June 1, 2010 ◆ Volume 81, Number 11?
American Family Physician 1339
Treatment of Breast Cancer
University of Virginia School of Medicine, Charlottesville, Virginia
ments? continue? to? evolve,? and? although?
family? physicians? do? not? generally? make?
primary? decisions? about? these? therapies,?
Breast? cancer? prognosis? and? treatment?
histologic? grade,? hormone? receptor? status,?
pausal? status? and? age? are? also? important?
reast? cancer? is? the? second? most?
factors.? Table 2? outlines? typical? treatment?
Stage 0: In Situ
Lobular? carcinoma? in? situ? is? an? inciden-
not? progress? to,? but? increases? the? risk? of,?
breast? by? approximately? 7? percent? over? ?
not? indicated,? but? affected? women? should?
The? National? Comprehensive? Cancer? Net-
work? recommends? annual? mammography?
and? clinical? breast? examination? every? six?
Understanding breast cancer treatment options can help family physicians care for their patients during and after
cancer treatment. This article reviews typical treatments based on stage, histology, and biomarkers. Lobular carci-
noma in situ does not require treatment. Ductal carcinoma in situ can progress to invasive cancer and is treated with
breast-conserving surgery and radiation therapy without further lymph node exploration or systemic therapy. Stages
I and II breast cancers are usually treated with breast-conserving surgery and radiation therapy. Radiation therapy
following breast-conserving surgery decreases mortality and recurrence. Sentinel lymph node biopsy is considered for
most breast cancers with clinically negative axillary lymph nodes, and it does not have the adverse effects of arm swell-
ing and pain that are associated with axillary lymph node dissection. Choice of adjuvant systemic therapy depends
on lymph node involvement, hormone receptor status, ERBB2 (formerly HER2 or HER2/neu) overexpression, and
patient age and menopausal status. In general, node-positive breast
cancer is treated systemically with chemotherapy, endocrine therapy
(for hormone receptor–positive cancer), and trastuzumab (for can-
cer overexpressing ERBB2). Anthracycline- and taxane-containing
chemotherapeutic regimens are active against breast cancer. Stage III
breast cancer typically requires induction chemotherapy to down-
size the tumor to facilitate breast-conserving surgery. Inflammatory
breast cancer, although considered stage III, is aggressive and requires
induction chemotherapy followed by mastectomy, rather than breast-
conserving surgery, as well as axillary lymph node dissection and
chest wall radiation. Prognosis is poor in women with recurrent or
metastatic (stage IV) breast cancer, and treatment options must bal-
ance benefits in length of life and reduced pain against harms from
treatment. (Am Fam Physician. 2010;81(11):1339-1346. Copyright ©
2010 American Academy of Family Physicians.)
▲ See related editorial
on page 1330.
▲ Patient information:
A handout on breast can-
cer treatment, written by
the authors of this article,
is provided on page 1347.
ILLUSTRATION BY ScOTT BOdeLL
1346 American Family Physician
Volume 81, Number 11 ◆ June 1, 2010
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