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October 28, 2021

Should Surgery Be Done Before Other Breast Cancer Treatments?

Should Surgery Be Done Before Other Breast Cancer Treatments?

The last decade has seen some great advancements in breast cancer treatments with more options than ever before, along with a better understanding of breast cancer and how it will respond to various treatments. Surgery is usually a part of every breast cancer patient’s treatment process. For many people, their first instinct is to see a breast surgeon to have the cancer removed. It may be surprising, but surgery is not always the first treatment recommended in this multi-step process.

What Factors Affect the Treatment Plan for Breast Cancer?

Your oncologist will review information about the size and behavior of the tumor along with several other factors that influence the treatment recommendations, including:

  • The age, overall health, and menopausal status of the patient

  • The hormone status of the tumor (including estrogen/progesterone receptor status and HER2 status)

  • The grade, location and size of the tumor

  • Presence of inherited breast cancer mutations (BRCA1 and BRCA2)

  • The genetic profile of the tumor itself. This is done through tumor profiling tools such as Oncotype DX.

Breast Cancer Staging

Cancer staging defines the extent to which the cancer cells have spread and helps the oncologist determine how much treatment may be needed and the order of the treatments. Breast cancer can be placed into five different stages.

Stage 0 is referred to as non-invasive ductal carcinoma in situ (DCIS). Stages 1 - 4 are referred to as invasive breast cancer. Staging is done before surgery as well as after surgery. The higher the number, the more the cancer has grown.

Types of Surgery for Breast Cancer

Lumpectomy: It involves the tumor along with a margin of cancer-free tissues. The procedure is also called breast-conserving surgery. Oncologists recommend lumpectomy followed by radiation therapy for patients with:

  1. Hormone receptor-negative tumors

  2. Larger tumors and

  3. Younger patients with invasive cancer

Mastectomy: It involves the removal of the complete breast. There are different methods of mastectomies, and the most suited surgery type differs from one patient to another.

While your oncology team will recommend one of these surgeries, the timing of the surgery is dependent on a few factors.

Neoadjuvant Therapy: Treatments Before Breast Surgery

By using standard treatments such as chemotherapy and radiation therapy before surgery, the size of the tumor can be reduced. This helps reduce the amount of tissue that will need to be surgically removed. It’s also helpful for those who have swollen lymph nodes under their arm. By treating the cancer, the swelling is likely to go down making the surgery easier to perform.

Breast Cancer Surgery and Neoadjuvant Chemotherapy

The cancer care team often recommends chemotherapy, targeted therapy, hormone therapy or immunotherapy before surgery for large and rapidly growing tumors. Neoadjuvant chemotherapy is commonly used for:

  • Breast cancer that is hormone positive. Hormone therapy can be given to slow the growth and shrink tumors before surgery

  • HER2+ breast cancer that can be shrunk with targeted therapy that will help reduce the size of the tumor.

  • Breast cancers that have reached the lymph nodes

  • Triple-negative breast cancer that can respond to immunotherapy to reduce the size and slow the growth of this aggressive breast cancer.

  • Inflammatory breast cancers

Breast Cancer Neoadjuvant Radiation Therapy

Most of the time you hear about radiation therapy after surgery to kill any remaining cancer cells in the area. This lowers the risk of breast cancer recurrence. There is evidence, however, that treating the tumor with chemotherapy and radiation therapy before surgery results in a lower risk of cancer recurrence over the next five years. More research is underway to determine when this combination of radiation therapy with other breast cancer treatments before surgery is most effective.

Breast Cancer Treatments After Surgery

Based on the stage and your body’s response to the treatments before surgery, your oncologist will determine if more treatment is needed. If the cancer is a later stage that has spread to other areas of the body, then it’s likely that more treatment is needed to kill any remaining breast cancer cells that are traveling in the body.

Because treatments may be most beneficial to start before surgery it’s often best to first consult with a medical oncologist before scheduling a breast cancer removal surgery. Our cancer care team in Brevard County works closely with breast surgeons who understand the value of treatments before surgery in some cases.

Breast Cancer Treatment at Cancer Care Centers of Brevard

Cancer Care Centers of Brevard delivers customized breast cancer treatments based on many different factors that are unique to each patient. Every decision regarding your cancer treatment is made to ensure optimal safety, efficiency, and comfort. Request an appointment with our breast cancer specialists if you would like to discuss treatment options or get a second opinion on the timing of breast cancer treatments and surgeries.

Categories: Breast Cancer