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Navigating Breast Cancer Treatments

New patients often face a confusing series of decisions. Here’s how to map the route to recovery.

Immune therapy

Another option for some women is an immune therapy called trastuzumab, which blocks the effects of a protein called HER2 found on the surface of a cancer cell and that signals it to grow. Between 15 percent and 25 percent of breast cancers produce excessive amounts of HER2, and these tumors tend to be more aggressive and more likely to occur. Trastuzumab reduces the risk of a recurrence by about 50 percent, and recent studies have shown a low incidence of the heart complications once thought to afflict people who had taken this drug.

Chemotherapy

Chemotherapy uses drugs to attack cancer cells. It can extend the life of women whose breast cancer has spread widely throughout their bodies. For women whose cancer is not known to have spread, it can reduce the risk of recurrence by about 25 percent. When given before surgery, it can even shrink large tumors enough to make lumpectomy a viable option.

When making decisions about chemo, most oncologists still focus on tumor size and whether the cancer has invaded the lymph nodes. But a more sophisticated test — Oncotype DX — is now available for women whose estrogen-receptor-positive cancer has not yet spread to lymph nodes. The diagnostic test looks at how 21 genes behave to evaluate a tumor’s aggressiveness and calculate the risk of a recurrence. "It really helps to assess the need for chemotherapy in these cases," Arun says.

Clinical trials

You may want to become part of a research study or clinical trial evaluating the safety and effectiveness of new treatments. In some cases, you might gain access to new therapies. But be sure you consult both your health team and the people running the trial so you’ll understand exactly what the potential drawbacks might be, including possible side effects. A tool on the National Cancer Institute's website allows visitors to search thousands of clinical trials by cancer type, location and treatment type.

Alternative therapies

While acupuncture, meditation or yoga won't fight cancer cells, these alternative therapies may help you manage the symptoms of the cancer and the effects of the treatments. Experts caution against "do-it-yourself" alternative therapies, particularly herbal supplements, which may interact with some chemotherapy drugs. Nevertheless, there is a growing discipline called "integrative oncology" that looks at treating the whole person with a combination of conventional treatments and complementary therapies.

"We have to find a way to integrate these approaches into our standard of care," Arun says. "It might not directly affect the cancer, but it can help with treatment or tumor-related symptoms."

Putting it all together

When all the test results are in, and you've discussed your options with people you trust, you’re likely to get a gut feeling about which treatment path to take, says Barbara Brenner, executive director of Breast Cancer Action, an advocacy group. "Trust your gut," she advises, "then try not to look backward."

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