The choice of initial treatment is based on many factors. For stage I, II, or III cancers, the main considerations are to adequately treat the cancer and prevent a recurrence either at the place of the original tumor (local) or elsewhere in the body (metastatic). For stage IV cancer, the goal is to improve symptoms and prolong survival. However, in most cases, stage IV breast cancer cannot be cured.

• Surgery may consist only of breast lump removal (lumpectomy ), or partial, total, or radical mastectomy, usually with the removal of one or more lymph nodes from the armpit (axilla). Special procedures to find the most likely lymph nodes to which cancer may have spread (sentinel nodes) are often used.
• Radiation therapy can be directed at the tumor, the breast, the chest wall, or other tissues known or suspected to have remaining cancer cells.
• Chemotherapy is often used to kill cancer cells that may still remain in the breast or that may have already spread to other parts of the body.
• Biologicals are an entirely new type of anti-cancer drug. Biologicals can be used alone or with chemotherapy. Trastuzumab (Herceptin) is an example of this class of drugs. It affects how cancer cells function and grow. Some 20 - 25% of breast cancers respond to trastuzumab. Trastuzumab is not chemotherapy, but it may be combined with chemotherapy. Recent studies show that adding trastuzumab to chemotherapy or treating with trastuzumab after chemotherapy helps prevent the cancer from coming back and can make people who had HER2-positive breast cancer live longer.
• Hormonal therapy with tamoxifen is used to block the effects of estrogen that may otherwise help breast cancer cells to survive and grow. Most women with breast cancers which express estrogen or progesterone on their surface benefit from treatment with tamoxifen. A new class of medicines called aromatase inhibitors, such as Aromasin, have been shown to be as good or possibly even better than tamoxifen in women with stage IV breast cancer.

Most women receive a combination of these treatments. For stage 0 breast cancer, mastectomy or lumpectomy plus radiation is the standard treatment. However, there is some controversy on how best to treat DCIS. For stage 1 and 2 disease, lumpectomy (plus radiation) or mastectomy with at least "sentinel node" lymph node removal is standard treatment.

Chemotherapy with or without trastuzumab, hormone therapy, or both may be recommended following surgery. The presence of breast cancer in the axillary lymph nodes is very useful for staging and the appropriate follow-up treatment.

Stage III patients are usually treated with surgery followed by chemotherapy with or without hormonal therapy. Radiation therapy may also be considered under special circumstances.

Stage IV breast cancer may be treated with surgery, radiation, chemotherapy, hormonal therapy, or a combination of these (depending on the situation).

The stress of breast cancer can often be helped by joining a support group where members share common experiences and problems. See cancer support group.

The clinical stage of breast cancer is the best indicator for prognosis (probable outcome), in addition to some other factors. Five-year survival rates for individuals with breast cancer who receive appropriate treatment are approximately:

• 95% for stage 0
• 88% for stage I
• 66% for stage II
• 36% for stage III
• 7% for stage IV

The axillary (armpit) lymph nodes are the main passageway that breast cancer cells must use to reach the rest of the body. Their involvement at any time strongly affects the prognosis.

Chemotherapy and hormone therapy can improve prognosis in all patients and increase the likelihood of cure in patients with stage I, II, and III disease.

Even with aggressive and appropriate treatments, breast cancer often spreads (metastasizes) to other parts of the body such as the lungs, liver and bones. The recurrence rate is about 5% after total mastectomy and removing armpit lymph nodes when the nodes are found not to have cancer. The recurrence rate is 25% in those with similar treatment when the nodes have cancer.

Other complications can be the result of surgery, altered drainage of the lymph from the arm, radiation changes and treatment with chemotherapy and tamoxifen. But the results of delaying or avoiding early detection and treatment of breast cancer are far more distressing and often deadly.

See your health care provider if you are a man or a woman who notices any of the symptoms which could indicate breast cancer or:

• If you are a woman, 40 years or older, and have not had a mammogram in the last year.
• If you are a woman, 35 years or older, and have a mother or sister with breast cancer, or have already had cancer of the breast, uterus, ovary, or colon.
• If you are a woman, 20 years or older, and do not know how or need help to learn how to perform a breast self-examination.

Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1659-72.

Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84.

Menard S, Pupa SM, Campiglio M, Tagliabue E. Biologic and therapeutic role of HER2 in cancer. Oncogene. 2003 Sep 29;22(42):6570-8.