“We’ve made a lot of progress for treating early and advanced breast cancer,” said Katherine Tkaczuk, MD, FACP, professor of medicine at University of Maryland School of Medicine and director of Breast Evaluation and Treatment Program at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center. “Many years ago, our treatment approach was based on aggressive surgical approaches. That approach is long gone.”
American women have a one in eight chance of developing breast cancer, according to the American Cancer Society. Fortunately, Dr. Tkaczuk says most breast cancer gets diagnosed in the early stages. Improvements in diagnostic tools have helped. 3D mammography, ultrasound and breast MRI now help screen for and diagnose breast cancer in its earliest stages.
Once diagnosed, you have access to more treatment options at University of Maryland Medical System than ever before. This is good news since every cancer is different.
Surgical Breast Cancer Treatments
With mastectomy, the surgeon removes the entire breast. For years, the surgeon also removed a lot of nearby lymph nodes, called an axillary lymph node dissection. These small structures located all over your body help your immune system fight infections but may also trap cancer cells. When many lymph nodes are removed from your armpit, you may experience pain and swelling of your arm and hand called lymphedema. Removing lots of lymph nodes puts you at higher risk for these complications.
Though once used with all breast cancer surgeries, today, the majority of women with breast cancer do not need to have many lymph nodes removed. Instead, they may have a sentinel node biopsy. With sentinel node biopsy, the surgeon only removes lymph nodes where cancer is most likely to spread first. Depending on your cancer stage, your surgeon may remove one or more lymph nodes in your armpit. These then get examined to see if cancer has spread to them.
Sentinel node biopsy isn’t the only surgical advance. More women now undergo lumpectomy rather than mastectomy. During lumpectomy, surgeons remove cancerous tumor mass, leaving as much healthy breast tissue as possible. Much of the breast tissue remains in place. If desired, reconstruction after lumpectomy is also less intense than with mastectomy.
Breast Cancer Treatments in Reverse
For years, surgery was almost always the first step in breast cancer treatment. Chemotherapy, radiation therapy or hormone therapy came next. Not anymore.
“We’ve reversed the treatment process,” Dr. Tkaczuk said. There was once one path breast cancer patients walked. “Now, the whole treatment routine is much more complicated, because there are so many options.”
This change is partially due to neoadjuvant therapy. Instead of surgery, chemotherapy, radiation therapy or hormone therapy comes first. Once this therapy shrinks the tumor, then surgery is initiated.
By transitioning to this new approach, surgeons have smaller tumors to remove. Smaller tumors are easier to remove and carry less risk of post-surgical complications.
Neoadjuvant therapy also helps us to find out if cancer is responsive/sensitive to systemic treatments. Sometimes the breast tumor may completely go away, but surgery is still needed to remove the area where the tumor was before. If other health problems make it hard for you to undergo surgery, neoadjuvant therapy can shrink breast tumors and give you time to improve your health. Once your health improves, you can undergo surgery safely. Until then, your tumors are kept in check.
Targeted Therapy Provides Custom Cancer Care
Certain breast cancers respond to a generic treatment regimen. Others need more specific therapy. Targeted therapy provides that specific treatment option. Some of these options target HER2 proteins.
Found inside breast cancer cells, HER2 proteins cause cancerous cells to grow. High levels of HER2 are diagnosed as HER2-positive breast cancer. Therapies that target HER2 help stop this fast-growing cancer.
One targeted therapy uses monoclonal antibodies. These antibodies search for HER2 proteins. Once the antibodies find HER2 proteins, they attach to them and slow the growth of cancer.
An additional advance makes monoclonal antibodies more effective. Known as antibody-drug conjugates, they combine chemotherapy with monoclonal antibodies. When the antibodies attach to HER2 proteins, they release cancer-killing chemotherapy molecules directly to the targeted cells. This kills cancerous cells and affects fewer healthy cells nearby.
“Antibody-drug conjugates represent a whole new group of anti-cancer agents,” Dr. Tkaczuk said. “They are revolutionizing the treatment of advanced and early-stage breast cancer.”
Immune checkpoint inhibitors are a third targeted therapy option. When you’re healthy, immune checkpoints keep your body from overreacting to various threats. Otherwise, your immune system would attack healthy cells. Immune checkpoint inhibitors help your immune system recognize cancerous cells as dangerous. Your immune system then gets better at seeking and destroying those cells.
