There are three paths that can be followed after the triple diagnosis.

• Women in whom the triple diagnosis suggests benign disease are closely monitored (physical exam every 3 to 6 months for at least a year) to ensure that the breast mass is stable.
• Women in whom the diagnosis suggest malignancy are referred for treatment.
• Women in whom any one of the triple tests suggests malignancy need to undergo excisional biopsy.

The choice of treatment is based upon many factors which depend upon the extent to which the cancer has spread, characteristics of the cancer, and general health of the patient.

The treatment of breast cancer involves local and systematic treatment. Treatment to the whole body involves systematic treatment, and local treatment involves treatment of breast area and the lymph nodes near it. Sometimes treatment may include more than one type of local or systematic treatment. Both systematic and local treatment is given in patients where the cancer has spread to other places beyond the breast.

Surgery

The main mode of treatment for breast cancer is surgery, especially so when the tumor is localized.

As mentioned earlier on breast cancer, is thought of as a cancer that affects the breast. It must be noted that this cancer can spread to other body parts via the lymphatic system which is why breast cancer treatment almost always involves surgery for the underarm glands that may involve either axillary clearance, sampling, or sentinel node biopsy.

There are several types of surgery.

Breast conserving surgery: An operation to remove the cancer but not the breast is called breast-sparing surgery.

Lumpectomy: In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it.

Segmental mastectomy: In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.

Total mastectomy: In total mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed

Radical mastectomy: The surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles.

Axillary Lymph node dissection: Removing some or all of the lymph nodes in the arm pit. Usually 10 to 20 lymph nodes in the arm pit are removed.

Surgery is often followed up with any of the following treatments depending upon the patient’s risk status- low or high risk . Age, type of cancer, size and metastasis of the disease decides the risk status of the patient.

Other treatment possibilities include chemotherapy, radiation therapy, hormone therapy, and immune therapy.

a) Chemotherapy is carried out in those who have undergone surgery . It is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. Even in the primary stage of the disease the cancer cells can break away from the original site and metastasize to other areas as well. These cells may not be detected during imaging studies or during physical exams. When left untreated, these cells have the potential to grow into malignant tumors. The aim of adjuvant chemotherapy is to kill these potentially dangerous, undetected cancer cells.

The drugs may be given in a pill or by injection. Either way, the drugs enter the bloodstream and travel throughout the body. Chemotherapy is preferred when the cancer is spread to the lymph nodes; cancer is more than a centimeter. Chemotherapy is not preferred for cancers with a low risk of spreading to other parts. Side effects of chemotherapy are nausea, vomiting, diarrhea, mouth sores, tiredness, susceptibility to infection, hair loss, aches and discomforts.

Some of the drug combinations used in the treatment are:-

• Cyclophosphamide methotrexate and 5-fluorouracil
• Cyclophosphamide, doxorubicin and 5-fluorouracil
• Doxorubicin and cyclophosphamide
• Epirubicin and cyclophosphamide
• Docetaxel, doxorubicin, and cyclophosphamide

Other chemotherapy drugs used in the treatment of women with breast cancer include Carboplatin (Paraplatin), cisplatin (Platinol), vinorelbine (Navelbine) and capecitabine (Xeloda) are some of the other drugs

When breast cancer has spread to the bones, it can be treated. but not cured. Drugs like Alpharadin are being developed to combat bone metastasis.This drug works by reducing estrogen levels, as estrogen provides the ambience for the tumors to grow. Clinical trial - phase II studies for this drug have shown good pain control and improved life quality.

b) Interstitial laser therapy – is a non surgical, minimally invasive, innovative method of treating breast cancer employing laser for treatment. There are no adverse reports recorded for this procedure .

c) Radiotherapy- is also used to kill malignant cells that have escaped surgery. Radiation, when applied correctly can reduce the risk of recurrence by 50-66% .

External radiation: Radiation may be directed at the breast by a machine.

Implant radiation: Radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast. Some women have both kinds of radiation therapy.

There are three main kinds of systematic treatments used for the whole body.

Hormonal therapy: Estrogen is a hormone which is required for cancer cells to grow. Estrogen binds to these cells and stimulates them to grow and divide. Anti-estrogens prevent the binding of estrogen. This stops the cells from growing and in doing so, prevents or delays breast cancer recurrence. Tamoxifen is the most commonly used Selective Estrogen Receptor Modulators (SERMs). You should take the drug as a pill once a day. Side effects of this therapy can be hot flashes, vaginal dryness or discharge, irregular periods, nausea and cataracts. Serious, but rare, side effects are endometrial cancer, blood clots in lung or brain.

Immune therapy: This treatment enhances the immune system of the body to fight cancer cells. Herceptin is the most commonly used immune treatment for advanced breast cancer. Herceptin works by attaching to HER 2 receptors on breast cancer cells. These receptors are involved in the signaling for growth and spread of cancer cells. Herceptin blocks and masks the HER 2 receptors which help in recognition of these cells for the immune system to detect and destroy them.

Biological therapy: is a treatment designed to enhance the body's natural defenses against cancer.