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Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Have chemotherapy after your surgery for early-stage breast cancer.
Don't have chemotherapy.

This information is for those who are deciding about chemotherapy for early-stage breast cancer. It is not about surgery or hormone therapy.

Key points to remember

Chemotherapy ("chemo") is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
Some types of cancer have a very small chance of coming back. Women who have those types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren't.
The drugs used for chemo can be very expensive. Insurance policies don't always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.

FAQs

What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.

When is chemotherapy used to treat early-stage breast cancer?

The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy ("chemo") and hormone therapy, that may help keep cancer from coming back.

It isn't possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive (ER+) breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.

The type of added treatment you have depends on the stage and classification of your breast cancer:

Stage: How far the cancer has spread in your breast and whether it has spread to nearby tissues or other organs is called the stage. This is one of the most important things in choosing the treatment option that is right for you. 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. Added treatment, including chemo, may help destroy cancer cells in your body.
Classification: Breast cancer is classified according to what the cancer cells look like under a microscope. This tells your doctor how fast 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 quickly, then chemo may help you. When cancer is the kind that grows quickly, doctors call it "aggressive" or "poorly differentiated." Breast cancers are also classified by types, such as hormone-receptor-positive or triple-negative.

What are the risks of chemotherapy?

Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.

Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.

Short-term side effects can include:

Nausea and vomiting.
Loss of appetite.
Fatigue.
Hair thinning or hair loss.
Mouth sores.
Diarrhea.
Increased chance of bruising, bleeding, and infection.
Memory and concentration problems.

Long-term side effects of chemotherapy can include:

Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones (osteoporosis).
Concentration problems that may last for many months after your treatments are finished.
In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.

Why might your doctor recommend chemotherapy?

Your doctor might recommend chemotherapy ("chemo") after surgery if:

You are younger than 35. Women younger than 35 usually have a more aggressive type of breast cancer.
Your breast cancer was bigger than a pea. Breast cancers that are at least 1 cm (0.4 in.) are more likely to come back later.
Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the cancer may also have spread to other places in your body.
Your breast cancer is HER-2 positive or triple-negative. These types of cancer tend to grow faster and spread more quickly.

Your doctor may use a genetic test to find your risk for having your cancer come back. This information can help you and your doctor decide about chemotherapy.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have chemotherapy after surgery Have chemotherapy after surgery

Most chemotherapy (chemo) medicines are injected into a vein in your hand or arm. This is called an IV. Sometimes the medicine is a pill that you take at home. Sometimes it's a combination of the two.
You will go to a hospital or clinic for each IV treatment, but you won't stay overnight. Treatments last from 10 minutes to an hour or longer.
You have a number of treatments several weeks apart. A complete course of chemotherapy may take a few months or a whole year.
Some women need to have a special catheter inserted if it's hard to find a vein for the IV. This catheter stays in place between treatments.

Chemo may help keep breast cancer from coming back.

Breast cancer may come back anyway.
Short-term side effects may include such things as nausea and vomiting, fatigue, hair loss, and mouth sores.
Long-term side effects may include early menopause.

Don't have chemotherapy Don't have chemotherapy

You will have regular checkups with your doctor to make sure that the cancer hasn't come back.

You avoid the side effects of chemo.

Depending on what type of breast cancer you have and how far it has spread, there may be a higher chance of your cancer coming back.

Personal stories about choosing chemotherapy for breast cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I found out about the breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that the cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help.

Brenda, age 57

I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Because of my age and the type of breast cancer I had, my doctor did some tests. It turned out that I was at a higher risk for having the cancer come back. So, I had chemo. I'm doing fine so far. And I think this was the right decision for me.

Janice, age 40

I was diagnosed with breast cancer just last year. The breast cancer was small, and I didn't have any cancer in the lymph nodes. But my doctor did a gene test and said my risk was high enough that I needed to decide whether I wanted to have chemo. I decided to go ahead and have it. And even though that was harder than I thought, I'm still glad I made that choice. It was the right one for me.

Paula, age 61

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat the breast cancer.

I would rather wait and see if the cancer comes back before I have more treatment.

More important

Equally important

More important

I would have strong feelings of failure if the breast cancer returned.

I know there's no way to know for sure whether chemo would keep the cancer from coming back.

More important

Equally important

More important

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without the added treatment.

More important

Equally important

More important

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having chemo

NOT having chemo

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Wendy Y. Chen MD, MPH - Medical Oncology, Hematology
Primary Medical Reviewer	Heather Quinn MD - Family Medicine

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have chemotherapy after your surgery for early-stage breast cancer.
Don't have chemotherapy.

This information is for those who are deciding about chemotherapy for early-stage breast cancer. It is not about surgery or hormone therapy.

