Integrative Breast Cancer Treatments
Last Updated on November 2, 2018, Read Time - 15 minutes Reading Level - College Graduate
Sometimes, women avoid regular breast screening because they’re more afraid of the treatments for breast cancer than actually having cancer itself.
Some have had family members that have gone through treatment and have personal experience in how difficult treatment could be. We always tend to think the worst whenever we hear the word cancer, but in reality, everyone’s different.
Each person could have a different diagnosis, tolerance, and response to treatment. The important thing is trying not to be overwhelmed when things are going a million miles a second around you.
To help with understanding how breast cancer treatments are improving, and to understand some of the conventional treatments that your oncology team might present to you, we’re going to talk about the most common modalities used to treat breast cancer. We will also cover how naturopathic therapies can help while undergoing these treatments.
We will try to cover as much as possible, but keep in mind, each diagnosis is unique to the individual, and a variety of factors may change the therapeutic options available to them. This makes it hard to cover all the options available or what order they will be recommended in.
At this stage of your cancer journey, you may be interacting with multiple specialists such as a medical oncologist, naturopathic oncologist, radiation oncologist, a breast cancer surgeon, and plastic surgeon.
One of the best things you can do to have a sense of stability and cultivate trust in your care team is to maintain honest and open communication with your care providers and discuss any questions or fears you may have regarding treatment.
Common Breast Cancer Treatments
In DCIS/ LCIS and early-stage breast cancer your team will most likely recommend surgical removal of the lesion.
This is generally done via a lumpectomy.
As described in our last post about diagnosis and staging, a ring of healthy tissue called a margin is taken out around the tumor and examined under the microscope to ensure that there are no residual microscopic cancer cells invading into surrounding tissue.
After surgery and to decrease your risk of recurrence your doctor may recommend you undergo adjuvant therapy. (Adjuvant refers to treatment that happens after surgery).
The goal of adjuvant therapies is to rid your body of any undetectable cancer cells, which helps to reduce the chance of breast cancer recurrence.
Adjuvant therapy can include radiation, chemotherapy, hormonal therapy, and targeted therapy. These therapies are expanded upon below.
Neoadjuvant Therapy (Before Surgery)
For tumors that are larger in size or more aggressive histologically, your team may recommend you undergo systemic treatment before surgery. This treatment that occurs before surgery is referred to as neoadjuvant therapy.
There are multiple reasons that your doctor may recommend neoadjuvant therapies, such as shrinking a tumor to a smaller size so that a lumpectomy can be done instead of a mastectomy, making a lesion smaller so surgery is safer to undergo or to see how aggressive tumors respond to chemotherapy.
There are other reasons your doctor may prescribe a neoadjuvant therapy, but these are the main ones. If you’re curious why your doctor is recommending a certain therapy, and what benefit it may have, ask! They will be in the best position to explain clearly what a therapy is, and what they hope it will accomplish.
Surgery entails the removal of an area of cancerous tissue. Breast cancer surgery is usually performed by a breast cancer surgeon, but may also be performed by a general surgeon.
In general, smaller tumors are easier to operate on than larger tumors.
Besides removing the tumor, your surgeons will most likely remove appropriate lymph nodes during surgery to examine whether or not cancer has spread to them.
Lumpectomy vs Mastectomy
A lumpectomy is where only the portion of the breast containing cancer is removed plus a margin or tissue surrounding the lesion. Afterward, the area where the lesion was excised and tissue surrounding the lesion is radiated to ensure any cancerous microscopic cells that were left behind are also killed.
In the case of a mastectomy, all breast tissue may be removed. The extent of your mastectomy depends on the extent of your disease. Your surgeon may need to remove some muscle from your chest wall or be able to spare breast skin and the nipple.
Women with a BRCA mutation may wish to undergo a prophylactic bilateral mastectomy. This is because a BRCA mutation increases the probability that they would develop breast cancer in both breasts. They might choose to undergo a mastectomy to remove breast tissue as a preventative measure to the development of breast cancer. We recommend speaking with your oncology team, which may include a genetic counselor if you have a family history of breast cancer and suspect you may have a BRCA mutation.
Whereas mastectomy may be a frightening word to some women, there are factors that could make it a more appealing option than even lumpectomy.
