Early Stage Breast Cancer
What is Early Stage Breast Cancer?
Early stage breast cancer is a small or medium-sized breast cancer with no or limited lymph node involvement. Early stage breast cancers include Stage I and Stage II breast cancers.
Early stage breast cancer is very curable. Surgery has a central role. Radiation therapy and/or drug therapy is usually recommended following surgery. Basic information about surgery, radiation therapy, and drug therapy can be found in the section titled Highlights of Breast Cancer Treatment.
Illustration: Early Stage Breast Cancer includes Stage I and Stage II breast cancers.
Treatment Options: Breast Conservation or Mastectomy
There are two options for treatment of the cancer in the breast. One is mastectomy. The other is breast conservation.
Breast Conservation with Lumpectomy and Radiation Therapy
Most patients with early stage breast cancer can be treated with breast conservation. Breast conservation is the combination of surgery and radiation therapy. Breast conservation is effective cancer treatment that preserves a woman's breast.
The first step of breast conservation is lumpectomy. This type of surgery removes only the cancerous mass and a small amount of surrounding breast tissue. The breast is otherwise left intact.
Illustration: Lumpectomy is the removal of the cancerous lump.
Lumpectomy alone is not sufficient. After lumpectomy, up to 40% of women have invisibly small deposits of cancer left behind in the scar area. Left untreated, these residual cancer cells can recur (regrow).
Illustration: Invisibly small amounts of cancer may remain after lumpectomy. If untreated, the cancer can re-grow (recur) in the breast. Radiation therapy after lumpectomy can prevent this from happening.
The second step of breast conservation is radiation therapy. Radiation therapy is used to eliminate the small amounts of cancer than may be left behind in the breast after lumpectomy.
How is Radiation Therapy Delivered After Lumpectomy?
Radiation therapy can be delivered to the breast in one of two ways:
- External Beam Radiation Therapy is administered with specially shaped 'beams' from a machine called a linear accelerator. Most patients receiving radiation therapy for breast conservation are treated with external beam radiation therapy. Treatments are given once daily for up to six and a half weeks. Serious side effects are rare. The treatment is extremely effective.
- Brachytherapy is a form of 'internal radiation.' Brachytherapy for breast cancer is a specialty treatment not offered by all physicians. It allows for very 'targeted' treatment, with less radiation exposure to the nearby healthy tissues. Treatments are given twice daily for one week. The treatment is extremely effective.
How Effective Is Breast Conservation?
The 'in-breast' cure rate with breast conservation is 93-95%. For the rare patients who experience re-growth (recurrence) of the cancer in the breast, mastectomy is very effective treatment. The ultimate cure rate and survival for women undergoing breast conservation is identical to that of women choosing mastectomy. For most patients, mastectomy offers no advantage over breast conservation.
Breast conservation (the combination of lumpectomy followed by radiation therapy), provides an excellent appearance and texture to the breast. Most patients are extremely pleased with the result.
Mastectomy for Early Stage Breast Cancer
Mastectomy is surgical removal of the breast.
Illustration: Mastectomy is complete surgical removal of the breast.
Mastectomy remains a very effective and reasonable treatment option for breast cancer. Many women choose this treatment for their early stage breast cancer. It is important to emphasize that the cure rate is not better with mastectomy compared to breast conservation.
Mastectomy is not 100% effective. Approximately 5-7% of women have the cancer grow back in the chest scar area. These recurrences may be successfully treated with more surgery followed by radiation and drug therapy.
Mastectomy leaves a flat chest wall after surgery. Many women chose to undergo plastic surgery to re-create a breast shape after mastectomy. This is called breast reconstruction. Breast reconstruction techniques have improved in recent decades. The appearance and texture of these reconstructed breasts is often excellent. The option of breast reconstruction surgery has made mastectomy more acceptable to some women.
Checking the Lymph Nodes
Surgery to inspect the lymph nodes in the armpit is usually done during the lumpectomy or mastectomy procedure. If cancer is found in the armpit lymph nodes, treatment following surgery may be different. For this reason, most women will be recommended some form of surgery to check the armpit area lymph nodes. The medical term for the armpit area is the axilla (ax-ILL-ah).
The most common procedure for checking the axillary lymph nodes is sentinel node surgery: one or two key lymph nodes are removed and inspected for cancer. If cancer is found in these lymph nodes, a more complete removal of nodes is done in another operation called axillary dissection. Axillary dissection can help ensure all the cancerous nodes are removed and help determine if radiation to the lymph node area may be useful.
The finding of cancer in the armpit lymph nodes has no effect on the ability to undergo breast conservation (lumpectomy and radiation). A woman can still have successful breast conservation even if cancerous lymph nodes are found in the armpit area.
Drug Therapy for Early Breast Cancer
Basic information about drug therapy for breast cancer is discussed in Highlights of Breast Cancer Treatment.
The information below is a brief summary of the use of drug therapy for early stage breast cancer. A more complete explanation is presented in Drug Therapy for Breast Cancer.
Why Is Drug Therapy Used For Early Breast Cancer?
Breast cancer is a threat to life because it can spread beyond the breast and damage other organs. Some patients with apparently early breast cancer have invisibly small amounts of cancer that has already spread to other organs, such as the bones or the liver. These small amounts of cancer in other organs (called metastases) are too small to see with any scan or test. If left untreated, these metastases will grow and ultimately threaten the patient's life.
Drug therapy given very early for these suspected metastases can destroy these small amounts of cancer before they can grow. If the drug therapy is withheld until the metastases are large enough to seen on a scan, they are much less effective. The use of drug therapy for patient who may have tiny metastases throughout their body is called adjuvant (ADD-joo-vent) treatment. Adjuvant means the treatment is added to surgery and radiation and is intended to attack cancer that may be too small to see on any scan or test.
Most women will be offered a consultation with a medical oncologist to discuss adjuvant treatment after surgery. Some patients have a low risk of undetectable cancer spread throughout their body and are not offered adjuvant drug therapy. Patients with higher risk may be offered adjuvant drug therapy to improve their chances of being cured.
Please note: Patients who decline mastectomy for such in-breast cancer recurrences after breast conservation may be candidates for carefully administered 'repeat breast conservation.' This is another lumpectomy to remove the recurrent cancer and repeat radiation therapy using very specialized techniques. This is not generally the preferred approach, but may be useful for some patients. We have unmatched experience in repeat breast conservation techniques and encourage interested patients to call for more information.