Page last updated: October 2024
The information on this webpage was adapted from Understanding Breast Cancer - Information for people affected by cancer (2024 edition). This webpage was last updated in October 2024.
Expert content reviewers:
This information is based on Australian clinical practice guidelines for early breast cancer and international guidelines for advanced breast cancer. It was developed with the help of a range of health professionals and people affected by breast cancer:
- Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre, NSW
- Prof Bruce Mann, Specialist Breast Surgeon and Director, Breast Cancer Services, The Royal Melbourne and The Royal Women’s Hospitals, VIC
- Dr Shagun Aggarwal, Specialist Plastic and Reconstructive Surgeon, Prince of Wales, Sydney Children’s and Royal Hospital for Women, NSW
- Andrea Concannon, consumer
- Jenny Gilchrist, Nurse Practitioner Breast Oncology, Macquarie University Hospital, NSW
- Monica Graham, 13 11 20 Consultant, Cancer Council WA
- Natasha Keir, Nurse Practitioner Breast Oncology, GenesisCare, QLD
- Dr Bronwyn Kennedy, Breast Physician, Chris O’Brien Lifehouse and Westmead Breast Cancer Institute, NSW
- Lisa Montgomery, consumer
- A/Prof Sanjay Warrier, Specialist Breast Surgeon, Chris O’Brien Lifehouse, NSW
- Dr Janice Yeh, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC
Treatment for early or locally advanced breast cancer varies from person to person. The treatment that is best for you will depend on:
- your test results
- where the cancer is in the breast
- the stage and grade of the cancer
- whether the cancer is hormone receptor and/or HER2 positive or triple negative
- your age and general health
- what treatment you want to have.
Treatment for breast cancer usually includes surgery. Before surgery, however, you may have other types of treatment to shrink the cancer. This is called neoadjuvant treatment.
Surgery
The type of surgery your doctor suggests will depend on the type and stage of the cancer, where it is in the breast, the size of your breast, and what you prefer.
In most cases, you will have one or more lymph nodes removed from the armpit (called axillary surgery). Some people also choose to have a new breast shape made during the operation (breast reconstruction).
The two different types of surgery used for breast cancer are:
- breast-conserving surgery – when only part of the breast is removed
- mastectomy – when the whole breast is removed.
Depending on your situation, you may have a choice between the two types of surgery. Research has shown that for most early breast cancers, having breast-conserving surgery followed by radiation therapy works just as well as a mastectomy.
The operations have different benefits, risks and side effects. Talk to your doctor about the best option for you.
Treatment before surgery
While surgery is often the main treatment for both early and locally advanced breast cancer, you may have other treatments before surgery. Called neoadjuvant treatment, it may be discussed at an Multidisciplinary Team meeting.
Chemotherapy is often used before surgery (neoadjuvant chemotherapy or NAC). Or, you may have hormone therapy, targeted therapy or immunotherapy, or a combination of these treatments.
Neoadjuvant treatment can help to reduce the size of the cancer before surgery and improve your chance of having a good outcome. It may also mean you can have less complex surgery.
For locally advanced breast cancer, for example, neoadjuvant treatment may mean you can choose to have breast-conserving surgery rather than a mastectomy.
In some cases – particularly for people with HER2+ or triple negative cancers – neoadjuvant treatment can kill all cancer cells. Called a complete pathological response, it improves the chance of a good outcome.
Ask your doctor if neoadjuvant treatment is an option for you. People with early breast cancer may find the Neoadjuvant Patient Decision Aid helpful.
After surgery, you may have radiation therapy, chemotherapy, hormone therapy, targeted therapy or immunotherapy. This is called adjuvant treatment. It helps to destroy any cancer cells that remain after surgery
Breast-conserving surgery
Removing only part of the breast is called breast-conserving surgery. It is also known as a lumpectomy or wide local excision. The surgeon removes the tumour and some of the healthy tissue around it, so that you can keep as much of your breast as possible.