For instance, most of the time, breast reconstruction can occur directly after your mastectomy, meaning that the fear of changes to your appearance or scarification can be minimized.
Because more tissue is removed than in a lumpectomy, the risk of missing cancerous cells surrounding a lesion may be reduced. So much so that depending on your case, you may be able to avoid radiation if you choose to undergo a mastectomy versus a lumpectomy.
In connection with that fact, there is a marginally higher risk of cancer recurrence if you choose to have a lumpectomy + radiation therapy; however, the overall survival rate of women who choose a lumpectomy is the same as for women who choose a mastectomy.
If you elect to do so, your surgeon may inject a dye or radioactive tracer into the tumor site to discover which lymph nodes receive drainage from the area around your tumor. This is known as a sentinel node biopsy. If these lymph nodes are cancer free it is likely that other lymph nodes under your arm also do not contain cancer.
A sentinel node biopsy may reduce the number of lymph nodes that need to be taken out and can prevent a condition called lymphedema from developing, as well as other issues such as loss of sensation, muscle weakness, and issues with range of motion.
If cancer is found in a sentinel lymph node, if you have an aggressive form of breast cancer, or if you were diagnosed with a higher stage of cancer your surgeon may perform an axillary lymph node dissection.
This is where multiple lymph nodes are taken from under the arm and they are examined for cancer.
In earlier stage cancer, an axillary dissection may be avoided if radiation is administered.
Once again there are many factors that influence these decisions and we recommend speaking to your oncology team about any questions or concerns you may have.
After your tumor is removed you may be given the option to have breast reconstruction which is performed by a plastic surgeon. If this occurs during your breast cancer surgery it is known as immediate reconstruction, if it occurs separately from your initial surgery it is known as delayed reconstruction.
Reconstruction surgery done at the same time as a lumpectomy to match your breasts to one-another is known as oncoplastic surgery.
If you wish to have a breast implant placed your surgeon may give you the option of having it on top of your pectoralis muscle or underneath it. Your surgeon may also place an expander in the area where your breast implant is to go to create the correct sized pocket for your implant.
You may also be able to undergo a flap procedure where tissue from other areas of your body is used to reconstruct your breasts.
Each of these options comes with their own set of pros and cons and, once again, we recommend speaking with your surgical team to determine which surgical option is right for you.
It must be noted that any condition that affects wound healing such as diabetes, smoking, connective tissue or vascular disease may influence which surgical options could be available to you.
Side effects of surgery are minimal but may include bruising, bleeding and infection. Overall surgery is a very safe and effective therapeutic modality.
Cryosurgery, also known as cryoablation therapy, is a therapy that can be used to treat early-stage breast cancers.
It may be preferred by some women because it can be done under local anesthesia and no breast tissue is removed, therefore breasts retain their natural shape.
On the other hand, sentinel nodes cannot be assessed during this procedure and clean margins are not guaranteed.
During cryosurgery, a hollow probe is inserted into the middle of a tumor with ultrasound guidance through a surgical incision.
Liquid nitrogen is passed through the probe which freezes the tumor inside a ball of ice.
This is repeated through multiple freeze and thaw cycles. The cancerous cells are killed, and healthy tissue remains intact.
We recommend speaking to our partners at Arizona BreastNet if you have any questions regarding cryoablation therapy.
Naturopathic Oncology and Breast Surgery
A naturopathic oncologist can aid you both before you undergo surgery and after your surgery is complete.
They will ensure your body is prepared for surgery and your surgical wounds heal quickly.
They do this by ensuring your body is replete with the proper nutrients needed for wound healing and prescribe supplements and IV therapies that help promote wound healing.
They will also make sure your immune system is healthy which in turn will help prevent infections.
If there are any side effects from surgery such as bruising, neuropathy, muscle weakness, or lymphedema then they will help you manage these side effects as well.
Lastly, many patients notice side effects from anesthesia such as impaired cognition. A naturopathic oncologist can help reduce these side effects and improve your cognition.
Radiation therapy uses x-rays or other high energy particles to damage cancerous cells, resulting in their death.
Such treatments are planned by and administered by a radiation oncologist.
Radiation treatments are usually administered daily for a set number of treatments which varies depending on your cancer.
After a lumpectomy radiation is usually administered Monday through Friday for 5-6 weeks to the whole breast. For the last week, radiation is usually focused on the area where the tumor was located, this is known as a boost.
However, some institutions have been experimenting with higher doses of radiation over a shorter period which is known as hypofractionation.
Some centers may be performing proton therapy, intensity modulated radiation therapy or experimenting with other new techniques/ particles. Once again it is important to speak with your radiation oncologist about potential treatment options available to you.
Radiation can be administered via a machine from outside the body. This is known as external beam radiation therapy.
Radiation can also be administered via a probe that is inserted into the tumor which is known as brachytherapy. This is usually reserved for small tumors.
As described above, radiation is usually administered after surgery, known as adjuvant treatment, and in some cases after chemotherapy.
Radiation may be administered before surgery to shrink a tumor, known as neoadjuvant therapy.
Side effects of radiation therapy can include fatigue, skin burning with blistering or peeling, skin discoloration, skin redness and swelling of the breast. Many women are concerned with lung and heart damage from radiation therapy, however, with modern technology and techniques, this is rarely a concern.
Naturopathic Oncology and Breast Radiation Therapy
During radiation therapy, cancerous cells are killed. As they are destroyed they release something called antigens (molecules that stimulate an immune response).
Once the immune system recognizes these antigens, it can mount an attack against cells with similar antigens, in this case, other cancerous cells.
This process requires an intact and functioning immune system. Therefore, it is one of the roles of a naturopathic oncologist to ensure the patient undergoing radiation therapy has an intact immune system and is able to mount a robust response to therapy.
Additionally, naturopathic oncologists can help reduce the side effects of radiation therapy such a skin burns and fatigue. They can also prescribe therapies that may help to sensitize cancerous cells to radiation while protecting non-cancerous cells.
Out of all the treatments on this list, chemotherapy is the one that causes the greatest fear and anxiety among patients.
This fear is not unwarranted as many chemotherapies have numerous, and sometimes severe side effects.
However, these therapeutics are some of the most effective at killing cancer cells.
Chemotherapies work to kill cancerous cells by inhibiting their ability to grow and replicate. They work based on the fact that cancerous cells grow and divide faster than most normal cells in your body. This is also why they cause the side effects that they do.
Since many cells in your body, such as those making up your hair and mucous membranes divide fairly rapidly, many chemotherapies may affect them in similar ways.
Chemotherapies are usually given in a specific number of cycles over a set period of time. This may be every 1-4 weeks.
Chemotherapies are also commonly given together in combinations which (in some instances) have been shown to be more effective than a single agent given alone.
Chemotherapies are commonly administered intravenously or orally.
There are multiple different chemotherapies that can be used in the treatment of breast cancer.
Some of the common chemotherapies include:
Docetaxel (Docefrez, Taxotere)
Pegylated liposomal doxorubicin (Doxil)
Fluorouracil (5-FU, Adrucil)
Methotrexate (multiple brand names)
Protein-bound paclitaxel (Abraxane)
Common combinations of chemotherapies for the treatment of breast cancer include:
(ACT) doxorubicin + cyclophosphamide followed by paclitaxel every 1-3 weeks
(TC) docetaxel + cyclophosphamide)
(AC) or (EC) doxorubicin or epirubicin + cyclophosphamide
(CMF) cyclophosphamide + methotrexate + flurouracil
(CAF) cyclophosphamide + doxorubicin + 5-FU
(CEF) cyclophosphamide + epirubicin + 5-FU
The most common chemotherapy regimen that we come across in the treatment of breast cancer is the ACT regimen.
Each of the chemotherapies in this regimen has a different mechanism of action and therefore has the potential to cause different side effects.
All three of these chemotherapies can cause hair loss, pain, mouth sores, nausea/ vomiting, diarrhea, low blood counts, fatigue, loss of appetite and others. However, each of these chemotherapies also have unique side effects as well.
The major side effect of doxorubicin is that it is toxic to your heart and can cause permanent damage to it.
Taxol frequently causes peripheral neuropathy and cyclophosphamide can cause bleeding of your bladder and infertility.
It must be noted that not all people experience all these side effects. In fact, many people experience minimal side effects.
