Pathway for early breast cancer

Before treatment, a multidisciplinary team meeting (MDM) will be held to determine the course of treatment. Such a team would normally include a surgeon, radiologist, pathologist, medical oncologist and a radiation oncologist. Breast care nurses and radiographers will usually be present at these meetings too. If women are diagnosed with breast cancer during pregnancy, an obstetrician and a gynaecologist (if appropriate) will also make up the team.

Depending on the pathology of the cancer, the size of the tumour and scale of lymph node involvement, treatment may be local or systemic, and chemotherapy, if required, may be given in the adjuvant or neo-adjuvant setting.

Adjuvant treatment

1. Patients receive surgery first in the adjuvant setting. The pathology of tumour is determined at the time of surgery (e.g. hormone receptor status) to decide treatment options. Lymph node involvement is determined by axillary sampling or sentinel lymph node biopsy at the time of surgery.
   
2. If no lymph nodes are involved, patients will go on to receive radiation therapy. This is followed by targeted endocrine therapy. If patients are HER2+, they will receive Herceptin for 12 months before hormonal therapy.
   
3. If lymph nodes are involved, the affected nodes are removed either via sentinel node biopsy or axillary dissection. Patients then receive systemic treatment in the form of chemotherapy, followed by radiation therapy and targeted endocrine therapy. If patients are HER2+, they will receive Herceptin for 12 months before endocrine therapy.

Neo-adjuvant treatment

1. In certain cases, patients receive systemic treatment before surgery. Neo-adjuvant chemotherapy is recommended for patients with inflammatory or inoperable locally advanced breast cancer, without evidence of metastases, and may be considered for patients with large breast tumours who have a preference for breast conserving surgery.
   
2. After surgery, radiation therapy is given, followed by targeted endocrine therapy. If patients are HER2+, they will receive Herceptin for 12 months before endocrine therapy.

Guidelines for treatment

The Management of Early Breast Cancer- Evidence-based Best Practice Guidelines details treatment recommendations and best practice guidelines.

Neoadjuvant Patient Decision Aid is a guide for women who are considering breast cancer treatment with chemotherapy and/or hormonal therapy before surgery.