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Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?
Get the facts
Your options
- Have chemotherapy after your surgery for early-stage breast cancer.
- Don't have chemotherapy.
Key points to remember
- Chemotherapy ("chemo") is often used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
- Some women have a very low risk of cancer coming back and don't need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
- Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
- Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren't.
- The drugs used for chemo can be very expensive. Insurance policies don't always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.
What is breast cancer?
Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.
When is chemotherapy used to treat early-stage breast cancer?
The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy ("chemo") and hormone therapy, that may help keep cancer from coming back.
Some people think of added treatment as an insurance policy designed to destroy any cancer cells that may still be in the body.
It isn't possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive (ER+) breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.
The type of added treatment you have depends on the stage and classification of your breast cancer:
- Stage: How far the cancer has spread in your breast and whether it has spread to nearby tissues or other organs is called the stage. This is one of the most important things in choosing the treatment option that is right for you. If breast cancer cells have spread to your lymph nodes, there is a greater risk that they may also have spread to other places in your body. Added treatment, including chemo, may help destroy cancer cells in your body.
- Classification: Breast cancer is classified according to what the cancer cells look like under a microscope. This tells your doctor how fast the cancer cells are growing and dividing and where they may have started in the breast tissue. If your cancer cells are growing and dividing quickly, then chemo may help you. When cancer is the kind that grows quickly, doctors call it "aggressive" or "poorly differentiated."
What are the risks of chemotherapy?
Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.
Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.
Short-term side effects can include:
- Nausea and vomiting.
- Loss of appetite.
- Fatigue.
- Hair thinning or hair loss.
- Mouth sores.
- Diarrhea.
- Increased chance of bruising, bleeding, and infection.
- Memory and concentration problems.
Long-term side effects of chemotherapy can include:
- Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones (osteoporosis).
- Concentration problems that may last for many months after your treatments are finished.
- In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.
Why might your doctor recommend chemotherapy?
Your doctor might recommend chemotherapy ("chemo") after surgery if:
- You are younger than 35. Women younger than 35 usually have a more aggressive type of breast cancer.
- Your breast cancer was bigger than a pea. Breast cancers that are at least 1 cm (0.4 in.) are more likely to come back later.
- Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the cancer may also have spread to other places in your body.
Your doctor may use a genetic test to find your risk for having your cancer come back. Or your doctor may use a computer program, such as Adjuvant!, to estimate your chances of having your breast cancer come back. This information can help you and your doctor decide about chemotherapy.
Compare your options
Compare
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
|
- Most chemotherapy (chemo) medicines are injected into a vein in your hand or arm. This is called an IV. Sometimes the medicine is a pill that you take at home. Sometimes it's a combination of the two.
- You will go to a hospital or clinic for each IV treatment, but you won't stay overnight. Treatments last from 10 minutes to an hour or longer.
- You have a number of treatments several weeks apart. A complete course of chemotherapy may take a few months or a whole year.
- Some women need to have a special catheter inserted if it's hard to find a vein for the IV. This catheter stays in place between treatments.
- Chemo may help keep breast cancer from coming back.
- Breast cancer may come back anyway.
- Short-term side effects may include such things as nausea and vomiting, fatigue, hair loss, and mouth sores.
- Long-term side effects may include early menopause.
- You will have regular checkups with your doctor to make sure that the cancer hasn't come back.
- You avoid the side effects of chemo.
- Depending on what type of breast cancer you have and how far it has spread, there may be a higher chance of your cancer coming back.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about choosing chemotherapy for breast cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was diagnosed with breast cancer 3 years ago. It was quite a shock. Even though my breast cancer was small and I did not have any cancer cells in my lymph nodes, I decided to take chemotherapy. My doctor said that even though it would not guarantee that the cancer would not come back, it would improve my chances for a cure. I was really worried about the side effects, but they were not that bad. I just wanted to do everything in my power to beat this breast cancer. My checkups have been fine so far, so I think I made the right choice.
Laurel, age 43
I was diagnosed with breast cancer about 3 years after I went through menopause. My breast cancer was small, and I did not have any cancer in my lymph nodes. I stopped taking my menopause hormones, had surgery and radiation, and have been taking tamoxifen ever since. I see my doctor a couple of times a year and so far have been okay. I'm going to ask my doctor if I'm a good candidate for switching to something like Arimidex. I hear that it's a smart choice for some women.
Marty, age 56
I found out about my breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that my cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help.
Brenda, age 50
I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Fortunately, my breast cancer was really small, and it hadn't traveled to the lymph nodes under my arm. My doctor used the Adjuvant! program and said that my chances of the cancer coming back were small, so I decided not to have the chemo. I keep in close contact with my doctor and really feel great. I think that passing on the chemo was the right decision for me.
Janice, age 40
I was diagnosed with breast cancer just last year. Thank goodness I have been having those mammograms. My breast cancer was small, and I didn't have any cancer in the lymph nodes. I stopped taking my menopause hormones, and my doctor suggested that I try a medication called tamoxifen. I had a few hot flashes, but nothing bad. I feel really good and continue to see my doctor for checkups. I will take the tamoxifen for 2 years and then take something else. Who knows what will be on the market by then?
Paula, age 61
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat my breast cancer.
I would rather wait and see if my cancer comes back before I have more treatment.
I would have strong feelings of failure if my breast cancer returned.
I know there's no way to know for sure whether chemo would keep my cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without treatment, to monitor my breast cancer.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having chemo
NOT having chemo
What else do you need to make your decision?
Check the facts
Is chemo the main treatment for early-stage breast cancer?
- YesNo, it's not a main treatment. Chemotherapy is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.
- NoYou're right. Chemotherapy is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.
- I'm not sureIt may help to go back and read "Get the Facts." Chemo is an added treatment, a sort of insurance policy designed to kill any cancer cells that may still be in your body after surgery.
Should every woman with early-stage breast cancer have chemotherapy?
- YesNo, not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.
- NoYou're right. Not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.
- I'm not sureIt may help to go back and read "Get the Facts." Not every woman will need chemo. It depends on what type of breast cancer she has and how far it has spread.
Are the side effects of chemo always bad?
- YesNo, some women are not bothered by side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting.
- NoThat's right. Some women are not bothered by side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting.
- I'm not sureIt may help to go back and read "Get the Facts." Some women are not bothered by side effects.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Douglas A. Stewart, MD - Medical Oncology |
Breast Cancer: Should I Have Chemotherapy for Early-Stage Breast Cancer?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Have chemotherapy after your surgery for early-stage breast cancer.
- Don't have chemotherapy.
Key points to remember
- Chemotherapy ("chemo") is often used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
- Some women have a very low risk of cancer coming back and don't need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
- Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
- Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren't.
- The drugs used for chemo can be very expensive. Insurance policies don't always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.
What is breast cancer?
Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumor. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.
When is chemotherapy used to treat early-stage breast cancer?
The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy ("chemo") and hormone therapy, that may help keep cancer from coming back.
Some people think of added treatment as an insurance policy designed to destroy any cancer cells that may still be in the body.
It isn't possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive (ER+) breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.
The type of added treatment you have depends on the stage and classification of your breast cancer:
- Stage: How far the cancer has spread in your breast and whether it has spread to nearby tissues or other organs is called the stage. This is one of the most important things in choosing the treatment option that is right for you. If breast cancer cells have spread to your lymph nodes, there is a greater risk that they may also have spread to other places in your body. Added treatment, including chemo, may help destroy cancer cells in your body.
- Classification: Breast cancer is classified according to what the cancer cells look like under a microscope. This tells your doctor how fast the cancer cells are growing and dividing and where they may have started in the breast tissue. If your cancer cells are growing and dividing quickly, then chemo may help you. When cancer is the kind that grows quickly, doctors call it "aggressive" or "poorly differentiated."
What are the risks of chemotherapy?
Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.
Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.
Short-term side effects can include:
- Nausea and vomiting.
- Loss of appetite.
- Fatigue.
- Hair thinning or hair loss.
- Mouth sores.
- Diarrhea.