New Radiation Options Improvement
Radiation therapy is a common therapy to destroy cancerous cells. Success requires multiple sessions, spread over a period of weeks. Advances have led to the following improvements:
- Fewer breast cancer treatments. Instead of undergoing radiation therapy for up to six weeks, partial breast radiation therapy only takes a couple of weeks. Following surgery, for some patients, partial breast radiation can be just as good as regular radiation therapy at preventing cancer recurrence.
- Proton therapy. Traditional radiation gets aimed at cancerous cells. However, the radiation beam continues beyond the cancerous area and may damage healthy cells. Proton therapy stops radiation from going beyond the tumor. As a result, there’s less risk of damage to nearby healthy cells.
Treating the Most Complicated Breast Cancer
Many advances in breast cancer treatment help with triple-negative breast cancer. Considered to be a challenging type of breast cancer to treat, triple-negative breast cancer affects up to 15 percent of women with breast cancer, according to the American Cancer Society.
Triple-negative breast cancer means your cancer cells have the following characteristics:
- No estrogen or progesterone receptors. These proteins live on or in cancer cells and attract either estrogen or progesterone. When an estrogen hormone attaches to the receptor, the cancer grows. Hormone-receptor-positive cancers have these receptors. Triple-negative breast cancers do not.
- Low amounts of HER2 protein. As discussed above, this protein causes cancer to grow.
Because it grows quickly, this type may spread beyond the original site. When it does, it’s known as metastatic breast cancer.
“Until recently,” Dr. Tkaczuk said, “the only treatment options we had for these patients were chemotherapy or a combination of multiple chemotherapies.”
Now, targeted therapies have opened the door to new options. Checkpoint inhibitors antibody therapy with neoadjuvant chemotherapy has improved outcomes. Cutting-edge treatments are curing breast cancer.
The effects have been so positive that chemotherapy is rarely the only treatment given. Rather, the typical treatment for triple-negative breast cancer now includes advanced therapies.
A Better Breast Cancer Treatment Experience
Only a few years ago, chemotherapy and targeted therapies required 60 or 90 minutes of intravenous administration. Now, some get administered with a subcutaneous injection. Instead of connecting you to an IV, your provider injects the medicine with a syringe. The process takes less than 10 minutes.
“The women we care for are often mothers with children, and it’s hard for them to find time for such treatments,” Dr. Tkaczuk said. “This is a huge quality of life improvement for them.”
As an added bonus, current breast cancer treatments cause fewer side effects.
New targeted therapies affect less normal tissue. They’re less likely to reduce your blood count and lead to anemia and other problems. Since targeted therapies don’t travel throughout the body, they’re less likely to affect nearby organs and tissue. So, there’s less risk of hair loss and other common side effects of chemotherapy and radiation therapy.
Breast Cancer Treatments in the Future
Statistically, breast cancer survival rates are improving. New cancer screening technology and advanced treatment options hold promise to help even more women survive and thrive after breast cancer. To help that become reality, UMMS providers actively participate in various clinical trials.
“Clinical trials are vital to pushing cancer care ahead,” Dr. Tkaczuk said. “That’s how we make progress.”
A 30-year oncology veteran, Dr. Tkaczuk participated in the first trials of Herceptin, a targeted therapy approved to treat HER2+ breast cancer. Since that trial, Herceptin has led to more therapies that improve breast cancer treatment.
Dr. Tkaczuk said current trials will continue growing the options available to those experiencing breast cancer. And researchers are spreading their nets deep and wide. They’re learning more about gene mutation, developing new targeted therapies and working toward breast cancer vaccines.
“We’re always learning more about breast cancer and why the immune system doesn’t recognize and destroy cancer cells,” Dr. Tkaczuk said. “Through clinical trials, we’ll continue learning and advancing cancer care for future generations.”
More to Read
- How Exercise Helps Breast Cancer Prevention and Recovery
- Genetic Testing for Breast Cancer
- Battling Breast Cancer Before It Begins
- Sharing Your Cancer Diagnosis
Medically reviewed by Katherine Tkaczuk, MD, FACP.
Updated June 2023