The operation will leave a scar, and it may change the size and shape of the breast and the position of the nipple.
Pathology tests on breast tissue
A pathologist looks at the removed tissue under a microscope to check for an area of healthy cells around the cancer (called a clear margin).
The pathologist will also give information about:
- the size and grade of the cancer
- whether the cells are hormone receptor positive and/or HER2+ or triple negative
- whether the cancer has spread to any lymph nodes.
If your removed tissue shows multiple cancers, each cancer will be tested separately. The pathology report will help your doctors work out what other treatment may be best for you.
If there are cancer cells found close at the edge of the tissue (which is called an involved or positive margin), there is a higher risk of the cancer returning. You may need to have further surgery to remove more tissue (a re-excision or wider excision).
Your doctor may also suggest that you have a mastectomy. After having breast-conserving surgery, you will usually then have radiation therapy to destroy any cancer cells that may be left in the breast or armpit.
Mastectomy
Surgery to remove the whole breast is called a mastectomy. One breast may be removed (single or unilateral mastectomy) or both breasts (double or bilateral mastectomy). A mastectomy may be recommended if:
- there is cancer in more than one area of the breast
- the cancer is large compared with the size of the breast
- it is difficult to get a clear margin around the tumour
- you have inflammatory breast cancer
- you have had radiation therapy to the same breast before and so cannot have it again
- the cancer has come back or you have a new cancer in the same breast
- you have the BRCA1 or BRCA2 gene mutation.
You may prefer to have a mastectomy instead of breast-conserving surgery – even if you have a very small cancer. You will not usually have radiation therapy after a mastectomy, although it may be offered in some situations.
The nipple is often removed in a mastectomy. In some cases, however, the surgeon may perform a skin-sparing or nipple-sparing mastectomy. This means that more of the normal skin (with or without the nipple) is kept.
If you have decided to have a reconstruction, and can have a skin-sparing or nipple-sparing mastectomy, the reconstruction is sometimes done at the same time.
If you don’t have a reconstruction, you have the option of wearing a soft breast form with a specially designed bra while your surgical wound heals. Breast Cancer Network Australia (BCNA) provides a free bra and temporary soft form.
Speak to your breast care nurse for more details. After the wound has healed and the area is comfortable, you have the option to be fitted for a permanent breast prosthesis.
What about the other breast?
If you need a mastectomy because of cancer in one breast, you may think it’s safer to have the other breast removed as well. For most people, the risk of getting cancer in the other breast is low.
If you have the BRCA1 or BRCA2 gene or another rare breast cancer gene mutation, this does increase the risk of developing another breast cancer, so you may choose to have a double mastectomy (bilateral mastectomy) to remove both breasts.
Whether to have a double mastectomy is a complex decision. It is best to talk with your treatment team about the risks and benefits before making a final decision.
Breast reconstruction
Breast reconstruction is surgery to make a new breast shape (also called a breast mound). There are different ways to construct a breast shape. It can be done using:
- implants
- a flap of your own skin, fat or muscle (an autologous reconstruction)
- a breast implant and your own tissue.
A breast reconstruction can be done at the same time as a mastectomy (immediate reconstruction); or you may prefer to wait for several months or years before having a reconstruction (delayed reconstruction).
If you are not having an immediate reconstruction but might consider it in the future, discuss this with your surgeon before surgery. This will help them to plan the mastectomy.
Some people decide not to have a reconstruction and prefer to “go flat”, while others choose to wear a breast prosthesis.
Removing lymph nodes
Cancer cells that spread from the breast usually first spread to the axillary lymph nodes, which are in and around the armpit. Removing some or all of these lymph nodes helps your doctor to check for any cancer spread.
The operation to remove lymph nodes is called axillary surgery. It is usually done during breast surgery but may be done in a separate operation. There are two main types of axillary surgery.
- Sentinel lymph node biopsy (SLNB) – When breast cancer spreads outside the breast, it first goes to a particular lymph node or nodes in the armpit or near the breastbone (sternum). These are called the sentinel nodes. A sentinel node biopsy finds and removes them so they can be tested for cancer cells . If there are no cancer cells in the sentinel nodes, no more lymph nodes are removed. If there is more than a small amount of disease in the sentinel nodes, you may have axillary lymph node dissection or radiation therapy.
- Axillary lymph node dissection (ALND) – If cancer is found in the lymph nodes, then most or all of the axillary lymph nodes (usually 10–25) may be removed to reduce the risk of the cancer coming back (recurrence) in the armpit. The nodes are tested and the results guide what other treatment may be needed. ALND is also called axillary lymph node clearance (AC). Radiation therapy may be used instead of ALND.
- Side effects – You may have arm or shoulder stiffness, weakness and pain; numbness in the arm, shoulder, armpit and parts of the chest; fluid collecting near the surgical scar (seroma); lymphoedema; and cording. Side effects are usually worse after ALND than after an SLNB because more lymph nodes are removed in an ALND.
Finding the sentinel nodes
To work out which lymph nodes are sentinel nodes, one or a combination of these procedures is used:

- Lymphatic mapping – A small amount of a harmless radioactive solution is injected into the skin over the breast cancer tumour. A CT scan is then taken to show which lymph nodes the radioactive solution flows to first. These are most likely to be the sentinel nodes. Lymphatic mapping is done either the day before or on the day of the surgery.
- Dye injection (not always used) – If dye is being used, it will be injected into the breast. The dye, which may be blue or green, moves into the lymphatic vessels and stains the sentinel nodes first. This is done under general anaesthetic during the surgery. Because of the dye, you may notice blue-green urine (wee) and bowel movements (poo) when you go to the toilet the next day. You may also have a blue patch on the breast for weeks or longer. Your skin may look a bit grey but will fade once the dye washes out in your urine.
- Handheld probe – As well as looking at where the dye travels to first (if used), the surgeon uses a small handheld device called a probe during the surgery to detect the radioactive solution injected during the lymphatic mapping. This helps to check that the sentinel nodes have been located and the surgeon can then remove them for testing.
What to expect after surgery
If you have any questions about your recovery and how best to look after yourself when you get home, ask the doctors and nurses caring for you.
If you are referred to a breast care nurse, they can give you information and provide support.
McGrath Breast Care Nurses are registered nurses specifically trained to support people with breast cancer from the time of diagnosis and throughout treatment.
Your hospital stay will depend on the surgery you have and how well you recover:
- breast-conserving surgery – you usually go home that day or may stay overnight
- mastectomy – you usually stay in hospital for one to two nights
- reconstruction after mastectomy – you usually stay in hospital for several days.
Tips for recovering from surgery
- Dressings and tubes – a dressing will cover the wound to keep it clean. This may be changed while you are in hospital but is usually removed after about a week. You may have one or more drainage tubes to drain fluid from the surgical site into a bottle. These can stay in place for up to one week, or occasionally two weeks. Nurses will show you how to look after the wound and drainage tubes at home, or a community nurse, GP or your surgeon may help you. If you notice redness or discharge around the surgical area or develop a fever over 38°C, let your treatment team know immediately.
- Recovery time – the time it takes to recover from surgery will depend on the type of surgery you have had and your health. You may feel better after a few days, or it may take several weeks or longer if you have had a mastectomy with a reconstruction.
- Avoid heavy lifting – do not do vigorous physical activity or heavy lifting in the initial weeks after surgery. Your treatment team will let you know when you can resume normal activities. You may be given some gentle exercises to reduce the risk of shoulder stiffness.
- Shower carefully – keep the wound clean, and gently pat it dry after showering. Avoid baths.
- Manage pain – while in hospital, you will have pain relief through a drip (intravenous or IV), an injection or as tablets. You will also be given pain medicine when you go home. You are likely to need stronger pain relief after an ALND or a mastectomy than after breast-conserving surgery
- Preventing blood clots – while in bed, you should try to do some deep breathing exercises, and move your legs around to help prevent blood clots in the deep veins of your legs (deep vein thrombosis or DVT). As soon as you are able, you will be asked to get up and walk around. You may wear elastic (compression) stockings or use other devices to help prevent clots. Your doctor might prescribe medicine that reduces the risk of blood clots forming.
- Avoid cuts – your treatment team may advise you to wait until the wound has completely healed if you want to shave or wax your armpits.
- Moisturise – gently massage the area with moisturiser once any stitches or adhesive strips are removed and the wound has completely healed. About six weeks after surgery, your surgeon may suggest that you use silicone gels and sheets to reduce scarring.
Side effects of surgery
Some common side effects are discussed below. Talk to your treatment team about the best ways to deal with them.
- Fatigue – Cancer treatment and the emotional impact of the diagnosis can be tiring. Fatigue is common and may continue for weeks or months. Research shows that exercise during and after cancer treatment is safe and can help improve fatigue. Cancer Council may run an exercise program near you – call 13 11 20. You can also ask your GP if you are eligible for some Medicare-funded sessions with an exercise physiologist or a physiotherapist.
- Shoulder stiffness – Arm and shoulder pain, weakness, stiffness and reduced movement are common after surgery and after radiation therapy. Ask your treatment team when you can start exercising your arm. A physiotherapist or exercise physiologist can show you exercises to reduce shoulder stiffness or pain. This may help prevent lymphoedema.
- Numbness and tingling – Surgery can bruise or injure nerves. You may feel numbness and tingling in the armpit, upper arm or chest area. You may also notice a loss of feeling in your breast or nipple. These changes often improve within a few weeks but may take longer. Sometimes the numbness or tingling may not go away completely. A physiotherapist or occupational therapist can give you exercises that may help.
- Seroma – Fluid may collect in or around the surgical scar and cause a balloon-like swelling. This is most common after a mastectomy. A seroma can also develop in the armpit after an ALND. The build-up of fluid can be uncomfortable but is not harmful. Some breast care nurses, your specialist or GP, or a radiologist can drain the fluid using a fine needle and a syringe. This procedure is not painful, but it may need to be repeated over a few appointments.
- Lymphoedema – Fluid building up in the tissue of the arm or breast may cause swelling after any lymph node surgery. It is common to have some swelling of your arm or breast after surgery, but this usually settles in the weeks afterwards. If this swelling builds up over weeks or months, this usually means you have lymphoedema. It can happen any time, even years after surgery (or radiation therapy) to the lymph nodes.
- Post-mastectomy pain – It is rare to have prolonged pain after a mastectomy but you may find the scar uncomfortable for some time. If pain or discomfort is ongoing, let your treatment team know.
- Cording – Also known as axillary web syndrome, cording is caused by hardened lymph vessels. It feels like a tight cord running from your armpit down the inner arm, sometimes to the palm of your hand.
What your breast looks like after surgery
How your breast will look after surgery depends on the type of surgery that you have, as well as the size of your breast and your body shape. It can take up to a few weeks for any bruising and swelling of the surgery area to go away.
- After breast-conserving surgery – The size and position of the scar will depend on how much tissue was removed. The scar will usually be less than 10 cm and near where the cancer was or around the areola or near the breast fold. But this can vary depending on your breast size and how much breast tissue needs to be removed. It can also change if you need to have further surgery to remove more tissue. If a larger area needs to be removed, surgical techniques known as oncoplastic surgery can reshape the breast after breast-conserving surgery.
- After a mastectomy – The scar will be across the skin of the chest. If you have surgery to remove the lymph nodes, the scar will also be in the armpit. At first the scar will be firm, slightly raised and red. Over the next few months, it will flatten and fade.
Impact on self-esteem
Scars or changes to how your breast looks can affect how you feel about yourself (self-image and self-esteem). If you have had a mastectomy (or part of your breast removed), it’s common to feel a sense of loss. It may also affect your sense of identity.
