Understand Your Conventional Treatment Options

You can expect breast cancer treatment recommendations to fall into one or a combination of three primary treatment modalities:

  • Surgery. An operation where doctors cut out cancer tissue.
  • Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
  • Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
  • Biological therapy. Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
  • Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer cells.

Surgery is the most frequently employed breast cancer treatment. It is best used when the cancer is small and has not moved to other parts of the body.

Radiation therapy is employed in approximately one-half of all breast cancer cases. It is often used in combination with other treatment options, for example after lumpectomy.

Chemotherapy is most often used when the cancer has spread or when it is thought the tumor needs to be reduced in size prior to surgery. Chemotherapy is often used in combination with radiation therapy and surgery in an attempt to prevent recurrence or control tumor growth.

Three other types of conventional medical treatment modalities are:

  • Hormonal: manipulates your body’s natural hormones
  • Biological/Immunotherapy: enhancing the body’s own immune function
  • Investigative: experimental programs

Hormonal treatment is used in breast cancers that depend on hormones such as estrogen and progesterone for their growth. Hormones are either removed, added, or their production is blocked through drugs. Cancer that is hormone-sensitive is slower growing and typically responds to hormone suppression treatment. Hormone-negative cancer does not call for this kind of treatment. To be sure, there are pharmaceuticals that seek to mitigate this condition. The most prominent hormone-suppressing drugs are tamoxifen and rolaxifene, often employed as a follow-up in an attempt to prevent recurrence.

Biologics/Immunotherapies include the cytokines like the family of interleukins and interferons, and are an attempt to boost or restore the body’s natural defense system. Many people believe immunotherapies will soon comprise a fourth widely accepted treatment modality.

HER-2 (human epidermal growth factor 2) positive breast cancer is one type of breast cancer. This is characterized by aggressive growth and typically linked with a poor prognosis. Approximately one in five breast cancers are HER-2+. While HER-2 refers to a genetic condition, the problem is not inherited but more likely the result of aging and less-than-healthful lifestyle. You can expect testing will be done to determine you’re her-2 status. While research is early, there is compelling evidence that HER-2 over-expression is one of those classic cases where improved lifestyle is able to stop the expression. Not surprisingly, there are drugs for HER-2 positive breast cancer patients. Commonly known as Herceptin and Tykerb, they are targeted immunotherapies and most often used in conjunction with other drugs. A long list of side effects can be viewed at http://www.drugwatch.com/ .
Investigative protocols are experimental. They are typically the last choice.

As you evaluate your conventional treatment options, please consider some of my personal observations from over a quarter-century of helping patients make informed choices:

  1. Surgery is the most common form of conventional treatment for breast cancer. It is also the most effective. Unless you are at stage 0 or stage IV, I urge you to consider the surgery. Generally, the only questions are mastectomy vs. lumpectomy, lymph nodes removal vs. sentinel lymph node dissection.
  2. If you agree to surgery, the decision as to who actually performs the procedure is yours. Your choice of surgeons is important. You’re more likely to get a well-qualified surgeon if you choose one who is a fellow of the American College of Surgeons and who is also board-certified in his or her field. Only about half of practicing surgeons are board-certified, so be sure to ask.

Special note to premenopausal breast cancer patients:

You typically have some flexibility on the timing of your surgery. Scientific evidence is mounting that fewer breast cancer recurrences are reported among women who choose to have their surgery during the luteal phase of the menstrual cycle, i.e., 14-30 days following the onset of menstruation. Except for one Canadian study which suggested Day 8 to be the optimal time, research shows surgery performed in the latter half of the menstrual cycle results in the fewest recurrences. You may have to assert yourself here; most surgeries are scheduled at the convenience of the surgeon and/or the hospital.

  1. Thoroughly understand chemotherapy. Before you say yes to chemotherapy, ask to see proof, such as scientific papers and reports, on the effectiveness of the treatment being offered. Examine the hard evidence that the suggested chemotherapy protocol actually cures, extends life, or improves quality of life. Those are the three “outcomes” against which you must measure all treatments—conventional, experimental, complementary, or alternative.
    If your clinician uses the terms “response” or “tumor response,” “surrogate markers” or “reduce the tumor burden,” these represent different standards. These terms mean shrinkage and a corresponding reduction in the immune-suppressive effect the tumor has. None of these terms are synonymous with “cure.”

The word cure must be used very carefully in breast cancer. In fact, if you find a clinician who uses the word loosely, in the context that he can guarantee a cure, don’t walk away—run! You deserve someone with more credibility.
A cure actually requires that your immune system eventually successfully keeps the cancer in check. Cure is more than treatment and indicates that your immune system can maintain a disease-free state.

Study the chemotherapy treatment option in depth. Do your own research. Ask about both short-term and longterm side effects. Request the names and phone number of long-term survivors who were treated with similar regimens. Ask them to share their experience. Know exactly what you can expect—and not expect—this recommended treatment option to accomplish. Once you possess that information, you are in a position to make a truly informed decision.

  1. The administration of chemotherapy is not an exact science. Ask your oncologist about chemotherapy sensitivity (in vitro) testing. Here, samples of your tissue are chemically analyzed in laboratory tests to determine interaction with different agents. In about a week, your oncologist will receive a report establishing which drugs are not likely to work as well as the most active agents. The net effect is a personalized treatment program optimized before you begin.
  2. Chemotherapy may be in pill form, to be taken by mouth or it may be in liquid form and injected into a muscle. But most commonly, chemo is given through a vein. The drugs may be administered in a daily, weekly, or monthly program for periods ranging from a few months to a lifetime. Side effects, once the fear of all patients, are now being more effectively controlled and vary widely from individual to individual. Refer in this book to #14, “Overcome Fatigue & Nausea,” for helpful actions you can take to control
    uncomfortable side effects.
  3. Radiation therapy is most often administered by means of an external beam machine. Internal radiation is becoming more common, where radioactive seeds are surgically implanted into or on the area to be treated. This procedure requires precision. You will maximize your opportunity for receiving excellent care if you choose a physician who is certified by the American Board of Radiology. Ask.

All breast cancers are treatable. Even in cases where the cancer is advanced, experimental investigative programs are available. If your cancer is not responding to conventional treatment, ask about hormonal treatment and biological response modifiers. Especially consider the many complementary and alternative programs described in this book. You are entitled to understand the full range of treatments available. From that understanding, you will have the knowledge and power to make the most intelligent treatment decisions.

Once again, conventional treatment has its important place. In interviews with thousands of cancer survivors, over 96-percent stated they initiated a course of conventional therapy. As much as I am exceedingly concerned about the probability that you may be over-diagnosed and over-treated, it is incorrect to report that cancer survivors turn exclusively to alternative, non-traditional cancer treatments.

In the late 1980’s, a Food and Drug Administration study estimated that 40- percent of cancer patients use nontraditional treatments. I believe the number may now be much higher, perhaps 70 to 80-percent. But clearly survivors do not give up the traditional treatments. They integrate complementary and alternative practices into a comprehensive recovery program. Breast cancer survivors go beyond treating the illness; they create health and healing. That is what this guidance is all about. Do the same.

An Essential Thing to Do

Ask your oncologist to explain the specific treatment options available to you in the areas of surgery, radiation, and chemotherapy. Ask also about hormonal, immunotherapy, and investigative programs. Ask for his or her recommendation. Record this information. Do not give your approval for treatment just yet. First, more work remains to be completed.

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