menopausal symptoms, such as hot flashes and vaginal dryness, as well as infertility and thinning bones (osteoporosis). You may have trouble concentrating for many months after your treatments are finished. Rarely, chemotherapy can cause damage to the heart and can increase your risk of other types of cancers, such as leukemia.

For more information, see the topic Breast Cancer.

Your choices, after surgery for early-stage breast cancer, are to try one or more of the following. Sometimes a combination of choices is best.

• Watchful waiting (surveillance). This is not the same thing as doing nothing. You will have regular follow-up appointments with your health professional.
• Chemotherapy that kills cancer cells.
• Hormone therapy that blocks hormones from helping cancer cells grow, or stops the body from making those hormones.

The decision about whether to use chemotherapy takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Circle the answer that best applies to you.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using chemotherapy to treat early-stage breast cancer. Discuss the worksheet with your doctor.

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use chemotherapy.

Check the box below that represents your overall impression about your decision.

Return to the topic Breast Cancer.

Citations

1. Paley PJ (2001). Screening for the major malignancies affecting women: Current guidelines. American Journal of Obstetrics and Gynecology, 184(5): 1021–1030.

2. Willett WC, et al. (2004). Nongenetic factors in the causation of breast cancer. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 223–276. Philadelphia: Lippincott Williams and Wilkins.

3. Dow KH, Kalinowski BH (2004). Nursing care in patient management and quality of life. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 1387–1404. Philadelphia: Lippincott Williams and Wilkins.

4. Schagen SB, et al. (2002). Late effects of adjuvant chemotherapy on cognitive function: A follow-up study in breast cancer patients. Annals of Oncology, 13(9): 1387–1397.