Talking to someone who has had breast cancer surgery can be helpful. Cancer Council’s Cancer Connect program may be able to link you to others who have had a similar experience.
Speaking with a counsellor or psychologist for emotional support and coping strategies can also help. Call Cancer Council 13 11 20 for details.
Breast appearance after surgery
What your breast will look like after surgery varies from person to person. It will depend on the type of surgery you have and how much tissue is removed.
The pictures below give some examples of how your breast might look but ask your surgeon for more photographs to help you choose the best approach for you.

Radiation therapy
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill cancer cells or damage them so they cannot grow, multiply or spread.
The radiation is usually in the form of x-ray beams. It does not cause you to become radioactive during the period of treatment. Radiation therapy may be recommended:
- after breast-conserving surgery – usually a part of standard treatment
- after a mastectomy – you may have radiation to the chest wall and lymph nodes above the collarbone, and sometimes lymph nodes next to the breastbone
- if the sentinel node has cancer cells – you may have radiation to the armpit instead of ALND
- after neoadjuvant chemotherapy and before surgery
- after adjuvant chemotherapy.
You will usually start radiation therapy within eight weeks of surgery. If you’re having chemotherapy after surgery, radiation therapy will begin about 3–4 weeks after chemotherapy has finished.
Planning radiation therapy
Treatment is carefully planned to cause the most harm to the cancer cells and to limit damage to the surrounding healthy tissues. Planning involves several steps, which may occur over a few visits. You will have a planning session at the radiation therapy centre.
During this appointment, you will have a planning CT scan of the area to be treated. Sometimes marks are put on your skin so the radiation therapists can ensure you are lined up correctly each time you are treated.
These marks are usually small dots (tattoos), and they may be temporary or permanent. Talk to your radiation therapists if you are worried about these tattoos. Invisible tattoos are available in some centres.
If you have had breast-conserving surgery, the surgeon can sometimes place tiny markers (called fiducial markers) in your breast tissue to show where the cancer used to be.
This helps the radiation oncology team to deliver the radiation therapy more precisely. You may be asked to try a deep inspiration breath hold (DIBH) technique. This involves taking and holding a deep breath for 20–30 seconds during treatment.
DIBH helps to inflate the lungs and move the heart away from the radiation field, reducing the risk of heart damage.
Having radiation therapy
You will probably have radiation therapy daily from Monday to Friday for 1–6 weeks. Most people have radiation therapy as an outpatient and go to the treatment centre each day. Each radiation therapy session will be in a treatment room.
Setting up the machine can take 10–30 minutes, but the actual treatment takes only 1–5 minutes. You will lie on a table under the machine and your breast will be exposed.
The radiation therapist will leave the room and then switch on the machine, but you can talk to them through an intercom. Radiation therapy is not painful, but you will need to lie still while it is given.
Most people will be lying on their back with their arms up. If DIBH is recommended for you, the radiation beam will only be turned on when you are in the DIBH position.
If you are having radiation therapy at a private centre, Medicare will cover some of the cost, but your private health insurance may not, so you may have to pay some of the cost yourself (out-of-pocket costs).
If you are worried about the cost, speak to your treatment team about having treatment in a public hospital.
Side effects of radiation therapy
Radiation therapy may cause the following side effects:
- Skin problems – You may have some redness around the treated area. The skin may become dry and itchy, blister, or become moist and weepy. It usually returns to normal 4–6 weeks after radiation therapy ends. Sometimes skin can become very irritated or peel (radiation dermatitis). You may need dressings, or special creams or gels, to help the area heal.
- Tiredness – You may start to feel tired 1–2 weeks after radiation therapy begins. Fatigue usually gets better a few weeks after treatment finishes.
- Aches – You may feel minor aches or shooting pain in the breast area during or after radiation therapy. It should ease over time.
