imported_womens-health

Extra Protection: Preventing Breast Cancer's Return

Survival rates for breast cancer have improved steadily over the last decade, thanks to earlier detection and better treatments. The aim of therapy, particularly among women with early-stage breast cancer, is to not only eliminate the cancer, but to prevent it from coming back. Typically, treatment begins with the surgical removal of the tumor, and continues in an effort to stop rogue cancer cells that may have been left behind.
Treatment that is given after surgery specifically to prevent recurrence is called adjuvant therapy. Adjuvant therapies for breast cancer include radiation treatment, chemotherapy and hormonal therapy.

Below, Dr. Marisa Weiss, an oncologist and president and founder of breastcancer, a non-profit organization for women with breast cancer, discusses the role of adjuvant therapy and explains each type of treatment.

What is adjuvant therapy?
Adjuvant therapy is the treatment for early-stage breast cancer after surgery has been completed. Its role is to reduce the chance of recurrence. Adjuvant therapy can include radiation to the whole breast, and systemic treatments that include hormonal treatments and chemotherapy.


The primary goal of treatment for breast cancer is to treat the whole breast. That can be accomplished by removal of the whole breast, or mastectomy. Or it can be accomplished by breast preservation therapy, which involves removal of the lump.

In general, the plan for adjuvant therapy is established after all the information comes back from surgery. So that means adjuvant therapy could begin as soon as two weeks after surgery. But it can also start up to month after surgery is finished.

In that period of time, a woman needs to get opinions from the surgeon, from the medical oncologist, the radiation oncologist, as well as the pathologist and the radiologist so that the treatment plan is tailored to the woman's situation.

What does chemotherapy involve?
Chemotherapy is one option for reducing risk of recurrence. Generally, chemotherapy works by blocking the growth of cancer cells, keeping them from making new cells and preventing cancer cells from repairing themselves.

Chemotherapy may be an option for someone who has cancer that is large; that has lymph node involvement; that does not have hormone receptors; or that has features that indicate it may be an aggressive tumor. The doctor uses these different pieces of information to determine a woman's risk of having cancer elsewhere.

Adjuvant chemotherapy is usually given in combination, where you get more than one chemotherapy drug at a time. They are usually introduced into the vein for a minimum of four cycles. Sometimes if the cancer has lymph node involvement, for example, eight cycles may be given. In general, the chemotherapy cycles are given every three weeks. But there are new, more concentrated ways of giving chemotherapy where the chemotherapy is given every two weeks.
The chemotherapy has the benefit of reducing the risk of recurrence, but it does have side effects. In the same way that chemotherapy affects cancer cell growth and repair, it also can affect normal cell growth and repair. Doctors give medications to ease nausea, to reduce any kind of discomfort and to help improve blood counts so that the immune system can tolerate the treatment.

What role does hormonal therapy have as adjuvant therapy?
Breast cancer that has estrogen or progesterone receptors will grow in the presence of the hormone estrogen. So the goal of hormonal therapies is to reduce the amount of estrogen in the body, or to block estrogen's ability to affect the breast cell, so that the breast cancer cells are not stimulated to grow.

There are different forms of hormonal therapy. Tamoxifen is a form of hormonal therapy that keeps estrogen out of the estrogen receptor and prevents it from stimulating the cells to grow. There are other forms of hormonal therapy that reduce the amount of estrogen available in the body. In a woman beyond menopause, where the ovaries are no longer making estrogen, there are drugs called aromatase inhibitors that block the production of estrogen.


In the premenopausal patient, the aim is to stop the ovaries from making estrogen. And that can be achieved through medications, surgical removal of the ovaries, or radiation.

What does radiation involve?
Radiation is very effective. It reduces the risk of recurrence by about two-thirds and it's very important for women with early-stage breast cancer.

Radiation starts out with planning session called simulation where we map out the area that needs to be treated. That usually involves the use of a CAT scan or three-dimensional treatment planning to map out two different treatment fields that encompass the whole breast.

The treatment is usually given five days a week for about six weeks. The goal of treatment is to maximize the radiation to where it needs to go and to avoid radiation to the healthy surrounding tissues.

Side effects of treatment include skin reactions, marked by pinkness, sometimes redness and itching, some burning, possible peeling, some tanning of the skin. Those symptoms can be much improved by various salves and medications. There can be some irritation of the chest wall like shooting discomfort, and a little bit of scar tissue on the lung underneath the breast area.

How important in breast cancer therapy is adjuvant therapy?
Adjuvant therapy after surgery saves many lives. I think that many of the advances that we've seen in the last 20 years are largely related to adjuvant therapies.

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