The first treatment for breast cancer is often surgery to remove it. After surgery, you may have treatments to reduce the risk of the cancer coming back. These treatments include:

• chemotherapy
• radiotherapy
• hormonal therapy
• targeted therapy drugs, such as trastuzumab.

Some women have treatments before they have surgery. Drugs called bisphosphonates are sometimes given to reduce the risk of breast cancer coming back. They can also be used to protect your bones from the side effects of treatments, such as hormonal therapies.

Your doctors look at different factors to help decide which treatments are likely to work best for you. These include:

• the stage and grade of the cancer
• if the cancer cells have oestrogen receptors (ER positive)
• if the cancer has HER2 receptors (HER2 positive).

Your cancer doctor and specialist nurse will explain the treatments that they think are best for you. They can help you to make decisions about your treatment.

Treatments for breast cancer are improving. Better treatments mean that more women are cured or living longer. Your cancer doctor may ask you if you would like to take part in a research trial.

Surgery

Your surgeon will talk to you about having one of these operations:

• breast-conserving surgery – this is where the cancer and some surrounding normal breast tissue is removed
• a mastectomy – this is when the whole breast is removed.

You will usually need some, or all, of the lymph nodes in your armpit removed. This is done with both these operations. Some women also have surgery to make a new breast shape (breast reconstruction) during the operation. Others choose to have this done at a later time.

Treatment before surgery

Some women have treatments such as chemotherapy or hormonal therapy before breast cancer surgery. You may have these treatments to:

• shrink a larger cancer to make it easier to remove with surgery
• treat a cancer that is growing more quickly.

Treatment after surgery

Your cancer doctor will usually offer you one or more of the following treatments after surgery. These treatments can reduce the risk of the cancer coming back and include:

• radiotherapy
• chemotherapy
• hormonal therapy
• targeted therapy

Your cancer doctor and specialist nurse will talk to you about the most effective treatments available to you. They may use an online tool such as Predict. Predict is designed to help women and their doctors make informed decisions about treatment after surgery for breast cancer.

It can show how much treatments may reduce the risk of the cancer coming back. You might find it helpful, especially if your cancer doctor has asked you to decide about whether to have chemotherapy.

Sometimes, doctors may suggest having a tumour profiling test on the cancer cells. This gives more information about the risk of the cancer coming back. It may help you to decide about having chemotherapy after breast cancer surgery.