The aim of treatment for breast cancer and the types of treatment recommended depend on the type, stage and location of the cancer and the patient’s age, health and preferences.

Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation

Surgery for early breast cancer includes:

• breast-conserving surgery or mastectomy
• sentinel node biopsy +/-/or axillary dissection
• oncoplastic surgery
• reconstruction immediately after a mastectomy or delayed to an appropriate time.

Neoadjuvant therapy, usually chemotherapy may be appropriate for patients with:

• triple-negative or HER2-positive cancer
• locally advanced or inflammatory breast cancer
• large operable cancers, with the aim of reducing the tumour size.

All patients with:

• invasive cancer should be considered for systemic therapy
• hormone receptor-positive cancer should be considered for endocrine therapy.

Adjuvant bisphosphonates improve survival and should be considered for selected patients being treated for breast cancer with curative intent.

Radiation therapy may be beneficial for:

• patients with early breast cancer after breast-conserving surgery
• selected patients after a mastectomy.

Partial breast irradiation can be considered for selected patients with early breast cancer.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Surgery should ideally occur within 5 weeks of the decision to treat (for invasive breast cancer) or 4–6 weeks after neoadjuvant systemic treatments are complete.

Neoadjuvant chemotherapy should begin within 4 weeks of the decision to treat.

Adjuvant chemotherapy should begin within 6 weeks of surgery.

Adjuvant chemotherapy for triple-negative breast and HER2-positive breast cancer should begin within 4 weeks of surgery.

Endocrine therapy should begin as soon as appropriate after chemotherapy, radiation therapy and/or surgery is complete (and in some cases will be started during neoadjuvant treatment).

Radiation therapy should begin 3–4 weeks after chemotherapy, or within 8 weeks of surgery, for patients who do not have adjuvant chemotherapy.