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).

After a breast cancer diagnosis, you may feel like you are in unfamiliar territory. It is important to focus on what you need, and to stay actively involved in decisions about your care. Remember that you also have clear rights as a patient. These include the right to receive understandable information about your diagnosis and treatment, the right to give or withhold consent, the right to privacy, and the right to access the care you need without discrimination. You have the right to ask questions, to see your medical records, to take the time you need to make decisions, and to choose the professionals you feel comfortable with. These rights exist to protect your dignity, ensure your safety, and support you in receiving care that respects your needs and values. Keeping them in mind can help you feel more empowered throughout your breast cancer journey.¹

Taking an active role, also known as self-advocacy, means learning about your diagnosis, treatment options, and the types of support available. Ask questions, share your concerns openly, and work together with your healthcare team to make decisions that feel right for you. It is important that treatment decisions are made collaboratively with your doctors, including how the treatment is given and what will work best for your daily life.²

Good communication with your care team is essential. Do not assume they know what you are worried about, tell them clearly. Studies show that oncologists may perceive your needs differently from you, and this communication gap can make the journey feel even harder.³

To help bridge this gap, make sure you get information about your diagnosis and treatment options in ways you can understand, both in writing and verbally. Do not hesitate to ask for information to be repeated if you need it, as many people remember information in pieces. Give yourself the space you need to ask questions, process the information and make sense of your options.²

It can help to prepare for appointments by making a list of questions in advance. Keeping a record of treatments, medications, and side effects can also make conversations easier. Consider bringing a friend or family member with you for support and remember that you have the right to discuss all aspects of your health, including sexual health and reproductive care.

By advocating for yourself and communicating openly with your care team, you can make sure your treatment truly reflects your needs and priorities, helping you feel more informed, supported, and confident throughout your care.

Sources

1. Active Citizenship Network. European Charter of patients’ rights. (2022).
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. Freyer, G. et al. HERmione: Understanding the Needs of Patients Living with Metastatic HER2-Positive Breast Cancer Through a Cross-Sectional Survey in Parallel with Patients and Oncologists. Cancers 17, 1349 (2025).

What can you do to improve your mental health?

As a man, you might find it difficult to talk about your feelings. That’s okay if you are comfortable with it. But it is very important that you do not try to “endure” mental stress. Just as pain can become a long-term problem, mental distress can also become persistent and negatively affect your therapy.

The following things can help you:

• Be aware that it is normal to feel upset and stressed.
• It can be very helpful to write down your thoughts – even for only yourself to read.
• Even though it can be difficult at first, talking can really help. Talk to your family, friends, acquaintances, your treatment team or other poeple in your situation. You could also take advantage of the many support services offered by cancer counselling centres and self-help groups.
• Exercise, art and meditation can also help to clear your head.
• Try to free yourself from thoughts of guilt.

Author: Dr. Volker Henn| Reviewer: Dr. Christian Keinki

Sources:

• Mental health and cancer. (2022, November 7). Cancer Research UK. Retrieved January 12, 2023, from https://www.cancerresearchuk.org/about-cancer/coping/mental-health-cancer
• Zhu, C., & Boutros, P. C. (2021). Sex Differences in Cancer Genomes: Much Learned, More Unknown. Endocrinology, 162(11). https://doi.org/10.1210/endocr/bqab170
• Rubin, J. B. (2022). The spectrum of sex differences in cancer. Trends in Cancer, 8(4), 303–315. https://doi.org/10.1016/j.trecan.2022.01.013
• Cancer and your emotions. (2019b, February 28). Macmillan Cancer Support. Retrieved January 12, 2023, from https://www.macmillan.org.uk/cancer-information-and-support/treatment/coping-with-treatment/cancer-and-your-emotions
• Managing Distress. (2020, February 3). American Cancer Society. Retrieved January 12, 2023, from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/emotional-mood-changes/distress/managing-distress.html