There are three treatments for breast cancer. The order in which these are performed depends on the patient’s individual treatment plan.

• Surgery – This completely removes the cancer and samples the lymph nodes to see if the cancer has spread.

• Radiation – This is given after surgery to target the tissue where the breast cancer was, and possibly the lymph nodes. The goal of radiation is to destroy any cancer cells left behind after the surgery.  Combined, surgery and radiation are extremely effective in destroying the breast cancer and ensuring the cancer does not regrow in the breast. However, surgery and radiation do not prevent the spread of cancer cells outside of the breast, to other organs (metastasis).

• Chemotherapy – The third treatment for breast cancer does prevent the spread of cancer cells. Chemotherapy are drugs given either through an IV or in pill form. Chemotherapy drugs circulate throughout the whole body on a “search and destroy” mission, preventing the spread of cancer cells outside of the breast.

 

Today, with our better understanding of breast cancer cells, we can take an individualized approach to treating breast cancer based on tumor biology. Tumor biology refers to characteristics of the cancer cells. These characteristics describe the type of cancer cells, how aggressive the cells appear under the microscope, and how we expect the cancer to respond to treatment.

Two characteristics – the “Histological Grade” and the “Receptor Status” – are used to determine which treatment path to offer each woman based on her unique breast cancer.

• Histological Grade – This describes the aggressiveness of the cells. Grade 1 is low grade, meaning the cells divide and grow slowly, and look like each other. These cells could be labeled as “better behaved.”

    Grade 2 are “in between,” cells that are not the best behaved, but not the worst behaved either.

    Grade 3 is high grade. These cells look very different from each other. They divide and grow rapidly. These are more dangerous cells.

• Receptor Status – Receptors on any cell are like a lock to a door. Particles, molecules, substances in the blood are ingredients that act like a key to fit the lock. If you have the right key, the door opens and the ingredient can enter the cell and be used for making new cells. Testing for receptor status on cancer cells helps to understand the behavior of the cells and how they will respond to different medications. For breast cancer, there are three main categories of cancer cells based on receptor status:

• Estrogen Receptor (ER) and Progesterone Receptor (PR) – About 60 percent of breast cancer cells use the hormones estrogen and progesterone to make new cancer cells. Having positive ER and PR receptors identifies the cancer as using these hormones to grow.

• HER2 – This is also a receptor specific to breast cancer cells. Having your cancer cells either positive or negative for HER2 receptors significantly affects your breast cancer treatment plan.

• Triple Negative – This refers to cancer cells that have no receptors on their cells. There are no estrogen, progesterone or HER2 receptors present.

 

Triple Negative, HER2 positive and grade 3 cancer cells are more aggressive. Today, we understand that women with these kinds of cells have increased chances of cancer spreading to other organs. Women with Triple Negative and HER2 positive receptor status will be recommended for IV chemotherapy in order to stop the spread of cancer cells and prevent metastasis.

Because these cells are so aggressive, women with these receptors are often considered for chemotherapy before surgery. This is called neo-adjuvant chemotherapy. It allows us to bring these cancer cells under control right away and lower the risk of having those cells leave the breast and go to other organs.

Neo-adjuvant chemotherapy also enables us to measure how well the drugs are working to destroy the cells in the breast and lymph nodes. After chemotherapy, surgical options may be expanded and improved. For all these reasons, neo-adjuvant chemotherapy may be the best path for treating a woman with aggressive breast cancer cells.

 ER/PR positive breast cancer tends to be very mixed in how we treat it. Most women who have ER/ PR positive cancer cells will be offered a pill that is taken daily for five years. This pill helps block the receptor, essentially jamming the lock, and not allowing estrogen into the cell to make new cancer cells.

ER/PR cancers are like a whole family of cancers. In every family, there are mostly “good actors,” but sometimes, there can be a “bad actor.” When we test ER/PR positive cancers, we can measure just how “behaved” those cells are and use that information to recommend treatments.

If we find a “bad acting” ER/PR positive breast cancer, IV chemotherapy may also be offered before taking the pills. Usually with ER/PR positive cancers, chemotherapy is offered after surgery, unless we need to give the drugs to shrink the tumor.

 

There are some cancer cells that are not as aggressive and less likely to spread. Generally, women with less aggressive cells will be offered pills instead of IV chemotherapy. Determining the behavior of breast cancer cells allows us to be more precise in every woman’s treatment. This is one reason why you can’t expect to be offered the same treatment as a family member, friend or neighbor.