Breast cancer belongs in the garbage can. Period.
Breast cancer needs to be cut out and thrown away. Done. The end.
If only it were that simple. Many surgeons will tell you that it is that simple. Just cut out the tumor and be done with it. But breast cancer is a very complex disease that requires a mosaic of treatments from a multidisciplinary team dedicated to the destruction of breast cancer.
Breast cancer can spread, what we call metastasis, or “mets” for short. The word was first used to mean ‘rapid transition from one point to another.’ When breast cancer metastasizes, it rapidly moves from the breast to elsewhere in the body.
The process of metastasis is a very involved process with many necessary steps: the cancer must learn how to leave the breast and enter the bloodstream; the cancer must learn to survive in the bloodstream; the cancer must learn to leave the bloodstream; and the cancer must learn to survive and grow in its new environment.
What are the chances that the breast cancer has spread? We grade and stage breast cancers, to assess the chance of spread and the need for systemic treatment, i.e. chemotherapy. Low-grade breast cancers (Grade 1) have less of a chance than high-grade cancers (Grade 3) to have spread. Stage 1 cancers carry a low risk of spread; Stage 2 cancers carry a moderate risk; Stage 3 cancers carry a high risk; Stage 4 cancers have already spread.
Stage 1 breast cancers can be cut out and thrown in the garbage can; surgery is their primary treatment. Stage 2 breast cancers have a moderate risk of spread, so often chemotherapy will be necessary, in which case, you should probably have chemotherapy prior to surgery. Stage 3 cancers have a high risk of spread, so these tumors should almost always have chemotherapy prior to surgery. Stage 4 cancers have already spread and require systemic therapy. Rarely do Stage 4 tumors benefit from surgery.
Why should you have chemotherapy prior to surgery? Because most women with Stage 2 or Stage 3 breast cancer will benefit from chemotherapy. Chemotherapy prior to surgery opens up three opportunities that benefit women with breast cancer. (1) We can learn if the cancer is responsive to chemotherapy. If all of the cancer is gone after the administration of chemotherapy, then we know you will have a great chance at a long life free of breast cancer. If some of the cancer remains, then you may benefit from additional chemotherapy after surgery. (2) The breast cancer can be shrunken by chemotherapy so that at surgical removal, the risk of a positive margin will be less, and you will have a better cosmetic result. (3) Any breast cancer that has spread to your lymph nodes can be killed by chemotherapy, what we call “sterilizing the axilla.” If there is cancer in your lymph nodes, you will benefit from and need your lymph nodes removed or radiated and this puts you at risk for lymphedema. If chemotherapy can sterilize your lymph nodes, then you need no further treatment to your lymph nodes and you risk of lymphedema will be low.
In the next blog post, we will discuss the types of systemic therapy and chemotherapy that are optimal for the different subtypes of breast cancer.