Breast Cancer and Adjuvant Therapy

Understanding Your Treatment Decisions

During my first visit with an oncologist, he kept using the term "adjuvant chemotherapy" in reference to future treatments for me. Since he never called it just "chemotherapy," I assumed that this was worse, or somehow different from the standard drug treatments that I'd often heard about. Then he went on to plan out "adjuvant hormone therapy." What I really needed was an "adjuvant medical interpreter" to translate what he was telling me.

So I'm going to do some translating for you, and hope that you will be better informed than I was before making your treatment decisions.

In order to help you understand more about adjuvant systemic therapy and treatment decisions, I looked up what the experts say in UpToDate -- a trusted electronic reference that is used by many of the oncologists who treat breast cancer patients.

You may or may not choose to have adjuvant systemic therapy. Regardless, you will need to know which treatments will be best for you. Start by reading this excerpt to see why adjuvant therapy may be important for you.

Introductory Discussion: Adjuvant systemic therapy for hormone-responsive early stage breast cancer in postmenopausal women From UpToDate

Following surgery, systemic (bodywide) anticancer treatment may be given to eliminate any microscopic tumor cells that might remain in the body. This type of therapy is called adjuvant therapy, and it is an important component of breast cancer treatment. Adjuvant systemic therapy significantly decreases the chance that the cancer will return (or recur), and it also improves a woman's chance of surviving her cancer.
Basics About Adjuvant Systemic Therapy For Breast Cancer

What is Adjuvant and Neoadjuvant Treatment?
The most basic meaning of adjuvant is "giving additional support." Adjuvant treatment is any type of cancer therapy given after breast cancer surgery. Its purpose is to make sure that any stray cancer cells that you may still have are killed, which helps lower your risk of recurrence.

Neoadjuvant treatments are those that may be given before surgery, to shrink tumors before those are removed.

What is Systemic and Localized Treatment?
Systemic treatment for cancer gets to nearly every tissue in your entire body and has the potential to impact every cell in your body. Localized treatments (such as radiation) are limited to a specific area of your body, and affect only the tissue that is targeted by the treatment. Breast cancer is an uncivilized disease that will use your lymph and blood systems to wander throughout your body. Systemic treatments are designed to make your body an inhospitable place for cancer, by traveling everywhere the cancer may have gone, and interfering with its growth and cell division. Healthy cells are also affected along the way, which may temporarily cause side effects.

What Are Options for Adjuvant Systemic Therapy?
Your oncologist may discuss several types of adjuvant treatments with you, depending on your surgery type and breast cancer diagnosis.

You will need to know the status of your lymph nodes, hormone receptors and HER2/neu expression. Once you have the results of those tests, you may consider three options for treatment.

  • Chemotherapy: Opinions differ on which patients will benefit most from chemotherapy, but having a tumor expression test like the Oncotype DX assay may tip the balance on this decision. Within the United States, national guidelines state that these patients should have chemo:
    • Positive lymph nodes, HER2-negative breast cancer, and any hormone receptor status
    • Negative lymph nodes, HER2-negative breast cancer, hormone receptor positive, high grade tumors that are >1 cm or 0.6 to 1.0 cm
    • Metastatic breast cancer, regardless of HER2 and hormone receptor status
  • Targeted biological therapy: These treatments are aimed at specific processes of cancer cell growth, division and lifecycle (or, in some cases, the blood vessels nourishing a tumor), and can be given for HER2 positive, HER2 negative, and metastatic disease.
  • Endocrine therapy: Given for tumors that are estrogen positive (ER), progesterone positive (PR), or both. Treatments may include Selective Estrogen Receptor Modulators (SERMs) and Aromatase Inhibitors (AIs).
Want to learn more? See UpToDate’s topic, "Adjuvant systemic therapy for hormone-responsive early stage breast cancer in postmenopausal women.," for additional in-depth, current and unbiased medical information on breast cancer, including expert physician recommendations.


Kathleen I Pritchard, MD, FRCPC, "Adjuvant systemic therapy for hormone-responsive early stage breast cancer in postmenopausal women." UpToDate. Accessed: February 2009.

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