Sequence of Treatment

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Your team of doctors will most likely recommend a particular sequence of treatment. Here is the most common "pathway":

  • Usually surgery is first. For some women, surgery to remove the breast cancer and surgery to reconstruct the breast happen during the same operation.
  • If chemotherapy is going to be part of your care, it is often given second.
  • Radiation therapy usually follows surgery and chemotherapy (when chemotherapy is given).
  • A hormonal therapy (such as tamoxifen or an aromatase inhibitor) is often started after the other treatments have been given if the cancer is hormone-receptor positive.

There are many exceptions to this sequence, however, or other treatments given. There are also many other variations in timing and sequence.

Talk with your doctor to determine the best sequence of treatment for you. While it may seem premature, it's also important to talk to your doctor and possibly a plastic surgeon about your options for breast reconstruction BEFORE you have cancer-removing surgery.

If you will be getting chemotherapy or radiation to treat breast cancer, your immune system will be weakened. If you had chicken pox as a child and you’re 50 or older, your age and your weakened immune system can put you at higher risk for shingles, a painful, blistering rash caused by the same virus that causes chicken pox. There is a shingles vaccine and in most cases it’s better to get it before you start breast cancer treatment. If your immune system is weakened, you shouldn’t get the vaccine until you’re done with treatment and your immune system is at full strength again.

If you had chicken pox as a child and are 50 or older, it’s a good idea to ask your doctor if getting the shingles vaccine before you start breast cancer treatment makes sense for you. While shingles can still flare up even if you get the vaccine, the rash is usually less painful and less severe.

For help understanding your diagnosis and treatment options, you can also use My Breast Cancer Coach. My Breast Cancer Coach is a questionnaire designed to help you better understand your type of breast cancer so you can focus on the information that's most relevant to you.

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