- Swelling – Some people have swelling or fluid build-up in the breast (breast oedema or lymphoedema) that can last for up to a year or longer. Radiation therapy to the armpit increases the risk of swelling in the arm (lymphoedema).
- Hair loss – Radiation therapy to the breast won’t make you lose the hair on your head, but you will usually lose hair from the treated armpit.
- Other side effects – Late effects can develop months or years after radiation therapy. Part of the lung behind the treatment area may become inflamed, causing a dry cough or shortness of breath. There is a slight risk of heart problems, but this usually happens only if you have treatment to your left breast or if you smoke. Hardening of tissues (fibrosis) may happen months or years after treatment. In rare cases, radiation therapy may cause a second cancer.
Get support
A cancer diagnosis can affect every aspect of your life. You will probably experience a range of emotions – fear, sadness, anxiety, anger and frustration are all common reactions.
To find good sources of support and information, you can talk to the social worker or breast care nurse at your hospital or treatment centre, or get in touch with Cancer Council 13 11 20.
Contact cancer support
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or slow their growth. It may be used before or after surgery. It is often used for breast cancers that are not sensitive to hormone therapy, are HER2+ or triple negative, or for inflammatory breast cancers.
Chemotherapy is sometimes used for hormone receptor positive breast cancers.
Having chemotherapy
Different types of chemotherapy drugs are used. The choice of drugs will depend on the type of cancer, how far it has spread and what other treatments you are having. Usually, you will have a combination of drugs.
Common drugs include carboplatin, cyclophosphamide, docetaxel, doxorubicin, epirubicin and paclitaxel. Your treatment team may also refer to the drugs by their brand names, or letters like AC or TC.
Your medical oncologist will talk to you about the most suitable types of chemotherapy drugs, as well as their risks and side effects.
Generally, chemotherapy is given through a vein (intravenously). You will usually be treated as an outpatient, but occasionally you may have to stay in hospital overnight. Chemotherapy is usually given once every 1–3 weeks for 3–6 months.
Side effects of chemotherapy
Chemotherapy damages cells as they divide. This makes the drugs effective against cancer cells, which divide rapidly. However, some normal cells – such as hair follicles, blood cells and cells inside the mouth or bowel – also divide rapidly.
Side effects happen when chemotherapy damages these normal cells. Unlike cancer cells, normal cells can recover, so most side effects are temporary.
- Nausea – You may feel sick for a few hours or days after each treatment. Not everyone feels sick, and you’ll be given medicine to help prevent it. Some medicines may cause constipation; talk to your doctor about this.
- Diarrhoea – You may have loose, watery stools and feel like you urgently need to go to the toilet. You may be given medicine to manage diarrhoea.
- Hair loss – You may lose the hair from your head and other areas of the body (e.g. eyebrows, underarms and pubic area). Cold caps may prevent hair loss on your head in some cases.
- Swelling (oedema) – Some medicines used with chemotherapy drugs can cause excess fluid (fluid retention) to build up in the body. This can affect the arms and the trunk, but it usually gets better when treatment ends.
- Changes to fertility – Chemotherapy can cause infertility in females and males. If you may want to have children in the future, it’s essential that you talk to your cancer specialists about your options and ask for a referral to a fertility specialist before treatment starts.
- Heart problems – The risk is small but chemotherapy can sometimes damage the heart muscle (cardiomyopathy). Your heart health will be checked before, during and after treatment. If you are at risk of heart damage, you may be offered other types of drugs.
- Peripheral neuropathy – You might develop tingling in your hands or feet. This is called peripheral neuropathy.
- Other side effects – These include an increased infection risk, fatigue, mouth ulcers, constipation, and memory changes.
Hormone therapy
Hormone therapy, also called endocrine therapy or hormone-blocking therapy, slows or stops the effect of oestrogen. It is used to treat breast cancer that is hormone receptor positive.
Hormone therapy is often used to lower the risk of the cancer coming back. It may also be used to reduce the risk of certain conditions, including LCIS and some DCIS, developing into invasive breast cancer.
