Breast cancer treatment has come a long way — from aggressive, one-size-fits-all treatments to more targeted and personalized therapies. This journey reflects our deeper understanding of cancer and underscores the importance of treating patients as individuals with unique needs.
For much of history, breast cancer was seen as a localized disease. The primary focus was on removing the tumor through surgery, often at great physical and emotional cost to the patient. Over time, we’ve come to understand that breast cancer can be a systemic disease — one that can spread through the bloodstream, even after surgery.
Surgery alone used to cure only about 20% of invasive breast cancer cases. Today, thanks to earlier detection and additional therapies, those numbers have significantly improved, but surgery remains just one piece of the puzzle.
Hormone therapy
In the 1970s, we saw a major breakthrough with the introduction of hormonal therapy, specifically tamoxifen. This medication works by blocking estrogen receptors on breast tissue cells, preventing estrogen from fueling cancer growth. Although tamoxifen had side effects like menopausal symptoms and an increased risk of blood clots, those side effects had to be balanced against the ability to lower the likelihood of breast cancer returning after surgical treatment.
Later, aromatase inhibitors were developed, offering an alternative for postmenopausal women by decreasing the amount of estrogen circulating in the body. These therapies marked a turning point in how we approach treatment.
Chemotherapy
Chemotherapy became a standard part of care in the 1980s. While effective at killing rapidly dividing cancer cells, it often causes severe side effects — hair loss, nausea and a weakened immune system — as it can’t distinguish between cancerous and healthy, fast-growing cells.
Over the years, however, we’ve developed more targeted therapies to identify molecules on the surface of the cancer cells that are unique or specific to that cancer. Then, those molecules are used to create drugs that attack and kill those cancer cells. Therefore, there's less damage to the body's normal tissue and fewer side effects.
For example, trastuzumab (Herceptin), introduced in the early 2000s, targets specific proteins on cancer cells, minimizing damage to healthy tissue and improving outcomes for patients with HER2-positive breast cancer. It's been very effective and has changed how we treat those tumors.
Immunotherapy
Another significant advancement is immunotherapy, which harnesses the body’s own immune system to fight cancer. Our immune system is designed to recognize and attack abnormal cells and abnormal things in your body. But cancer is smart and often develops mechanisms to thwart this effort so cancer cells continue to grow and thrive.
Medications like pembrolizumab (Keytruda) have shown promise in treating triple-negative breast cancers, cancers that don’t respond to other hormonal therapies. Immunotherapy offers hope to patients who previously had limited options.
Surgery
Even surgical approaches have become less invasive. In the late 1990s, sentinel lymph node biopsy was introduced. By identifying and removing only the first few lymph nodes likely to be affected, this technique reduces the need for extensive lymph node removal, often leading to complications like lymphedema. More recent studies suggest that in select patients with early-stage breast cancer or small tumors, even sentinel node biopsies may not always be necessary, further reducing surgical burden.
Radiation therapy
Radiation therapy has also evolved. Once a crude tool, it’s now used with precision to target cancer while sparing healthy tissue. Techniques like partial breast radiation and optimized timing and dosage have significantly improved outcomes and reduced side effects. There have been a lot of refinements in the technique of radiation for taking care of breast cancer patients. It still is not a method that would replace surgery unless the patient is not a surgical candidate, but it's an essential part of taking care of breast cancer.
Genetic testing
Finally, advances in genetic and genomic testing have transformed how we prevent and treat breast cancer. We can assess risk and take preventive measures by analyzing DNA and identifying hereditary gene mutations like BRCA1 and BRCA2. Determining if a patient harbors one of these hereditary mutations also helps us better know how to take care of that cancer if it develops.
The impact of these advancements is evident, offering hope and improving outcomes and quality of life for millions of women.
Every woman’s cancer is different, and our goal is to develop treatment plans that are as unique as the patients we care for. A multidisciplinary approach, involving oncologists, surgeons, radiologists, pathologists and nurse navigators, is crucial to achieving this.
While we still have work to do, the strides we’ve made give me hope that one day, breast cancer will no longer be a life-threatening diagnosis.
Learn more about breast cancer treatment at Northside Hospital Cancer Institute.
