Early-stage breast cancer refers to stage 0-2 breast cancer. These are typically small (5cm or less), with little to no involvement of the axillary lymph nodes. Non-invasive breast cancer, ductal carcinoma in-situ (DCIS), refers to cancer cells stuck inside the ducts of the breast, without invasion into the surrounding breast tissue. DCIS is stage 0 breast cancer. Stage 1 and 2 breast cancer, refers to cancer cells that have broken out of the breast duct or lobe and have invaded the surrounding breast tissue.

Early-stage breast cancer treatment is managed in the form of multidisciplinary and multimodality care – using surgery, radiation, and medication. Locoregional treatments include surgery and radiation; systemic treatments include medical therapies such as chemotherapy and endocrine therapy.

Surgery
In patients with early-stage breast cancer, surgery is typically the first form of treatment. There are two main surgical options for patients with early-stage breast cancer – Lumpectomy and Mastectomy.

1) Lumpectomy (also known as “breast conserving therapy”): involves the removal of cancer along with a margin of healthy breast tissue. In most patients, lumpectomy is paired with radiation therapy (see below) to decrease the risk of cancer returning in that same breast.
2) Mastectomy: involves removal of the entire breast, and in some cases, removal of the nipple and areola. Any woman who undergoes mastectomy has the option of reconstruction which is coordinated with a plastic surgeon.

It is important to remember is there is no difference in survival between the two surgical options; and some studies have shown survival to be improved with breast conserving therapy. Meaning, patients do not live longer simply because they had a mastectomy.

In patients with invasive breast cancer, the lymph nodes will also be assessed at the time of surgery. This typically occurs in the form of a sentinel lymph node biopsy. The sentinel, or guardian, lymph nodes help breast cancer doctors understand if the cancer has begun to spread beyond the breast tissue. A sentinel lymph node biopsy is performed with the injection of one or two dyes underneath the nipple on the day of surgery. These dyes travel along the lymphatic channels which drain the breast and sit in the sentinel lymph nodes for the surgeon to identify. Approximately 1-4 lymph nodes are removed and sent to the pathologist to evaluate if any cancer cells are present. This information can help to guide adjunctive therapies such as radiation, chemotherapy and potentially need for additional surgery (axillary lymph node dissection).

Radiation
In patients who undergo lumpectomy, and in some patients who undergo mastectomy, radiation to the breast is recommended. Radiation is a localized treatment to the breast which acts to decrease the risk of cancer recurrence by 50%. The radiation treatment is directed to the affected breast and beams are angled away from important nearby structures such as the lung and heart. Radiation treatments usually begin after a patient has healed from their surgery and typically occur every weekday for 4-6 weeks. Treatments last approximately 15-20 minutes. Most patients are able to work and perform their usual activities while they go through radiation. Side effects from radiation include a burn to the skin and/or darkening of the skin which is cared for with moisturizers and creams. Fatigue is also a common side effect from radiation.

Reasons radiation might be recommended:
• Lumpectomy as primary surgical management
• Large size of breast cancer
• Positive margins (cancer cells present at the edge of the removed specimen)
• Lymph nodes containing cancer cells