There are different types of hormone therapy. The type used will depend on your age, type of breast cancer and if you have reached menopause
Learn more
Tamoxifen
Tamoxifen can be used at any age, whether you have been through menopause or not. You need to take a daily tablet for 5–10 years.
Side effects
In females, tamoxifen can cause menopausal symptoms, although it doesn’t bring on menopause. It may also cause changes in thinking and memory, and vaginal discharge.
There is a very small risk of developing cancer of the uterus (endometrial cancer), particularly if you have gone through menopause. Always let your treatment team know if you have any unusual vaginal bleeding.
In males, side effects can include low sex drive (libido) and erection problems. Tamoxifen increases the risk of blood clots.
See a doctor immediately if you have swelling, soreness or warmth in an arm or leg, or a sudden shortness of breath or chest pain.
You are unlikely to have all of these side effects, and they usually improve with time. Your doctor and breast care nurse can help you to manage side effects.
Tell your doctor if you take an antidepressant. Some types of antidepressant drugs may affect how well tamoxifen works
Aromatase inhibitors
After menopause, the ovaries stop making oestrogen. However, both females and males make small amounts of oestrogen in body fat and the adrenal glands.
Taking aromatase inhibitors will help reduce how much oestrogen is made in the body. This is important because oestrogen can cause some cancers to grow.
Aromatase inhibitors (e.g. anastrozole, exemestane and letrozole) are mostly used if you have been through menopause, have had your ovaries removed, or are male.
They may be used if you have not been through menopause but have a high risk of the cancer returning. You may also be given a drug to stop the production of oestrogen (e.g. goserelin).
This can be started before or after chemotherapy but must be continued while you take the aromatase inhibitor.
Side effects
Aromatase inhibitors can cause menopausal symptoms such as vaginal dryness and low mood. These drugs may also cause itchiness, joint pain, and weakening of the bones (osteoporosis).
Your bone health will be monitored during treatment and you may be prescribed a drug to protect your bones. Consider seeing a physiotherapist or exercise physiologist for an exercise plan.
If you have arthritis, aromatase inhibitors may worsen joint stiffness and pain. Exercise or medicines from your doctor may help. Your doctor may also suggest changing to one of the other types of aromatase inhibitor.
Ovarian suppression
If you have not been through menopause, drugs or surgery can stop the ovaries from producing oestrogen. This is called ovarian suppression.
It may also be recommended as an additional treatment for people taking tamoxifen or for premenopausal women taking an aromatase inhibitor instead of tamoxifen.
Temporary ovarian suppression
The drug goserelin stops oestrogen being made. It is given as an injection into the abdomen (belly) once a month for 2–5 years to bring on temporary menopause.
Side effects are similar to those of permanent menopause.
The drug may also help protect the ovaries during chemotherapy, so it is often given to women who want to preserve their fertility.
Permanent ovarian treatment
Ovarian ablation is rarely needed, but this procedure permanently stops the ovaries from producing oestrogen. It usually involves surgery to remove the ovaries (oophorectomy). Sometimes radiation therapy is used.
Ovarian ablation will bring on permanent menopause. This means you will no longer be able to fall pregnant naturally.
Targeted therapy
Targeted therapy drugs attack specific features of cancer cells to stop the cancer growing and spreading. Different types of targeted therapy drugs are used for different types of breast cancer.
HER2-targeted agents
For early or locally advanced HER2+ breast cancer, the most common targeted therapy drug used is trastuzumab. Your treatment team may refer to trastuzumab by a brand name (e.g. Herzuma, Kanjinti or Ogivri).
It is also known as Herceptin, although this version is now rarely used in Australia.
Trastuzumab works by attaching itself to HER2+ breast cancer cells, destroying the cells or reducing their ability to divide and grow. It also encourages the body’s own immune cells to help find and destroy cancer cells.
Usually used in combination with chemotherapy drugs for early breast cancer, trastuzumab can increase the effect of the chemotherapy. Trastuzumab can be given through a drip into a vein (infusion) or as an injection under the skin.
