Breast cancer therapy is geared specifically to each patient. A number of factors are included when a physician and patient sit down to discuss treatment options. Some of these factors are age, the patient’s overall health, and menopausal status. Other factors are: 1) type of breast cancer; 2) speed of tumor growth; 3) stage of the cancer; 4) location of the cancer (ie, in the breast only or has spread to lymph nodes or other areas of the body); 5) levels of estrogen-receptor and progesterone-receptor in tumor tissue; and 6) presence of high levels of human epidermal growth factor type 2 receptor (HER2/neu) in the cells.

Breast cancer therapies range from standard, commonly used treatments to new and experimental options. Four of the standard types of breast cancer treatment are: 1) radiation therapy, 2) hormone therapy, 3) chemotherapy, and 4) targeted therapy.

Radiation therapy uses radiation or x-rays to keep cancer cells from growing and dividing. This form of therapy is often given after surgery to prevent recurrence and to eliminate as much of the cancer as possible. Radiation therapy can be delivered externally or internally. With external radiation, the patient receives treatment from a machine. With internal radiation, the radiation dose is contained in and delivered via needles, seeds, wires or catheters that are placed near to or directly into the cancer. The method used to administer radiation depends on the type and stage of the cancer.

Some hormones are known to be involved in the growth of some types of cancer. Roughly two-thirds of women with breast cancer have tumors that contain estrogen receptors (known as ER-positive). Tumors designated as ER-positive depend on estrogen to grow. Hormone therapy can block the body’s natural production of estrogen as well as slow or terminate a cancer’s growth. Tamoxifen is a well-known and effective type of hormone therapy. Long-term use of tamoxifen has been shown to decrease both recurrence and new breast cancers in women who have ER-positive or ER-unknown tumors. Unfortunately, tamoxifen also increases the likelihood of developing uterine cancer, therefore patients on tamoxifen should keep up-to-date with yearly pelvic exams and report any unusual bleeding to their physician.

Aromatase inhibitors (or blockers) appear to be more effective than tamoxifen but more study is needed. In addition, they are only effective in women past menopause. Aromatase inhibitors prevent the body from producing estrogen by blocking the aromatase enzyme which is crucial to the production of estrogen.

Chemotherapy is a treatment that uses drugs to slow or prevent the growth of cancer cells by killing them or stopping them from dividing. Drugs that are commonly used to treat breast cancer include Cyclophosphamide, Vinorelbine, Gemcitabine, and Doxorubicin. Chemotherapy can be used as an “adjuvant therapy” (ie, to prevent or postpone cancer from recurring after initial surgery or radiation), neo-adjuvant therapy (ie, when a cancer is so large that shrinking it will make it easier to perform surgery), and to treat metastatic disease (when the cancer has spread to other parts of the body outside the breast and lymph nodes). Chemotherapy can be delivered systemically or regionally. With systemic chemotherapy, the drugs enter the bloodstream via injection into a vein or muscle. With regional chemotherapy the drugs are placed directly into an organ, body cavity or the spinal column, and mainly affect cancer cells in that specific area.

Targeted therapy is aimed at specific characteristics of cancer cells. This treatment is milder than chemotherapy or radiation because it minimizes damage to the surrounding organs and tissue. Two types of targeted therapies that are currently being studied are monoclonal antibodies and tyrosine kinase inhibitors.

Monoclonal antibody therapy uses antibodies produced in the laboratory from a single type of immune system cell. These antibodies can determine substances on cancer cells or normal substances in the body that help cancer grow. The antibodies literally attach themselves to the substances, thereby preventing the growth and spread of the cancer cells. Monoclonal antibodies are administered via infusion.

Tyrosine kinase inhibitors are drugs that block signals necessary for a tumor to grow. For example, Lapatinib is an inhibitor that blocks proteins inside tumor cells as well as the effects of the HER2 protein.

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