Chemotherapy, radiation, endocrine, targeted therapy, and surgery are the five types of treatment for most localised breast cancers in TT, and their roles are dependant on localised versus metastatic disease.

Oncologist Dr Visham Bhagaloo explained each person's situation is unique, so the use of each option is determined by the patient's stage, risk for recurrence and many other risk factors that are discussed at multidisciplinary meetings which involve surgeons, oncologists, and pathologists.

The order in which treatment is delivered may vary from patient to patient. Some may receive surgery first with chemotherapy given after (adjuvant) while other may receive up front chemotherapy (neo adjuvant) followed by surgery. Radiotherapy is always given after chemotherapy and surgery is completed.

Chemotherapy is the administration of medication via an intravenous access or in some cases oral medication which treats every cell in the body.

'Chemotherapy is offered when high-risk factors for distal recurrence are present, including triple negative breast cancer, HER2 (human epidermal growth factor receptor-2) positive, larger sized tumours, nodal involvement, and other high-risk pathological features. There are many additional factors including the patient's performance status (activity level), molecular analysis, and most importantly the patient's wishes which all impact on the final decision.'

Radiation therapy or radiotherapy, he continued, is a localised treatment for patients who have a high risk of local recurrence. For instance, if a patient has breast conserving surgery (lumpectomy), large tumours (more than five centimetres) or nodal involvement they usually receive post-surgery radiotherapy. Radiotherapy is generally well tolerated and most patients have minimal if any complaints.

Patients who are hormonally positive (oestrogen or progesterone positive) receive endocrine treatment which is generally better tolerated than chemotherapy. Bhagaloo describes hormonal treatment as an additional 'insurance treatment' of oral medication for five to ten years after they receive radical treatment with chemotherapy, radiotherapy and surgery. Additionally, HER2 positive patients receive targeted therapy.

Triple negative breast do not benefit from the hormonal tablets.

Metastatic disease (stage IV)

Metastatic breast cancer is typically treated with a combination of chemotherapy or hormonal therapies depending on the situation. Patients with oestrogen or progesterone positive disease who have a small volume of disease will receive hormonal medication to control the disease until the disease worsens. HER2 positive patients also receive Herceptin indefinitely once the disease is controlled. Surgery and radiotherapy may be considered in isolated situations in stage IV disease.

Treatment developments

Bhagaloo said HER2-positive patients, metastatic and localised, usually had a poor prognosis. However, over the past