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Will I need Chemotherapy for My Breast Cancer?

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Published on Mar 26, 2018

We teach you how your tumor receptors, lymph nodes, genomic assays, and breast cancer stage indicates if you would benefit from chemotherapy.

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Questions for your Medical Oncologist and Breast Surgeon:
1. Would I benefit from chemotherapy?
2. What factors suggest I will benefit from chemotherapy?
3. What is the risk to my life if I do not undergo chemotherapy?
4. What are the advantages of “Neoadjuvant Chemo” before surgery?
5. Would a “Genomic Assay” help determine if I need chemotherapy?
6. What is chemotherapy?

Chemotherapy is the use of certain medications to treat cancer systemically, meaning throughout the whole body. If needed, chemotherapy is usually given after surgery for invasive breast cancer. It is a more intense cancer treatment than hormonal therapy (usually pills). Only a minority of breast cancer patients will ever need it. These complex decisions are ones you will make with your medical oncologist. You will make better treatment choices when you are informed about chemotherapy and hormonal therapy before meeting with your medical oncologist.

General indications for chemotherapy

We outline below some of the more common indications for needing chemotherapy. The decision to undergo chemotherapy also involves being healthy enough to tolerate the treatment. Deciding who needs chemotherapy and what type of chemotherapy to administer is one of the most difficult decisions made in medicine. Your medical oncologist will guide you.

Do my “receptors” suggest I need chemotherapy?

Once a breast biopsy is found to be cancerous, the pathologists will automatically run more tests on the same tissue to determine what “receptors” are expressed. Your receptor pattern is a key piece of information that comes early in your breast cancer journey. In about 30% of patients with an invasive breast cancer, the receptor pattern alone can strongly suggest that chemotherapy will be needed regardless of what is found at surgery. The key points regarding receptors are outlined below.

Estrogen Receptor Negative (ER -) tumors (20%) do not respond to anti-estrogen oral medications that are essential in treating estrogen receptor positive (ER +) tumors. Quite simply, patients with ER negative tumors will benefit from chemotherapy if they are healthy enough to tolerate it. ER negative tumors are more aggressive cancers, but respond more favorably to chemotherapy than ER positive breast cancers.

HER2 Receptor Positive (HER2+) tumors (20%) are very responsive to chemotherapy when paired with new breakthrough drugs that target these tumors, such as Herceptin and Perjeta. The same holds true even if a HER2-positive tumor is also Estrogen Receptor positive (ER+). HER2+ tumors are more aggressive cancers, but we now can treat them more effectively with chemotherapy and new drugs that are “targeted” to destroy HER2-positive cancers.

“Triple Negative” (ER-)(PR-)(HER2-) tumors are fast growing tumors that are usually treated with a specific chemotherapy regimen. These tumors are not responsive to hormonal therapy at all, but may be sensitive to chemotherapy.

What if cancer is detected in the lymph nodes?

If you have “lymph node positive” breast cancer, it is likely you will be offered chemotherapy. Premenopausal women and those with multiple “positive” lymph nodes generally benefit from chemotherapy. If your breast surgeon detects cancer in your lymph nodes before surgery, there may be specific advantages to undergoing “neoadjuvant chemotherapy.”

“Inflammatory Breast Cancer” requires chemotherapy
If you have been diagnosed with inflammatory breast cancer, the first step is neoadjuvant chemotherapy before surgery. This type of cancer has a high likelihood of spreading to the lymph nodes and other parts of the body. Starting chemotherapy as soon as possible is essential to treating this aggressive breast cancer. A mastectomy is performed after chemotherapy, followed by radiation to the area of the mastectomy to lessen the chance of cancer growing back in that area.

What are the advantages of “neoadjuvant chemotherapy”?

Neoadjuvant chemotherapy is when chemotherapy is given before surgery, not afterwards. There are specific advantages to neoadjuvant chemotherapy in appropriately selected patients.

How can a genomic “Oncotype DX” test be helpful?

Patients who have a small, estrogen receptor positive, HER2 receptor negative tumor and no evidence of cancer in their lymph nodes may benefit from an Oncotype DX genomic assay. This cutting-edge test looks deeper into breast cancer cells to better identify people who may benefit from chemotherapy with ER+, HER2 – breast cancers.

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