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Breast cancer adjuvant therapy options
By Mayo Clinic staffWhen it comes to adjuvant therapy, you do have choices: whether you're going to have adjuvant therapy at all, and if so, what kind.
Types of adjuvant therapy
Adjuvant therapy is a form of therapy added to the primary treatment — surgery to remove the tumor — to keep cancer from returning. Adjuvant therapy can include:
- Chemotherapy
- Radiation
- Hormone therapy
- Targeted or biological therapy
- Any combination of the above
If your doctor believes you're at high risk of breast cancer recurrence, he or she will likely recommend adjuvant therapy to try to prevent your breast cancer from coming back.
Adjuvant therapy can be either local or systemic:
- Local adjuvant therapy targets a specific location in hopes of destroying any cancer cells remaining after surgical removal of a tumor. Local adjuvant therapy refers to radiation therapy.
- Systemic adjuvant therapy targets the entire body in hopes of destroying any cancer cells that may have traveled to more distant parts of the body. Systemic adjuvant therapy includes chemotherapy, hormone therapy, targeted therapy or a combination of these.
Factors in your decision
Several key factors can help you make an informed decision about adjuvant therapy. They include:
- Age. Younger women, especially those 35 and younger, sometimes have more aggressive breast cancer. In addition, younger women have more "at risk" years — future years during which the cancer has a chance to recur. Your age and whether you have entered menopause may be factors in your decision making.
- Size of primary tumor. Women with small tumors — 2 centimeters (slightly more than 3/4 of an inch) or less in diameter — usually have better outcomes than do women with larger tumors, especially tumors larger than 5 centimeters (about 2 inches) in diameter.
- Spread to lymph nodes under the arm. With invasive breast cancer, your surgeon removes some of the lymph nodes in the armpit (axilla) to look for cancer cells that may have spread from the breast. If cancer is found in these lymph nodes, there's a greater chance that cancer cells may have spread to other parts of your body as well.
- Microscopic appearance of cells. The grade of a tumor refers to how the cells look under a microscope. Tumor cells that resemble normal breast cells are called "well differentiated." Those that look very different are called "poorly differentiated." Moderately differentiated cells fall somewhere in between. Higher grade tumors — those with poorly differentiated cells — are more likely to spread than are low grade tumors.
- Hormone sensitivity of cancer cells. Hormone (estrogen or progesterone) receptor positive cancer cells tend to grow less aggressively than do hormone receptor negative tumors, and they may respond to hormone therapy, whereas hormone receptor negative tumors will not.
- Human epidermal growth factor receptor 2 (HER2) status. HER2 plays a role in cell growth and differentiation and is associated with a greater risk of cancer recurrence and possibly an increased risk of resistance to some anti-cancer drugs. Newer treatments that directly target the HER2 protein are available, but they only help those women whose tumors are HER2-positive.
When deciding about adjuvant therapy, also consider these key questions:
- Is there evidence that adjuvant therapy helps women with a similar cancer live longer or have a lower chance of their cancer coming back?
- What's the chance of your breast cancer coming back?
- How much will adjuvant therapy help to reduce the chance of cancer returning?
- What are the side effects of adjuvant therapy?
- Do you and your doctor think that the potential benefits outweigh the risks?
- How will you feel if your cancer returns, and you did take adjuvant therapy?
- How will you feel if your cancer returns, and you didn't pursue adjuvant therapy?
Other factors
Medical scientists are working to find additional factors that can help predict who will benefit from adjuvant therapy. These include:
- Proliferation markers. Flow cytometry — a technique for examining microscopic particles — estimates the rate at which cancer cells divide (S phase fraction) and how many chromosomes are in the cells (DNA content). Cells that have a high proliferative rate divide more rapidly, tend to be faster growing and generally are associated with poorer outcomes.
- Gene expression. Looking at the gene pattern present in a breast cancer cell may help your oncologist predict the chance that your cancer will recur. Gene expression tests are also being studied as a tool to tell doctors which women will benefit most from chemotherapy.
- Cytochrome P450 2D6 (CYP2D6). CYP2D6 is an enzyme that plays an important role in your body's metabolism of the anti-estrogen drug tamoxifen. In women who metabolize CYP2D6 poorly, either because of a genetic variation or concurrent drug therapies, tamoxifen may not be very effective. Specialized genetic testing for CYP2D6 metabolism may predict which women would be better off taking tamoxifen or an aromatase inhibitor as adjuvant therapy.
Recommendations about new tests will evolve as scientists continue to study and gain a better understanding of breast cancer.
Chemotherapy for breast cancer Welcome to Adjuvant therapy for breast cancer guide
