Breast cancer treatment options
Breast Cancer in Men: Treatment Options
ON THIS PAGE. You will learn about the different ways doctors use to treat men with this type of cancer. To see other pages, use the menu on the side of your screen.
This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, read the Clinical Trials and Latest Research sections.
In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team .
The biology and behavior of a breast cancer affects the treatment. Some tumors are small but grow fast, while others are large and grow slower. When planning the treatment for breast cancer, the doctor will consider many factors, including:
- The stage of the tumor
- The tumor’s hormone receptor status (ER, PR) and HER2 status (see Diagnosis )
- Other markers, such as Oncotype DX™ and Mammaprint™ (if appropriate)
- The patient’s age, general health, and preferences
- The presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2
Even though the doctor will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating breast cancer.
For both DCIS and early-stage invasive breast cancer, doctors generally recommend surgery to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor. Although the goal of surgery is to remove all of the visible cancer, microscopic cells can be left behind, either in the breast or elsewhere. For larger cancers, or those that are growing more quickly, doctors may recommend treatment with chemotherapy before surgery, called neoadjuvant therapy. Neoadjuvant hormonal therapy may also be recommended in other specific situations.
The next step in the management of early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells. This is called adjuvant therapy. Adjuvant therapies include radiation therapy, chemotherapy, hormonal therapy, and/or targeted therapy. See below for more information on these types of treatment. Whether adjuvant therapy is needed depends on the chance that any cancer cells remain in the breast or the body and the chance that a specific treatment will work to treat the cancer. Although adjuvant therapy lowers the risk of recurrence, it does not completely get rid of the risk.
Along with staging, other tools can help estimate prognosis and help you and your doctor make decisions about adjuvant therapy. The website Adjuvant! Online (www.adjuvantonline.com ) is a tool that your doctor can access to interpret a variety of prognostic factors. This website should only be used with the interpretation of your doctor. In addition, other tests that can predict the risk of recurrence for your specific tumor, such as Oncotype Dx, and Mammaprint (see Diagnosis ), may also be used to better understand whether chemotherapy may work.
When surgery to remove the cancer is not possible, chemotherapy, radiation therapy, hormonal therapy, and/or targeted therapy may be given to shrink the cancer.
The treatment of recurrent cancer and metastatic cancer depends on how the cancer was first treated and the characteristics of the cancer mentioned above, such as ER, PR, and HER2.
Descriptions of the most common treatment options for breast cancer in men are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions .
Surgery is the removal of the tumor and surrounding tissue during an operation. Surgery is also used to examine the nearby underarm or axillary lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The types of surgery include the following:
- A lumpectomy is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor. Because men do not have much breast tissue, a lumpectomy is generally not an option.
- A mastectomy is the surgical removal of the entire breast.
Lymph node removal and analysis
Cancer cells can sometimes be found in the axillary lymph nodes in some patients. It is important to find out whether any of the lymph nodes near the breast contain cancer, as part of treatment planning.
Sentinel lymph node biopsy. The sentinel lymph node biopsy procedure allows for the removal of one to a few lymph nodes, avoiding the removal of multiple lymph nodes in an axillary lymph node dissection (see below) procedure for patients whose sentinel lymph nodes are free of cancer. The smaller lymph node procedure helps patients lower the risk of swelling of the arm called lymphedema and decreases the risk of numbness, as well as arm movement and range-of-motion problems, which are long-lasting issues that can severely affect a person’s quality of life.
In a sentinel lymph node biopsy, the surgeon finds and removes about one to three sentinel lymph nodes from under the arm that receive lymph drainage from the breast. The pathologist then examines these lymph nodes for cancer cells. To find the sentinel lymph node, the surgeon injects a dye and/or a radioactive tracer into the area of the cancer and/or around the nipple. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. The surgeon can find the node when it turns color if the dye is used or gives off radiation if the tracer is used.
If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer and no further surgery is needed. If the sentinel lymph node shows that there is cancer, then the surgeon may perform an axillary lymph node dissection to remove more lymph nodes to look for cancer, depending on the stage of the cancer, the features of the tumor, and the amount of cancer in the sentinel lymph nodes. It is recommended that patients with signs of cancer in the axillary lymph nodes receive an axillary lymph node dissection, regardless of whether a sentinel lymph node biopsy is done. Find out more about ASCO's recommendations for sentinel lymph node biopsy .
Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm, which are then examined by a pathologist for cancer cells. The actual number of lymph nodes removed varies from person to person. If cancer is found in the sentinel lymph node, whether more surgery is needed to remove additional lymph nodes varies depending on the specific situation.
Most patients with invasive cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. A sentinel lymph node biopsy may not be done if there is obvious evidence of cancer in the lymph nodes before any surgery. In this situation, a full axillary lymph node dissection is preferred.
Summary of surgical options
To summarize, surgical treatment options include the following:
- Removal of cancer in the breast: Usually a removal of the cancer and all of the breast tissue
- Lymph node evaluation: Sentinel lymph node biopsy and/or axillary lymph node dissection
Talk with your doctor about the specific surgery recommended for you and the possible side effects of that surgery, including how side effects will be managed. The most significant side effect of surgery is lymphedema. which can occur when lymph nodes are removed or damaged during surgery. Because the lymph nodes are part of the channels that drain the lymphatic fluid from the arm, damage to the area may hold back the flow of lymphatic fluid and cause it to back up in the arm. The use of sentinel node biopsy has been shown to reduce the risk of developing lymphedema.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using a probe in the operating room, it is called brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove, although this approach is rare. Adjuvant radiation therapy is recommended for some men after a mastectomy depending on the size of their tumor, the number of cancerous lymph nodes under the arm, and the width of the tissue margin around the tumor removed by the surgeon.
Radiation therapy can cause side effects, including fatigue, swelling of the breast, redness and/or skin discoloration/hyperpigmentation and pain in the skin where the radiation was aimed, sometimes with blistering or peeling. Rarely, a small amount of the lung can be affected by the radiation, causing pneumonitis, a radiation-related swelling of the lung tissue. In the past, with older equipment and techniques of radiation therapy, patients who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from the effects of radiation.
Many types of radiation therapy may be available to you with different. Talk with your doctor about the advantages and disadvantages of each option.
Types of radiation therapy
Several approaches to radiation therapy have been studied in women, but have not been studied in very many men with breast cancer. Talk with your doctor for more information.
- Hypofractionated radiation is giving a higher daily dose of radiation over a shorter time, usually 3 to 4 weeks instead of 6 to 7 weeks.
- Partial breast irradiation (PBI) is radiation therapy that is given directly to the tumor area, usually after a lumpectomy, instead of the entire breast, as is usually done with standard radiation therapy. Targeting radiation directly to the tumor area more directly usually shortens the amount of time that patients need to receive radiation therapy.
- Intensity-modulated radiation therapy (IMRT) is a more advanced way to give external-beam radiation therapy to the breast. The intensity of the radiation directed at the breast is varied to better target the tumor, spreading the radiation more evenly throughout the breast. The use of IMRT lessens the radiation dose and the possible damage to nearby organs, such as the heart and lung, and lower the risks of some immediate side effects
Chemotherapy is the use of drugs to destroy cancer cells, which work usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.
Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
Chemotherapy may be given before surgery to shrink a large tumor and reduce the risk of recurrence, called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy. Chemotherapy is also commonly given if a patient has a metastatic breast cancer recurrence.
A chemotherapy regimen (schedule) consists of a specific treatment schedule of drugs given at repeating intervals for a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every two weeks (also called dose-dense), once every three weeks, or even once every four weeks. Common drugs for breast cancer include:
- Capecitabine (Xeloda)
- Carboplatin (Paraplatin)
- Cisplatin (Platinol)
- Cyclophosphamide (Neosar)
- Docetaxel (Docefrez, Taxotere)
- Doxorubicin (Adriamycin)
- Pegylated liposomal doxorubicin (Doxil)
- Epirubicin (Ellence)
- Eribulin (Halaven)
- Fluorouracil (5-FU, Adrucil)
- Gemcitabine (Gemzar)
- Ixabepilone (Ixempra)
- Methotrexate (multiple brand names)
- Paclitaxel (Taxol)
- Protein-bound paclitaxel (Abraxane)
- Vinorelbine (Navelbine)
A patient may receive one drug at a time or combinations of different drugs at the same time. Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. The following drugs or combinations of drugs may be used as adjuvant therapy to treat breast cancer:
- AC (doxorubicin and cyclophosphamide)
- AC or EC (epirubicin and cyclophosphamide) followed by T (doxorubicin and cyclophosphamide, followed by paclitaxel or docetaxel, or the reverse)
- CAF (cyclophosphamide, doxorubicin, and 5-FU)
- CEF (cyclophosphamide, epirubicin, and 5-FU)
- CMF (cyclophosphamide, methotrexate, and 5-FU)
- TAC (docetaxel, doxorubicin, and cyclophosphamide)
- TC (docetaxel and cyclophosphamide)
Trastuzumab, pertuzumab, and lapatinib are HER2-targeted therapies that may be given with chemotherapy for HER2-positive breast cancer (see Targeted therapy, below). Bevacizumab (Avastin) is another targeted therapy that has been used in combination with chemotherapy for the treatment of metastatic breast cancer, but is no longer approved for the treatment of breast cancer.
