The care of women initially diagnosed with breast cancer requires a team of specialists including a radiologist, surgeon, radiation oncologist, plastic surgeon, pathologist and medical oncologist. The surgeons and radiation oncologists are primarily focused on the treatment of the cancer within the breast. A medical oncologist is concerned with the treatment of cancer that may potentially be elsewhere in the body.
Past experiences with women treated with surgery, with or without radiation, alone for their breast cancer demonstrate that some patients will ultimately have their breast cancer turn up somewhere else in the body in the future. This indicates that the cancer had spread even before the local treatment of the breast occurred. On the other hand, many women are cured by surgery with/without radiation therapy alone. The challenge then is to identify those women whose breast cancer may have spread at the time of diagnosis and therefore would benefit from additional treatment. Unfortunately, at present there is no imaging or blood test that can accurately identify those women.
Thus, the decision regarding adjuvant therapy (from the Latin, adjuvantare – to aid) is made on the basis of the known factors regarding the primary breast tumor staging and biological characteristics. Adjuvant therapy options include chemotherapy, hormonal therapy for those tumors that are estrogen receptor-positive and Herceptin for those tumors that are positive for the HER-2/neu protein.
Factors important in making adjuvant treatment decisions include:
Additionally, recently available tests that look at the genetic makeup of an individual tumor can predict the relative effectiveness of hormonal therapy alone in estrogen receptor-positive tumors and the likely benefit of chemotherapy in those patients.
Ultimately, decisions regarding adjuvant therapy must weigh the benefits of therapy versus the risks of potential side effects and toxicity from the therapy. These decisions must be made in the context of evaluating breast cancer patients within the context of their overall health and incorporating individual patient preferences regarding risk tolerance. Thus, it is important to have an open dialogue regarding the risks and benefits of the adjuvant therapy and for the treatment decision be a joint one between the physician and the patient.