Overview

Screening

Management

The management of breast cancer depends on the staging, tumour type and patient background. It may involve any of the following:

• surgery
• radiotherapy
• hormone therapy
• biological therapy
• chemotherapy

Surgery

The vast majority of patients who have breast cancer diagnosed will be offered surgery. An exception may be a very frail, elderly lady with metastatic disease who may be better managed with hormonal therapy.

Prior to surgery, the presence/absence of axillary lymphadenopathy determines management:

• women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
  • if negative then they should have a sentinel node biopsy to assess the nodal burden
• in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
  • this may lead to arm lymphedema and functional arm impairment

Depending on the characteristics of the tumour women either have a wide-local excision or a mastectomy. Around two-thirds of tumours can be removed with a wide-local excision. The table below lists some of the factors determining which operation is offered:

Women should be offered breast reconstruction to achieve a cosmetically suitable result regardless of the type of operation they have. For women who've had a mastectomy this may be done at the initial operation or at a later date.

Radiotherapy

Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds. For women who've had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes