The first 60 days: Breast cancer (all types)
Breast cancer is not one disease. Which of three receptor patterns the tumour carries decides its treatment: hormone receptor-positive (about 70 percent), HER2-positive (about 15 percent) or triple-negative (about 15 percent). The pages for each type hold the detail; this page holds what they share. Below, week by week, is what OnCo's record of Breast cancer (all types) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Early disease, all types.
- RadiologistNamed in the standard of care for: Screening.
- SurgeonNamed in the standard of care for: Early disease, all types, Ductal carcinoma in situ.
- Medical oncologistNamed in the standard of care for: Early disease, all types, Ductal carcinoma in situ.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early disease, all types, Ductal carcinoma in situ.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Mammography every one to three years from around age 40 to 50 depending on country; MRI for high-risk women.
Breast-conserving surgery with radiotherapy or mastectomy, sentinel node biopsy, then treatment by receptor type on the subtype pages.
Surgery with or without radiotherapy and endocrine therapy; active surveillance under study.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Oestrogen and progesterone receptors, HER2, Ki-67 and grade, Genomic recurrence scores, BRCA1/2 and other germline variants), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Triple-negative breast cancer.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Screening
- For my situation (screening), which of the standard options do you recommend and why?Guideline options include: Mammography every one to three years from around age 40 to 50 depending on country; MRI for high-risk women.
Early disease, all types
- For my situation (early disease, all types), which of the standard options do you recommend and why?Guideline options include: Breast-conserving surgery with radiotherapy or mastectomy, sentinel node biopsy, then treatment by receptor type on the subtype pages.
Ductal carcinoma in situ
- For my situation (ductal carcinoma in situ), which of the standard options do you recommend and why?Guideline options include: Surgery with or without radiotherapy and endocrine therapy; active surveillance under study.
Any stage
- Are there clinical trials I could join, for example of Trastuzumab deruxtecan, Datopotamab deruxtecan, Oral SERDs?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Metastatic disease remains incurable for almost everyone”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Triple-negative and inflammatory breast cancer still have the worst outlook”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- I-SPY 2Phase platform · active · NCT01042379Newly diagnosed stage 2 and 3 breast cancer at high risk of recurrence: new drugs added to standard chemotherapy before surgery, randomised adaptively within biomarker subtypes, with pathological complete response as the endpoint
- I-SPY 2.2Phase platform · recruiting · NCT01042379High-risk early breast cancer: a sequential multiple assignment randomised design that starts with a new agent chosen by response-predictive subtype and escalates or de-escalates treatment according to MRI and biopsy response
- TAPUR (Targeted Agent and Profiling Utilization Registry)Phase 2 · recruiting · NCT02693535Advanced solid tumours, multiple myeloma and B-cell lymphoma with a genomic alteration that an approved targeted drug addresses in another cancer: the drug is given off-label in a pragmatic basket with cohorts by drug and tumour type
- WISDOM (Women Informed to Screen Depending on Measures of Risk)Phase observational · active · NCT02620852Women aged 40 to 74 without breast cancer: personalised, risk-based screening (start age, interval and imaging chosen from genetic and clinical risk) against annual mammography
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Breast cancer (all types): the full pageBreast cancer is not one disease. Which of three receptor patterns the tumour carries decides its treatment: hormone receptor-positive (about 70 percent), HER2-positive (about 15 percent) or triple-negative (about 15 percent). The pages for each type hold the detail; this page holds what they share.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Mechanical theory: stiffness, pressure and force as causes: Cancer cells feel their surroundings.
- Seed and soil hypothesis of metastasis (Paget): Stephen Paget asked in 1889 why breast cancer spread to some organs more than blood flow could explain, and answered that a travelling cancer cell (the seed) grows only where the organ (the soil) suits it.
Every term links to the glossary.