Key points to remember

Chemotherapy ("chemo") is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
Some types of cancer have a very small chance of coming back. Women who have those types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren't.
The drugs used for chemo can be very expensive. Insurance policies don't always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.

FAQs

What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.

When is chemotherapy used to treat early-stage breast cancer?

The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy ("chemo") and hormone therapy, that may help keep cancer from coming back.

It isn't possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive (ER+) breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.

The type of added treatment you have depends on the stage and classification of your breast cancer:

Stage: How far the cancer has spread in your breast and whether it has spread to nearby tissues or other organs is called the stage. This is one of the most important things in choosing the treatment option that is right for you. 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. Added treatment, including chemo, may help destroy cancer cells in your body.
Classification: Breast cancer is classified according to what the cancer cells look like under a microscope. This tells your doctor how fast 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 quickly, then chemo may help you. When cancer is the kind that grows quickly, doctors call it "aggressive" or "poorly differentiated." Breast cancers are also classified by types, such as hormone-receptor-positive or triple-negative.

What are the risks of chemotherapy?

Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.

Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.

Short-term side effects can include:

Nausea and vomiting.
Loss of appetite.
Fatigue.
Hair thinning or hair loss.
Mouth sores.
Diarrhea.
Increased chance of bruising, bleeding, and infection.
Memory and concentration problems.

Long-term side effects of chemotherapy can include:

Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones (osteoporosis).
Concentration problems that may last for many months after your treatments are finished.
In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.

Why might your doctor recommend chemotherapy?

Your doctor might recommend chemotherapy ("chemo") after surgery if:

You are younger than 35. Women younger than 35 usually have a more aggressive type of breast cancer.
Your breast cancer was bigger than a pea. Breast cancers that are at least 1 cm (0.4 in.) are more likely to come back later.
Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the cancer may also have spread to other places in your body.
Your breast cancer is HER-2 positive or triple-negative. These types of cancer tend to grow faster and spread more quickly.

Your doctor may use a genetic test to find your risk for having your cancer come back. This information can help you and your doctor decide about chemotherapy.

2. Compare your options

	Have chemotherapy after surgery	Don't have chemotherapy
What is usually involved?	Most chemotherapy (chemo) medicines are injected into a vein in your hand or arm. This is called an IV. Sometimes the medicine is a pill that you take at home. Sometimes it's a combination of the two. You will go to a hospital or clinic for each IV treatment, but you won't stay overnight. Treatments last from 10 minutes to an hour or longer. You have a number of treatments several weeks apart. A complete course of chemotherapy may take a few months or a whole year. Some women need to have a special catheter inserted if it's hard to find a vein for the IV. This catheter stays in place between treatments.	You will have regular checkups with your doctor to make sure that the cancer hasn't come back.
What are the benefits?	Chemo may help keep breast cancer from coming back.	You avoid the side effects of chemo.
What are the risks and side effects?	Breast cancer may come back anyway. Short-term side effects may include such things as nausea and vomiting, fatigue, hair loss, and mouth sores. Long-term side effects may include early menopause.	Depending on what type of breast cancer you have and how far it has spread, there may be a higher chance of your cancer coming back.

Personal stories

Personal stories about choosing chemotherapy for breast cancer

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was diagnosed with breast cancer about 3 years after I went through menopause. The breast cancer was small, and I did not have any cancer in my lymph nodes. I stopped taking my menopause hormones, had surgery and radiation, and have been taking tamoxifen ever since. I see my doctor a couple of times a year and so far have been okay. I'm going to ask my doctor if I'm a good candidate for switching to something like Arimidex. I hear that it's a smart choice for some women."

— Marty, age 56

"I found out about the breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that the cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help."

— Brenda, age 57

"I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Because of my age and the type of breast cancer I had, my doctor did some tests. It turned out that I was at a higher risk for having the cancer come back. So, I had chemo. I'm doing fine so far. And I think this was the right decision for me."

— Janice, age 40

"I was diagnosed with breast cancer just last year. The breast cancer was small, and I didn't have any cancer in the lymph nodes. But my doctor did a gene test and said my risk was high enough that I needed to decide whether I wanted to have chemo. I decided to go ahead and have it. And even though that was harder than I thought, I'm still glad I made that choice. It was the right one for me."

— Paula, age 61

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat the breast cancer.

I would rather wait and see if the cancer comes back before I have more treatment.

More important

Equally important

More important

I would have strong feelings of failure if the breast cancer returned.

I know there's no way to know for sure whether chemo would keep the cancer from coming back.

More important

Equally important

More important

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without the added treatment.

More important

Equally important

More important

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having chemo

NOT having chemo

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Wendy Y. Chen MD, MPH - Medical Oncology, Hematology
Primary Medical Reviewer	Heather Quinn MD - Family Medicine

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.

To learn more about Healthwise, visit Healthwise.org.

© 1995-2023 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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