It must also be noted that the use of naturopathic medicine in conjunction with these therapies can prevent, or greatly reduce the effects of these side effects. This is why it is important to work together with an integrative care team while you are undergoing treatment for cancer.
Naturopathic Oncology and Chemotherapy
One of the main reasons that patients’ seek out naturopathic oncologists is because they want to avoid and prevent the deleterious side effects of chemotherapy.
As stated above we are very successful in preventing and managing the side effects of many different chemotherapies. Furthermore, your naturopathic oncologist may prescribe therapies that enhance the effectiveness of your chemotherapy regimen.
Hormonal therapy also referred to as endocrine therapy, is offered to women with hormone receptor-positive tumors (ie. Estrogen receptor and progesterone receptor positive cancer).
As stated in our last post on breast cancer diagnosis, many breast tumors are hormone receptor positive. This means that they have receptors on them that estrogen and progesterone can bind to which in turn stimulate their growth.
By blocking estrogen and progesterone production/ binding we can reduce the growth of these tumors.
Decreasing hormone levels is also an effective method to prevent breast cancer recurrence since any leftover microscopic cancer cells have their growth stimulus reduced.
Hormone therapy can be administered neo-adjuvantly to decrease tumor size before surgery, but more often it is given adjuvantly after surgery.
There are two main types of anti-hormonal therapies offered to women with breast cancer.
The first is tamoxifen which is a pill that is administered orally. Women usually take this pill for 5 years, but it may also be recommended that they take it for 10 years based on their cancer.
Tamoxifen works by binding to the estrogen receptor which blocks endogenous estrogens from binding to the cell.
Tamoxifen is mainly used in women who are pre-menopausal. It may also be offered to women who have high-grade DCIS that is hormone receptor positive.
Side effects of tamoxifen can include joint pain, hot flashes, vaginal dryness, vaginal discharge, and bleeding. It also increases the risk of developing uterine cancer as well as developing a blood clot.
The other class of endocrine therapies prescribed to women is aromatase inhibitors (AIs). These are oral pills that block the conversion of testosterone to estrogen in women via inhibiting the enzyme aromatase which facilitates this conversion.
Common aromatase inhibitors include anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara).
Aromatase inhibitors should only be taken by post-menopausal women since they will not be effective at blocking estrogen production that occurs in the ovaries of pre-menopausal women.
In some instances, you may be given the option of having your ovaries removed or given medications that suppress ovarian function. Medications such as goserelin (Zoladex) and leuprolide (Lupron) can be given via injection and stop estrogen production in the ovaries for 1-3 months. An aromatase inhibitor will generally be given alongside this treatment.
Side effects of aromatase inhibitors include hot flashes, muscle and joint pain, vaginal dryness, and decreased bone density. All three aromatase inhibitors have similar efficacy however if you experience side effects on one you may not experience side effects on the others. Like tamoxifen, AIs may be prescribed for 5-10 years. Women may also start on tamoxifen, but if they become menopausal or for other reasons they may be switched to an aromatase inhibitor.
There is a new class of endocrine therapies on the market known as a selective estrogen receptor degraders (SERD). Fulvestrant (Faslodex) is the name of the pharmaceutical drug currently available on the market. This pharmaceutical is administered via an injection. It binds to estrogen receptors and destroys it which in turn prevents estrogen binding and stimulating growth. It is given to post-menopausal women with metastatic breast cancer or those who have tumors that are unable to be surgically removed.
Many women are concerned about the side effects of endocrine therapies such as tamoxifen and aromatase inhibitors. These fears are not completely unwarranted as many women do experience side effects from these therapies.
This is why it is important to have an open conversation with your medical oncologist and not be afraid to voice these concerns. In our experience, women may have side effects on one endocrine therapy, but minimal side effects on another.
Naturopathic Oncology and Hormonal Therapy
Naturopathic medicine is very effective at alleviating many of the side effects caused by endocrine therapies. Naturopathic oncologists may also prescribe therapies that enhance the effectiveness of endocrine therapies. This is why it is important to incorporate a naturopathic oncologist into your care team as we are very effective at increasing the efficacy of conventional therapy and decreasing their side effects.
This is a newer class of therapies that may be used in the treatment of breast cancer.
