The treatment of breast cancer depends on several key factors, including how advanced the cancer is, the specific type of cancer, and the results of certain lab tests that help assess risk.^1,2

Before treatment begins, your care team will carry out a number of tests to understand your cancer better. This includes a biopsy to study the cancer and nearby lymph nodes. These samples are examined to determine the exact type of the cancer, and whether the cancer is influenced by hormones (oestrogen or progesterone) or growth proteins. Additional tests, such as gene expression analysis, may be used in some cases to guide decisions around the need for chemotherapy.^1,2

Understanding Breast Cancer Staging

Staging is the process used to describe how big the cancer is, where it is located, and whether it has spread to other parts of the body. Knowing the stage of the cancer is essential, as it helps your doctor determine the most appropriate treatment plan and understand the likely course of the disease.

There are two main types of staging:

• Clinical staging: Takes place before any treatment and is based on a physical exam, blood tests, and imaging scans.
• Surgical staging: Takes place after surgery and is based on examination of the tissue that has been removed.

To get a complete picture of the cancer, your care team may recommend additional imaging tests. These can include:

• CT scan: A detailed x-ray that shows a cross-section of the internal organs.
• MRI scan: Uses magnets and radio waves to create detailed images of the body.
• Bone scan: Uses a small amount of radioactive material to check for cancer in the bones.
• PET scan: A scan that uses a special dye to detect areas of cancer that other scans might miss. It is often combined with a CT scan.

A lymph node biopsy is often performed as part of staging. This may include a sentinel lymph node biopsy, a technique that identifies and tests the first lymph node most likely to contain cancer cells. This approach helps determine whether the cancer has started to spread beyond the breast. It is also an important step in planning treatment, because when the sentinel node is found to be free of cancer, some women can safely avoid chemotherapy.^1,2

The stage of a breast cancer describes how far the disease has progressed in the body according to the TNM system.³ It takes into account the size of the Tumour (T) in the breast, whether cancer has reached nearby lymph Nodes (N), and whether it has Metastases (M), meaning it has spread to other parts of the body, such as the bones, liver or lungs. Doctors usually describe breast cancer using stages from 0 to IV, which range from very early disease confined to the milk ducts, to cancer that has spread to distant organs.^3,4 In general, lower stages mean smaller cancer and less spread, with a better prognosis. Your doctor will explain exactly which stage applies to you and what it means for your care.¹

Another important factor is the grade of the cancer, which refers to how abnormal the cancer cells look under a microscope and how quickly they are growing. Grades range from 1 to 3 – higher grades indicate faster-growing, more aggressive cancers.^1,4

Understanding your cancer’s stage, grade, and biology helps your care team choose the most effective treatment. This is a complex process, but you are not alone. Your case will be reviewed by a multidisciplinary team, including surgeons, oncologists, nurses and other specialists who will work together to recommend the best treatment plan for you. These discussions will also take your individual preferences, needs, and lifestyle into account.¹

For patients with symptoms or a higher stage of the disease (for example, Stage II or above), further scans may be recommended to check whether the cancer has spread to other parts of the body, such as the bones, liver, or lungs. If a person has a strong family history of cancer or meets certain criteria, genetic testing may also be offered, especially if targeted treatments are being considered.²

It is also worth noting that some groups of patients – such as younger or older individuals – may need slightly different treatment approaches. However, treatment decisions should be based more on a person’s overall health than on age alone.²

Sources

1. ESMO. Breast Cancer: A Guide for Patients. (2018).
2. Loibl, S. et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol. 35, 159–182 (2024).
3. Breast Tumours. (OMS, Geneva).
4. Cancer Research UK. About breast cancer staging and grades. https://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-grades/about (2023).

The choice of therapeutic strategy in breast cancer requires careful evaluation of several factors, some related to the characteristics of the cancer, in particular its biological profile, and others dependent on the patient, such as your overall health and preferences. In the decision-making process, it is essential to consider prognostic factors, predictors of response to anticancer treatment, and the biological subtype of the disease.

Treatment is usually provided by a multidisciplinary team, which consists of a group of specialists (including surgeons, oncologists, radiologists, nurses, and others) who work together to decide the best care plan for you. Most patients receive a combination of different treatment types, and these may happen before or after surgery.¹

Treatment usually involves a combination of approaches:

• Local treatments, such as surgery and radiotherapy, focus on removing or targeting the cancer in the breast and surrounding areas.
• Systemic treatment, such as chemotherapy, hormone therapy, targeted therapy, or immunotherapy, travel throughout the body and help treat cancer that may have spread.

In many cases, these treatments are used in sequence, depending on the specific needs of the patient. Biomarker results (such as hormone receptor status for example) are used to help tailor the treatment plan.

Treatment Options for Breast Cancer

Surgery

Surgery is often the first step in treating breast cancer. The goal is to remove the cancer from the breast while preserving as much healthy tissue as possible. There are two main types of surgery:

• Breast-conserving surgery (BCS): Also called a lumpectomy, this removes the cancer and a small margin of surrounding tissue. It is usually followed by radiotherapy to reduce the risk of cancer returning.
• Mastectomy: This removes the entire breast. In some cases, this may be the best option due to cancer size or location.