- Increased chance of bruising, bleeding, and infection.
- Memory and concentration problems.
Long-term side effects of chemotherapy can include:
- Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones (osteoporosis).
- Concentration problems that may last for many months after your treatments are finished.
- In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.
Why might your doctor recommend chemotherapy?
Your doctor might recommend chemotherapy ("chemo") after surgery if:
- You are younger than 35. Women younger than 35 usually have a more aggressive type of breast cancer.
- Your breast cancer was bigger than a pea. Breast cancers that are at least 1 cm (0.4 in.) are more likely to come back later.
- Your breast cancer has spread to the lymph nodes under your arm. If that's the case, there is a bigger chance that the cancer may also have spread to other places in your body.
Your doctor may use a genetic test to find your risk for having your cancer come back. Or your doctor may use a computer program, such as Adjuvant!, to estimate your chances of having your breast cancer come back. This information can help you and your doctor decide about chemotherapy.
2. Compare your options
| Have chemotherapy after surgery | Don't have chemotherapy | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about choosing chemotherapy for breast cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was diagnosed with breast cancer 3 years ago. It was quite a shock. Even though my breast cancer was small and I did not have any cancer cells in my lymph nodes, I decided to take chemotherapy. My doctor said that even though it would not guarantee that the cancer would not come back, it would improve my chances for a cure. I was really worried about the side effects, but they were not that bad. I just wanted to do everything in my power to beat this breast cancer. My checkups have been fine so far, so I think I made the right choice."
— Laurel, age 43
"I was diagnosed with breast cancer about 3 years after I went through menopause. My breast cancer was small, and I did not have any cancer in my lymph nodes. I stopped taking my menopause hormones, had surgery and radiation, and have been taking tamoxifen ever since. I see my doctor a couple of times a year and so far have been okay. I'm going to ask my doctor if I'm a good candidate for switching to something like Arimidex. I hear that it's a smart choice for some women."
— Marty, age 56
"I found out about my breast cancer earlier this year. I don't have a family history of it or any of the risk factors that you read about. I chose to have a lumpectomy. My doctor had some gene tests done on the tissue that was removed during my surgery. The tests showed that my cancer was not very aggressive and that chemotherapy would not be helpful for me. So instead I'm taking letrozole every day. I am glad that there are tests for women with ER+ cancer that can show if chemo will help."
— Brenda, age 50
"I got breast cancer 2 years ago. What a surprise! I don't have any family history (that I know of), and I don't have the other risk factors that my doctor talked to me about. Fortunately, my breast cancer was really small, and it hadn't traveled to the lymph nodes under my arm. My doctor used the Adjuvant! program and said that my chances of the cancer coming back were small, so I decided not to have the chemo. I keep in close contact with my doctor and really feel great. I think that passing on the chemo was the right decision for me."
— Janice, age 40
"I was diagnosed with breast cancer just last year. Thank goodness I have been having those mammograms. My breast cancer was small, and I didn't have any cancer in the lymph nodes. I stopped taking my menopause hormones, and my doctor suggested that I try a medication called tamoxifen. I had a few hot flashes, but nothing bad. I feel really good and continue to see my doctor for checkups. I will take the tamoxifen for 2 years and then take something else. Who knows what will be on the market by then?"
— Paula, age 61
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat my breast cancer.
I would rather wait and see if my cancer comes back before I have more treatment.
I would have strong feelings of failure if my breast cancer returned.
I know there's no way to know for sure whether chemo would keep my cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without treatment, to monitor my breast cancer.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having chemo
NOT having chemo
5. What else do you need to make your decision?
Check the facts
1. Is chemo the main treatment for early-stage breast cancer?
- Yes
- No
- I'm not sure
2. Should every woman with early-stage breast cancer have chemotherapy?
- Yes
- No
- I'm not sure
3. Are the side effects of chemo always bad?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Douglas A. Stewart, MD - Medical Oncology |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: June 28, 2011
Author: Healthwise Staff
Medical Review: Sarah Marshall, MD - Family Medicine & Douglas A. Stewart, MD - Medical Oncology
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