The first infusion takes about 90 minutes (called the loading dose). The following infusions each take 30–60 minutes.
You will usually have a dose every 3 weeks, for up to 12 months. The first 4–6 doses are given while you are having chemotherapy treatment.
Side effects
Side effects are usually caused by the chemotherapy drugs, and often ease once chemotherapy finishes and you are having trastuzumab only.
Side effects from trastuzumab are uncommon, but can include headache, fever and diarrhoea. In some cases, trastuzumab can affect how the heart works, so you will have tests to check your heart function before and during treatment.
Other drugs
Several new drugs have been developed to treat HER2+ breast cancer with or after trastuzumab. These include: pertuzumab, which is given before surgery (neoadjuvant); and trastuzumab emtansine (T-DM1), which is given after surgery (adjuvant).
Your doctor will let you know if these drugs are appropriate for you.
CDK inhibitors
Abemaciclib is a type of cyclin-dependent kinase (CDK) inhibitor. It is used with hormone therapy.
Abemaciclib may be used after surgery and chemotherapy for larger, high-risk ER+, HER2– breast cancers, for cancers involving several lymph nodes, or cancers at high risk of returning.
Another drug (ribociclib) may soon become more widely available.
Side effects
Nausea or diarrhoea may occur, but this can be managed. Your blood count may be affected, so regular blood tests are needed.
PARP inhibitors
There are several new drugs for people who have inherited a BRCA mutation, or whose cancer has developed BRCA mutations. These are called poly (ADP-ribose) polymerase (PARP) inhibitors and include the drug olaparib.
Ask your doctor if this may be suitable for you.
Immunotherapy
Immunotherapy is a treatment that uses the body’s own immune system to fight cancer. A drug called pembrolizumab may be used for people with certain types of triple negative breast cancer.
Pembrolizumab is used together with a chemotherapy drug. Pembrolizumab is given through a vein (intravenously), and treatments usually take about 30 minutes.
Side effects of immunotherapy
These may be caused by the immunotherapy, the chemotherapy or both. Common side effects include a rash, fatigue, diarrhoea (which can be severe), breathlessness, joint pains, diabetes, nerve problems, muscle weakness and dry eyes.
It can cause inflammation in other organs, including the thyroid, pituitary gland, liver, kidneys and pancreas. It can also affect the adrenal gland, which can lead to low levels of certain hormones (e.g. cortisol).
If you notice these or any other side effects, it’s important to let your treatment team know – some side effects can be life-threatening if left untreated. Most side effects, however, can be managed if they are reported early.
Sometimes, immunotherapy may need to be stopped or interrupted. Side effects from immunotherapy can occur for up to 12 months after the last dose was given. Pregnancy should be avoided during this time.
Learn more
Treatment for advanced breast cancer
Advanced breast cancer is different from locally advanced breast cancer. Locally advanced breast cancer is cancer (larger than 5 cm) that has spread to tissue around the breast or to a large number of lymph nodes.
Advanced breast cancer is cancer that has spread to more distant body parts. It is also called metastatic or secondary breast cancer.
Breast cancer can spread to many different parts of the body, but it is most likely to spread to the bones, liver, lungs or brain.
The treatment for advanced breast cancer varies from person to person. It will depend on the type of breast cancer and where in the body the cancer has spread.
The treatment for advanced breast cancer aims to control the spread of the cancer and relieve any symptoms you may develop. You may have one or more of the following treatments:
In some cases, radiation therapy may be used to reduce the size of the cancer and to relieve pain. Surgery is not often used for advanced breast cancer, but it may be used to treat cancer in the bones, lungs, brain or liver.
While it’s not possible to cure advanced breast cancer at this time, these treatments may improve quality of life for many months and sometimes years. For more information related to advanced breast cancer, see our other resources:
Breast Cancer Network Australia has more detailed information about advanced breast cancer.