In some cases, your care team may recommend drug treatment around the time of surgery. Treatment before surgery is called neoadjuvant therapy, and treatment after surgery is called adjuvant therapy. The decision to administer drug therapy before surgery (“neoadjuvant therapy”) depends on the size of the cancer, lymph node involvement, and the biological characteristics of the cancer that influence the risk of recurrence or metastasis.

Neoadjuvant therapy is becoming increasingly common even when the cancer is operable because it can shrink the cancer, making surgery less extensive and sometimes allowing the breast to be preserved. It can also help lower the risk of the cancer returning or spreading. Importantly, it shows how the cancer responds to medical treatment, which helps your doctors tailor the most effective adjuvant treatment after surgery.

If there is concern that the cancer may have spread to nearby lymph nodes, your surgeon may perform a sentinel lymph node biopsy, which is a procedure that checks the first lymph node likely to be affected. If cancer is found here, additional nodes may be removed.²

After a mastectomy, patients are often offered breast reconstruction, either at the time of surgery (immediate) or later on (delayed). This can be done using implants or your own body tissue. Your care team will discuss the best option based on your anatomy, cancer treatment, and preferences.²

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. It is usually given after breast-conserving surgery and sometimes after a mastectomy, especially if there is a higher risk that cancer may return.

• Whole breast radiotherapy (WBRT): Most patients receive this to treat the entire breast.
• Boost radiation: An extra dose of radiation to the area where the cancer was removed, especially for higher-risk patients.
• Accelerated partial breast irradiation (APBI): A shorter treatment used for low-risk patients that targets only the area around the cancer site.

In advanced or metastatic cases, radiotherapy may also be used to ease symptoms, such as pain from bone metastases, which occur when cancer cells spread to the bone.

Systemic treatments

Systemic treatments are medications that travel through the bloodstream to reach cancer cells throughout the body. These may include chemotherapy, hormone therapy, and targeted therapy.

Chemotherapy

Chemotherapy is commonly used for more aggressive breast cancers. It uses drugs that kill fast-growing cells, including cancer cells. Chemotherapy is often given through an IV every one to three weeks and may be followed by oral treatments.

Hormone (endocrine) therapy

Many breast cancers grow in response to oestrogen or progesterone. If your cancer is hormone-receptor positive, hormone therapy may be recommended to block or reduce hormone levels.

Targeted therapy

Targeted therapies are a kind of personalised therapy and work by blocking the signals that cancer cells rely on to grow. These are often used in combination with other treatments.

Moving towards more personalized medicine

Treatment is increasingly being guided by the unique biology of each person’s cancer. Tests for markers like HER2, hormone receptors, and Ki-67 (a marker of cancer growth speed) help doctors choose the most effective therapies.

Gene expression profiles and “genetic fingerprints” of cancers may help predict how likely a cancer is to return and what treatments may work best. However, these biological features can change over time, so repeated testing may be needed if cancer comes back.³

Sources

1. ESMO. Breast Cancer: A Guide for Patients. (2018).
2. Loibl, S. et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann. Oncol. 35, 159–182 (2024).
3. ESMO. Personalised Medicine at a Glance: Breast Cancer. https://www.esmo.org/for-patients/personalised-medicine-explained/breast-cancer (2017).

Breast cancer treatments are highly effective, but they may also lead to side effects. These vary depending on the type of treatment and from person to person. While some women experience very few issues, others may find certain symptoms challenging. The good news is that most side effects can be prevented, reduced, or managed with appropriate care and support. Your medical team will try their best to closely monitor you throughout treatment and offer solutions to help you maintain your comfort and well-being.

Surgery, whether it involves removing only the cancer (breast-conserving surgery) or the entire breast (mastectomy), can lead to temporary pain or tightness at the site of the operation. Some women also notice numbness or a tingling sensation in the chest or underarm area. If lymph nodes have been removed, the shoulder may feel stiff, and a small number of patients may develop swelling in the arm known as lymphoedema. Your medical team will provide medication to relieve pain and refer you to a physiotherapist if needed. Gentle exercises and precautions, such as avoiding injury or infection in the affected arm, can reduce the risk of complications and help restore movement.¹

Radiotherapy may cause redness, dryness, or irritation of the skin in the treated area, similar to sunburn. Fatigue is also a common side effect and may increase as the treatment progresses. Some women notice mild swelling or firmness in the breast, and, in rare cases, treatment may affect nearby organs such as the heart or lungs. Most skin reactions are temporary and can be eased with gentle skin care products and wearing soft, loose clothing. Fatigue usually improves a few weeks after treatment ends, and staying active with light physical activity can help restore energy levels.¹

Chemotherapy can affect fast-growing cells in the body and may cause hair loss, nausea, fatigue, or changes in appetite and taste. Because chemotherapy can temporarily weaken the immune system, you may also be more prone to infections. Tingling or numbness in the hands and feet (known as peripheral neuropathy) may also occur, especially with certain drugs. Your care team will provide anti-nausea medications and support you in managing any digestive symptoms. Some women choose to use cooling caps to reduce hair loss. It is important to report any fever or signs of infection promptly, and your team will advise you on strategies to manage fatigue, emotional changes, or menopausal symptoms that may occur during treatment.¹

