Not your grandmother's breast cancer treatment

Recent advances have transformed a one-size-fits-all approach into a personalized treatment arsenal.

Though, some things never change: a breast cancer diagnosis still evokes a storm of anxiety — just as it did decades ago — despite the fact that survival rates have soared. Indeed, while more than two million women worldwide receive a breast cancer diagnosis each year, the average risk of dying in the following five years has dropped from 14% to 5% since just the 1990s, according to a June 2023 study involving more than a half-million women.

"For many women, a breast cancer diagnosis is particularly unsettling because we often don't know why a patient developed it," says Dr. Harold Burstein, a medical oncologist at Harvard-affiliated Dana-Farber Cancer Institute. "But the good news is, outcomes are getting better and better."

There's good reason for this survival swing. While breast cancer was once believed to be a single disease requiring a single treatment approach, scientists can now categorize breast tumors by cell type, opening the door for treatment combinations tailored toward each.

Nowadays, surgery is still de rigueur for most types of breast cancer. But once-mainstay chemotherapy may be used in smaller amounts or skipped entirely. Meanwhile, newer drugs have enabled doctors to personalize each woman's arsenal of options. These include immunotherapy — which harnesses the power of the immune system to kill cancer cells — and targeted therapies aimed at gene mutations or proteins active in cancer growth.

"As we recognize these important subsets of breast cancer, we're tailoring treatment to the individual and the special characteristics of each breast cancer," Dr. Burstein says. "There isn't an infinite number of treatments, but the toolbox keeps getting bigger."

Why treatments are improving

Even the past 10 years brought marked shifts in treatment approach, thanks to extensive research that clarifies how genes and cells behave in various cancer subtypes. This, in turn, fueled the development of groundbreaking tests. Some can identify women with BRCA gene mutations that drastically raise their risk of developing breast cancer, while other tests help predict the likelihood a tumor will grow or spread to better pinpoint treatment needs.

These efforts have revealed that some types of breast cancer may respond to less intensive chemotherapy, while one especially aggressive type needs more.

For more information on breast cancer, check out Your Breast Cancer Action Plan, an Online Guide from Harvard Medical School.

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