Are there any alternatives to chemotherapy for breast cancer after a mastectomy?

Hi Eli thank you for your direct to doctor query. Sorry to hear about your breast cancer diagnosis.

Whether you need chemotherapy depends on the stage of your cancer and specific cancer characteristics. I agree with Dr Lim Hwee Yong , there are very established treatment algorithms that is based on good scientific data according to breast cancer type.

I don't know the details of the histological report of your breast cancer but if you are still in a quandary about chemotherapy there are tests available to test genes in the cancer to predict risk of cancer coming back or to predict the likelihood of the benefit of chemotherapy. For example, for patients with early-stage, ER-positive, HER2-negative, node negative, and node-positive (1-3) breast cancer Oncotype Dx can be ordered.

The subject matter expert for chemotherapy would be oncologists like Dr Lim. So do get some opinions from them.

My input from my area of expertise surgical oncology is I would want to make sure that the cancer is removed with sufficient margins (completely removed) as that would impact on you cancer outcome. There is no reason why adequate margins cannot be obtained.

And wearing my plastic surgeon hat, I would say that chemotherapy is not a problem if you have had a reconstruction neither is it a problem if you are planning to do reconstruction after your chemotherapy treatment.

Wishing you all the best

Chemotherapy is an adjuvant treatment modalty aimed to reduce the overall risk of cancer recurrence. The benefit and need for chemotherapy can vary from patient to patient depending on the stage of cancer, cancer biology, patient baseline health status and relative age of the patient.

Stage 3 breast cancers will generally benefit from chemotherapy and omitting it may lead to a high chance of recurrence.

Depending on tumour biology and one of which is what we call the receptor status of the tumour ,will dictate if the patient is suitable for endocrine treatment (tablets).

In early breast cancers (Stage 1&2), endocrine therapy alone without chemotherapy can suffice provided the tumour biology is favourable, this needs to be dicussed with the patient's oncologist to assess the risk profile.

In the last decade, a new tool was developed to give an objective assessment if chemotherapy is necessary in a sub-group of patients with early breast cancers.This tool is known as the Oncotype Dx which asseses 21 gene profile from the individual's cancer that has been removed.

I would like to highlight some misconceptions that if one does mastectomy as oppossed to lumpectomy, then chemotherapy is not required.

The type of surgery chosen does not determine the need for chemotherapy as these are independent treatment arms to ensure a comprehensive treatment strategy for each individual which is usually tailored after discussions with both the surgeon and the medical oncologist.

The treatment of cancer has an established algorithm based upon many decades of established research and treatment data.

It is pretty much based upon:

• the stage of your cancer
• the appearance of your removed breast cancer samples under the microscope and also
• specific molecular or cancer genetic information

In some cases, we might need to do extended multiple gene array studies to determine the need for chemotherapeutic treatments.

Hence it is based upon good science. Whether you can tolerate the treatment depends again on multiple factors, including:

• personal factors (like your medical history and present physiological condition of your body)
• the type of chemotherapy regimen you require and
• what kind of preventive measures you receive

With proper preventive measures during treatment, chemotherapy can be well tolerated in this current age too. Hence, overall, it is important to take good medical advice and work closely with your oncologist for the best treatment you should receive. All the best wishes!

First and foremost, I am sorry to hear about your diagnosis of breast cancer and I hope you are recovering well from your surgery.

In the treatment of any cancer, it is always important to consider the stage of the tumour (how advanced it is, how much it has spread) and also certain features of the tumour which can affect how aggressive the tumour is (grade, hormone receptor status, HER2 protein status etc).

From your question, I am assuming your cancer surgeon has performed a mastectomy (whole breast removal) with clear margins and has advised you to go for chemotherapy.

Chemotherapy has certainly evolved through the years, and constant research and development has resulted in newer chemotherapy drugs with a much better side effect profile.

Furthermore, not every patient will have side effects, and the degree of the side effects can also vary within in the same patient from chemo cycle to cycle. Your oncologist will be the best person to talk to regarding these side effects, and they will be able to monitor and manage the side effects should they occur.

For breast cancer, certain patients may benefit from hormonal therapy. If your breast tumour contains hormone receptors, then hormone treatment can help prevent hormones from sticking to these receptors and thus prevent it from growing – even after the tumour has been removed, this may be beneficial to reduce your chances of recurrence.

Beauty, you have already battled your cancer halfway with your mastectomy. Chemotherapy and/or hormonal therapy will hopefully help you win the other half of your battle with cancer.

Remember, your breast surgeon and oncologist are trained professionals who are constantly updating their knowledge in the field of breast cancer management, and will be the best people to assist you in this journey. Do not hesitate to voice any concerns and worries you may have with them. I wish you the very best!