Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.
The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy ("chemo") and hormone therapy, that may help keep cancer from coming back.
Some people think of added treatment as an insurance policy designed to destroy any cancer cells that may still be in the body.
It isn't possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive (ER+) breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.
The type of added treatment you have depends on the stage and classification of your breast cancer:
Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.
Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.
Short-term side effects can include:
Long-term side effects of chemotherapy can include:
Your doctor might recommend chemotherapy ("chemo") after surgery if:
Your doctor may use a genetic test to find your risk for having your cancer come back. Or your doctor may use a computer program, such as Adjuvant!, to estimate your chances of having your breast cancer come back. This information can help you and your doctor decide about chemotherapy.
|Have chemotherapy after surgery||Don't have chemotherapy|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was diagnosed with breast cancer 3 years ago. It was quite a shock. Even though my breast cancer was small and I did not have any cancer cells in my lymph nodes, I decided to take chemotherapy. My doctor said that even though it would not guarantee that the cancer would not come back, it would improve my chances for a cure. I was really worried about the side effects, but they were not that bad. I just wanted to do everything in my power to beat this breast cancer. My checkups have been fine so far, so I think I made the right choice."
— Laurel, age 43
"I was diagnosed with breast cancer about 3 years after I went through menopause. My breast cancer was small, and I did not have any cancer in my lymph nodes. I stopped taking my menopause hormones, had surgery and radiation, and have been taking tamoxifen ever since. I see my doctor a couple of times a year and so far have been okay. I'm going to ask my doctor if I'm a good candidate for switching to something like Arimidex. I hear that it's a smart choice for some women."
— Marty, age 56
"I found out about my breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that my cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help."
— Brenda, age 57
"I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Fortunately, my breast cancer was really small, and it hadn't traveled to the lymph nodes under my arm. My doctor used the Adjuvant! program and said that my chances of the cancer coming back were small, so I decided not to have the chemo. I keep in close contact with my doctor and really feel great. I think that passing on the chemo was the right decision for me."
— Janice, age 40
"I was diagnosed with breast cancer just last year. Thank goodness I have been having those mammograms. My breast cancer was small, and I didn't have any cancer in the lymph nodes. I stopped taking my menopause hormones, and my doctor suggested that I try a medication called tamoxifen. I had a few hot flashes, but nothing bad. I feel really good and continue to see my doctor for checkups. I will take the tamoxifen for 2 years and then take something else. Who knows what will be on the market by then?"
— Paula, age 61
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat my breast cancer.
I would rather wait and see if my cancer comes back before I have more treatment.
I would have strong feelings of failure if my breast cancer returned.
I know there's no way to know for sure whether chemo would keep my cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without treatment, to monitor my breast cancer.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having chemo
1. Is chemo the main treatment for early-stage breast cancer?
2. Should every woman with early-stage breast cancer have chemotherapy?
3. Are the side effects of chemo always bad?
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Douglas A. Stewart, MD - Medical Oncology|