Treatment given to weaken and destroy breast cancer BEFORE surgery is called neoadjuvant treatment. Neoadjuvant treatment isn't routinely used to treat early-stage breast cancer, but may be used if the cancer is large or aggressive.
One or more chemotherapy medicines usually make up a neoadjuvant regimen. The targeted therapy Herceptin (chemical name: trastzumab) and hormonal therapy sometimes also are given before surgery. Many women who receive neoadjuvant treatment get chemotherapy and other treatments after surgery, too. Treatments given after surgery are called adjuvant treatments. Adjuvant treatments are given to lower the risk of the cancer coming back (recurrence).
Some surgeons don't like to do lumpectomy (instead of mastectomy) after neoadjuvant chemotherapy. Because the neoadjuvant chemotherapy usually shrinks the breast cancer, the surgeons are concerned they won't be able to tell how much breast tissue was involved with the breast cancer and so won't know how much tissue to remove during lumpectomy. Not removing all the affected tissue can increase the risk of the cancer coming back in the breast area (loco-regional recurrence).
A study presented at the September 2011 Multidisciplinary Breast Cancer Symposium found no difference in the risk of loco-regional recurrence between women diagnosed with early-stage breast cancer who had neoadjuvant chemotherapy and then lumpectomy and women who had lumpectomy and then adjuvant chemotherapy. Instead of the timing of the chemotherapy, the characteristics of the cancer were what affected the risk of recurrence. The results suggest that lumpectomy still may be a good surgical choice for many women who will get neoadjuvant chemotherapy.
The researchers looked at the outcomes of nearly 3,000 women diagnosed with early-stage breast cancer who had lumpectomy; 88% of the women didn't get chemotherapy before surgery and 22% did.
Most of the women who got neoadjuvant chemotherapy had a good response:
- 93% had the cancer shrink significantly before surgery
- 20% had no cancer present by the time of surgery
Overall, the women who got neoadjuvant chemotherapy were no more likely to have a loco-regional recurrence than the women who got chemotherapy after surgery.
Still, when the researchers looked at the cancers' aggressiveness and the risk of recurrence based on patient variables (such as age) and cancer characteristics (such as size and hormone-receptor status), they found that the women who got neoadjuvant chemotherapy for more aggressive cancers were more likely to have a loco-regional recurrence than women who got neoadjuvant chemotherapy for less aggressive cancers.
Based on these and other results, experts think that lumpectomy is a good option for many women who will get neoadjuvant chemotherapy to treat early-stage breast cancer, but mastectomy may be a better choice for women who get neoadjuvant chemotherapy and have a high risk of loco-regional recurrence.
If you've been diagnosed with early-stage breast cancer and your doctor recommends chemotherapy before surgery, you may want to ask your doctor about this study, your risk of recurrence, and if lumpectomy (vs. mastectomy) is a good option for you based on your unique situation.