ABSTRACT
Treatment depends on the cause of the breast tumour and whether it is benign or malignant; treatment may be split into 3 modalities: 1 Conservative: patient and family education; refer to Macmillan nurses; offer genetic counselling; provide psychological assessment and support 2 Medical: prognosis of disease is assessed using the Nottingham Prognostic Index (NPI):
NPI = (0.2 × invasive size) + lymph node stage + grade of tumour
Medical therapy may be split into adjuvant hormone therapy, chemotherapy or
HER2 directed therapy, depending on the type of tumour Hormone treatment: premenopausal women are treated with tamoxifen (a selective oestrogen receptor modulator); postmenopausal women are treated with anastrazole (an aromatase inhibitor). This is because trials such as the ATAC trial have suggested that aromatase inhibitors are superior to tamoxifen in postmenopausal women. If a woman becomes menopausal during treatment she will benefit from switching medications Chemotherapy and radiotherapy regimens: vary depending on tumour type
HER2 directed therapy: treatment with trastuzumab (herceptin). This is a monoclonal antibody against the extracellular domain of the HER2 receptor 3 Surgical: the primary aim of surgery is to remove the invasive and noninvasive cancer with clear margins. Lumpectomy followed by a radiotherapy regime has been shown to be as effective as mastectomy, but mastectomy may be recommended in certain circumstances such as multifocal breast disease. The ipsilateral axilla should also be assessed with ultrasound, fine needle aspiration or core biopsy.
