About treatment for breast cancer

Surgery is the most important treatment for breast cancer. Many patients are cured after their operation.

However even after successful surgery, almost all patients are offered some additional treatment. This is called adjuvant therapy, and it improves the chance of permanent cure. The treatments can just be to the surgical area (radiotherapy) or to the entire body (hormone tablets or chemotherapy).

Until about 15 years ago, doctors thought of breast cancer as a single illness. Chemotherapy was used for all patients. But with further lab research it has become clear that there are different types of breast cancer. Some scientists think there could be as many as ten, which behave in completely different ways, and each type needs its own individualised treatment. Some of these breast cancers definitely need treatment with chemotherapy, others may not.

The commonest form of breast cancer is the hormone sensitive type, in which the individual cancer cells depend on the female hormone oestrogen to help them grow.

The OPTIMA study is concerned with this type of breast cancer. It is usually referred to as oestrogen receptor (ER) positive and HER2 negative. We have very strong evidence that there is substantial benefit from taking hormone tablets for five to ten years.

But we are less certain about the benefit of chemotherapy for all such patients. For some patients with this diagnosis, we think that chemotherapy may not provide any benefit, and it is more important to start effective hormone tablet treatment immediately.