The side effects of chemotherapy depend on the individual, the drug(s) used, and the schedule and dose used.
These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects can often be prevented or managed during treatment, and they usually go away once treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers.
Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor, oncology nurse, or pharmacist is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases .
Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors (ER-positive or PR-positive; see Diagnosis ) for both early-stage and metastatic cancer. Because most men with breast cancer have ER-positive disease, hormonal therapy is often part of the treatment plan. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually slows the growth of the tumor.
Hormonal therapy after surgery may be used by itself or after chemotherapy. Hormonal therapy options for men include:
- Tamoxifen (Nolvadex, Soltamox) is the primary hormonal therapy used for men with breast cancer. It blocks estrogen from binding to cancer cells. It is a pill taken daily, usually for many years.
- Aromatase inhibitors decrease the amount of estrogen made by the body. This type of treatment is effective in treating breast cancer in women, but there is not much information on their use for men with breast cancer, although research has shown that they could be effective. Caution is urged in using aromatase inhibitors in men who still have their testicles (testes), as these treatments could cause androgen levels to increase.
- Fulvestrant (Faslodex) is a drug that is given by injection once a month. It stops estrogen from helping a cancer grow in a way that is different from tamoxifen. Like aromatase inhibitors, there is not much information on its use for men, but research has shown that it may be effective.
- Megesterol (Megace) is a progesterone-like drug used to treat a hormone receptor-positive tumor. It is rarely used for men with breast cancer.
Side effects of hormonal therapy can include hot flashes, decreased sexual desire or ability, and mood swings.
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about targeted treatments .
The first approved targeted therapies for breast cancer were hormonal therapies. Then, HER2 targeted therapies were been approved to treat HER2-positive breast cancer. Most recently, a drug that targets a protein called mTOR, which contributes to cancer growth, was approved in combination with hormonal therapy for the treatment of metastatic breast cancer. Targeted therapy is also used to prevent growth of cancer that has spread to the bone and to maintain bone health. Talk with your doctor about possible side effects of specific medications and how they can be managed.
HER2 targeted therapy
- Trastuzumab is approved for both the treatment of advanced breast cancer and as an adjuvant therapy for early-stage HER2-positive breast cancer. Currently, one year of trastuzumab is recommended for the treatment of early-stage breast cancer. For metastatic cancer, trastuzumab is given in combination with different types of chemotherapy. Patients receiving trastuzumab have a small (2% to 5%) risk of heart problems. This risk is increased if a patient has other risk factors for heart disease or receives chemotherapy that also increases the risk of heart problems at the same time. These heart problems do not always go away, but they are usually treatable with medication.
- Pertuzumab is approved for the treatment of advanced breast cancer, and is being studied as a treatment for early-stage disease. Research shows that adding pertuzumab to trastuzumab and the chemotherapy drug docetaxel for advanced breast cancer not yet treated with either chemotherapy or trastuzumab increases the effectiveness of treatment and lengthens lives with few additional side effects. Based on this data, the combination of trastuzumab, pertuzumab, and either docetaxel or paclitaxel has become the standard of care for the treatment of untreated advanced breast cancer. Pertuzumab is also approved as neoadjuvant treatment for breast cancer in the United States, in combination with trastuzumab and docetaxel or paclitaxel.