Hormone (endocrine) therapy, which is recommended for many patients with hormone-sensitive cancers, may cause hot flushes, joint pain, fatigue, or mood changes. In some cases, it may lead to bone thinning over time. Your doctor may suggest bone density monitoring and, if needed, prescribe medication or supplements to protect bone health. Lifestyle changes such as regular physical activity, a balanced diet, and stress management can also help ease many of these side effects. Resources are also available to help manage vaginal dryness or emotional concerns.¹

Targeted therapies, which are designed to block specific signals that help cancer cells grow, often have more focused effects than chemotherapy, but side effects can still occur. Depending on the medication, you might experience diarrhoea, skin changes, fatigue, or effects on the heart or liver. Some women may also develop high blood pressure, and you might need to have regular cardiology check-ups, especially if you are receiving HER2-targeted therapies. Your team will carry out regular monitoring and act early to manage any concerns. With the right adjustments, many people can continue treatment without major disruption.¹

It is important to remember that you are not alone in facing these effects. Keep track of how you feel and discuss any changes with your care team. This will help them support you more effectively. A range of professionals – including nurses, physiotherapists, psychologists, and dietitians – are available to help you manage symptoms and maintain your quality of life throughout treatment. With the right care, many side effects can be controlled, and your comfort and recovery can be greatly improved.¹

Sources

1. ESMO. Breast Cancer: A Guide for Patients. (2018).

Some treatments for breast cancer can affect your bones, making them weaker and more likely to break. This condition is called osteoporosis. Normally, bone loss happens slowly as we age, but certain cancer treatments can speed up this process. It is important to be aware of how your treatment may affect your bones and what can be done to reduce your risk.¹

Some breast cancer treatments lower oestrogen levels in the body, which is helpful for slowing the growth of the cancer—but oestrogen also helps keep bones strong. Hormone therapies such as aromatase inhibitors or ovarian function suppression can lead to bone loss over time. Chemotherapy can also reduce oestrogen levels by affecting the ovaries. Other treatments, such as high-dose or long-term steroid use, and the removal of both ovaries before menopause, can have a similar effect. Radiotherapy to certain areas, like the spine or pelvis, may weaken bones in the area being treated. However, not all cancer treatments lead to bone loss, and your doctor will let you know if your treatment puts you at risk.²

If your treatment is known to increase the risk of bone loss, your doctor will assess your risk of fractures. This includes looking at your age, body weight, history of smoking, use of steroids, and whether anyone in your family has had a hip fracture. You may also be asked to have a special type of scan called a DXA (dual energy X-ray absorptiometry), which measures your bone mineral density. This helps your doctor determine how strong or thin your bones are.

The result of the DXA scan is given as a “T score.” A score of –1 or higher means your bones are normal. If your score is between –1 and –2.5, it means your bones are thinner than normal (a condition called osteopenia). A score of –2.5 or lower means you have osteoporosis and are at higher risk of bone fracture. Based on this assessment, your doctor may recommend regular follow-up scans and steps to help protect your bones.²

If you are at risk of osteoporosis, your doctor may recommend treatment with a bone-targeted medicine to help strengthen your bones. These medicines work by slowing down the natural breakdown of bone, helping to prevent fractures.

There are two main types of bone-targeted treatments: one involves medicine injected under the skin that blocks a protein responsible for triggering bone loss, while the other includes bisphosphonates – drugs given as tablets or intravenously – that are absorbed by bone cells to help prevent bone breakdown.²

If your treatment increases your risk of bone loss, there are effective options to manage it. With proper assessment and monitoring, your care team can help protect your bone health during and after cancer treatment.

Nutrition to help with osteoporosis

Some breast cancer treatments can reduce your body’s levels of oestrogen, which can increase the risk of bone loss and osteoporosis. To help protect your bones, make sure you are getting enough calcium and vitamin D. Good sources of dietary calcium include dairy products, leafy greens like collard greens, broccoli or turnip greens, dried fruits, and seeds such as sunflower seeds. It is best to obtain calcium from food, as the body can absorb only about 400–500 mg at a time. If your doctor recommends calcium supplements, they will help you choose the right amount and type. Vitamin D is important because it helps your body absorb calcium effectively.²

Exercise for osteoporosis

If you are at risk of osteoporosis due to cancer treatment, regular exercise can help strengthen your bones and reduce the risk of fractures. Weight-bearing exercises—such as walking, jogging, dancing, stair climbing, and weight training—are especially helpful, because they work the bones and muscles against gravity.² The program should include resistance training to strengthen muscles and balance training to help prevent falls. Aerobic exercise is helpful, but it is best not to focus on it alone without also including strength and balance exercises.³ Always talk to your healthcare team before starting new exercises so they can help you choose the safest and most effective plan for you.

Sources

1. ESMO. Breast Cancer: A Guide for Patients. (2018).
2. ESMO. The Patient Guide on Bone Health in Cancer. (2022).
3. Giangregorio, L. M. et al. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos. Int. 25, 821–835 (2014).