Treatment for early breast cancer aims to remove the cancer and reduce the risk of the cancer spreading or coming back (recurring).

Treatment may include surgery, chemotherapy, radiotherapy, targeted therapy and hormone (endocrine) therapy. Usually more than one treatment is used, and treatments can be given in different combinations.

As there are different types of breast cancer, treatment varies from person to person. Your doctors will consider several factors to recommend the most suitable treatment for you.

The choice of treatment will depend on:

• your test results

• where the cancer is in the breast

• whether the cancer has spread

• whether the cancer is hormone receptor or HER2 positive

• your age and general health

• your preferences.

Men diagnosed with early breast cancer have similar treatment options to women. Some men feel embarrassed that they have what is considered a woman’s disease. Resources for men with breast cancer are available at the Cancer Australia website.

Surgery

Surgery for breast cancer will involve either breast conserving surgery, where part of the breast is removed, or mastectomy, where the whole breast is removed. In most cases, breast surgery also involves removing one or more lymph nodes from the armpit (see below).

Which surgery should I have?

Some women will be offered a choice between breast conserving surgery and a mastectomy. Men don’t usually have breast conserving surgery.

Research has shown that breast conserving surgery with sentinel lymph node biopsy (see below), followed by radiotherapy, is as effective as mastectomy for most women with early breast cancer. The chance of a recurrence is the same regardless of which surgery you have.

The operations have different benefits, side effects and risks. Talk to your doctor about the best option for you.

Breast conserving surgery

Surgery to remove the breast cancer and some surrounding healthy tissue is called breast conserving surgery. It is also called lumpectomy or wide local excision. Breast conserving surgery is recommended if the cancer is small compared to the size of your breast.

The surgeon removes the smallest amount of breast tissue possible.

This will leave a scar and may change the size and, potentially, the shape of the breast, and it may affect the position of the nipple.

Oncoplastic breast conserving surgery combines oncological surgery (to remove the cancer) with plastic surgery (to reshape the breast and preserve its appearance as much as possible). This specialised surgical technique is performed by oncoplastic breast surgeons and some breast surgeons.

The removed breast and lymph node tissue is sent to a laboratory. A specialist called a pathologist checks it under a microscope to see if there is an area of healthy cells around the cancer – this is known as a clear margin. The pathologist will create a report, which will include information about the size and grade of the cancer, whether it has spread to any lymph nodes (the stage), whether the margins contain cancer cells, and whether the cells are hormone and/or HER2 receptor positive or negative.

If cancer cells are found at the edge of the removed tissue (an ‘involved’ or ‘positive’ margin), there is a greater chance of the cancer returning. You may need more tissue removed (re-excision or wider excision), or your doctor may recommend you have a mastectomy (see below).

After breast conserving surgery, radiotherapy to the whole breast is usually recommended to destroy any undetected cancer cells that may be left in the breast or armpit, and to keep the cancer from coming back (recurrence). For some women, radiotherapy may not be required.

Some women also need chemotherapy, targeted therapy or hormone therapy.

Mastectomy

Surgery to remove the whole breast is called a mastectomy. You may be offered a mastectomy if:

• there is cancer in more than one area of the breast

• the cancer is large compared to the size of the breast

• you have had radiotherapy to the same breast before and so cannot have it again

• clear margins cannot be obtained after one or two breast conserving procedures.