- Lapatinib is commonly used for HER2-positive metastatic breast cancer when trastuzumab and pertuzumab in combination with docetaxel are no longer effective at controlling the cancer’s growth. The combination of lapatinib and the chemotherapy capecitabine is approved to treat advanced or metastatic HER2-positive breast cancer when a patient has already received chemotherapy and trastuzumab. Lapatinib is also used in combination with trastuzumab for patients whose cancers were growing on trastuzumab. Lapatinib is being studied for early-stage breast cancer in combination with trastuzumab. The recent approval of ado-trastuzumab emtansine (see below) has changed the use of lapatinib, as this drug was shown to be more effective than the combination of lapatinib and capecitabine. Lapatinib is now more commonly used following treatment with T-DM1 (see below).
- Ado-trastuzumab emtansine or T-DM1 is approved for the treatment of metastatic breast cancer for patients who have previously received trastuzumab and chemotherapy with either paclitaxel or docetaxel. T-DM1 is made up of trastuzumab linked to a type of chemotherapy. Research shows that treatment with this drug caused fewer side effects and controlled tumor growth better than the combination of lapatinib and the capecitabine. T-DM1 is given by vein every three weeks. Studies are now testing T-DM1 as a treatment for early-stage breast cancer
mTOR inhibitor therapy
- Everolimus (Afinitor) and similar drugs are being researched in combination with hormonal therapy for metastatic and early-stage breast cancer.
Osteoclast targeted therapy (drugs that block bone destruction)
- Bisphosphonates are drugs that block the cells that destroy bone, called osteoclasts. Bisphosphonates are commonly used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones. For breast cancer that has spread to bone, higher doses of bisphosphonates have been shown to reduce the side effects of cancer in the bone, including broken bones and pain. Pamidronate (Aredia) and zoledronic acid (Zometa) are two intravenous bisphosphonates used to treat breast cancer bone metastasis.
- Denosumab (Xgeva) is another osteoclast-targeted therapy called a RANK ligand inhibitor. Recent studies have shown that denosumab works well to treat breast cancer bone metastases, and may be better than bisphosphonates at controlling the symptoms of bone metastases. Denosumab is also effective at treating osteoporosis and is being studied as a cancer treatment in early-stage breast cancer.
Getting care for symptoms and side effects
Cancer and its treatment cause symptoms and side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called supportive or palliative care, and it includes supporting the patient with his physical, emotional, and social needs.
Supportive or palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care .
Metastatic breast cancer
If cancer has spread to another location in the body, it is called metastatic cancer or metastatic recurrent cancer. Symptoms of metastatic breast cancer may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue.
Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials .
The treatment of metastatic or recurrent breast cancer depends on the previous treatment(s), the time since the original diagnosis, and the characteristics of the tumor, such as ER, PR, and HER2. Your health care team may recommend a treatment plan that includes a combination of systemic therapies, such as chemotherapy, hormonal therapy and targeted therapy, which are generally the primary treatment for recurrent metastatic cancer. Radiation therapy and surgery may be used in certain situations for men with a distant metastatic recurrence. Often radiation is used to treat cancer that has spread to the bone. Supportive care will also be important to help relieve symptoms and side effects.
For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.
A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions after treatment for early-stage breast cancer are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return, and will help you make decisions about your treatment. Learn more about coping with the fear of recurrence .
If the cancer does return after treatment for early-stage disease, it is called recurrent cancer. It may come back in the breast (a local recurrence); in the chest wall (a regional recurrence); or in another part of the body, including distant organs such as the lungs, liver, and bones.
A local recurrence is frequently considered curable with further treatment. A metastatic (distant) recurrence is generally considered incurable, but it is often treatable. Some patients live years after a metastatic recurrence of breast cancer.
Generally, a recurrence is found when a person has symptoms or an abnormal finding on a physical exam. These symptoms depend on the site of the recurrence and may include:
- A lump under the arm or along the chest wall
- Bone pain or fractures, a possible sign of bone metastases
- Headaches or seizures, a possible sign of brain metastases
- Chronic coughing or trouble breathing, possible signs of lung metastases
- Abdominal pain or a yellowing of the skin and eyes called jaundice, which may be associated with liver metastases
If a man has a recurrence, a cycle of testing will begin to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. A biopsy of the recurrent site is often recommended to be certain of the diagnosis and to check for ER, PR, and HER2 status, because this may have changed from the time of the original diagnosis. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence .
If treatment fails
Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.
This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.
Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .
The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.