Unlike chemotherapies which have a systemic impact, these therapies act on very specific pathways such as genes, proteins, or other molecules that aid in cancer growth and survival (hence the name targeted). Usually, these therapies are used in more advanced stages of breast cancers.
As we already discussed each cancer is unique and may have unique mutations. Therefore, your doctor may run additional testing to determine which targeted therapies may be beneficial to you.
One of the more common targeted therapies prescribed to women with breast cancer are those that block HER2. For a recap of what HER2 is its significance in breast cancer, take a look at our recent post on breast cancer diagnosis and staging.
The most commonly used of these therapies is trastuzumab also known as Herceptin. Other drugs in this category are pertuzumab (Perjeta), ado-trastuzumab emtansine (Kadcyla) and neratinib (Nerlynx). These drugs are administered via infusion alongside your conventional chemotherapy regimen and are usually administered for up to 1 year after treatment.
One of the major side effects of Herceptin is that it can cause heart problems, therefore, you will undergo regular cardiac testing while on this therapy.
Since endocrine therapies increase bone loss, putting you at risk of osteopenia and osteoporosis, your doctor may put you on a therapy that helps reduce bone loss. Furthermore, if your cancer has metastasized to your bones these therapies help prevent fractures and may inhibit further spread to your bones. The names of some of these therapies are zoledronate (Zometa) and denosumab (Xgeva).
The last type of targeted therapies we will discuss are predominantly used in more advanced stage cancers.
The first is an oral pharmaceutical used in patients that are HER2 negative and have a known or suspected BRCA mutations. This drug is olaparib (Lynparza) and is known as a poly (ADP-ribose) polymerase (PARP) inhibitor.
The second drug is used in women with ER+, HER2- breast cancers that are locally recurrent or metastatic. This drug is known as palbociclib (Ibrance) and is known as a cyclin-dependent kinases CDK4 and CDK6 inhibitor.
While these names and mechanisms may sound complicated what we want you to take away is that there are new therapies that are being developed with increased efficacy and a decreased side effect profile.
Naturopathic Oncology and Targeted Therapies
Even though these newer drugs do have a reduced side effect profile compared to chemotherapy, they do cause side effects. You can help to prevent and manage these side effects by working with a naturopathic oncologist while undergoing conventional treatment.
Should You Fear Breast Cancer Treatments?
It’s scary to be diagnosed with cancer. It just is.
Will treatment work, will the treatments hurt, will I be able to maintain my schedule, keep my job, provide for my family, have a social life…so many questions, fears, and unknowns running through your head at once.
We hope that understanding a little bit more about common breast cancer treatments has alleviated some of the fear surrounding them.
Yes, there are known side effects to these cancer treatments, but modern medicine is constantly improving upon and refining these treatments making them safer and more effective.
Furthermore, working with a naturopathic oncologist while undergoing conventional care can help conventional treatment to be more effective, and minimize negative side effects. It can help you to keep on your medications and avoid treatment breaks and delays. It can help you to recover from surgery more effectively, and involve your immune system to improve your body’s ability to recognize and fight cancer to the best of its ability.
Even if you’ve watched as a loved one has gone through breast cancer treatment, remember that their experience may not be the case for you.
For example, people have come to us saying that they refuse the idea of chemotherapy because of what it did to their loved one…but when we ask more questions, we find out that their loved one wasn’t on a chemotherapy at all, and it was a totally different therapy and situation.
Remember to keep your options open, and really make informed decisions with your medical team.
If you don’t feel like you can do that currently, find an oncology team that is willing to listen to your concerns and discusses options with you.
A naturopathic oncologist can be an incredible resource to your oncology team because of our expertise in reducing the side effects of conventional therapies while improving their effectiveness. We also act as your advocate, and explain your options clearly, working in association with the other members of your oncology team.
Your overall health is our first concern.
While the prospect of treatment is daunting it isn’t the end all be all. The overall idea behind treatment is to get rid of cancer so you can not only have a life but have the best life possible.
(Our blog isn't designed to provide specific medical advice or replace a medical professional. If you have any specific questions about your health, how to make changes responsibly, or would like to set up an appointment with our clinic, head to our Contact Us page and let us know)!