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Neoadjuvant chemotherapy

Chemotherapy is most commonly used after breast cancer surgery to kill any cancer cells that may be left in the breast or lymph nodes or in other parts of your body. When it is used after surgery, it is referred to as adjuvant chemotherapy.

Sometimes doctors suggest chemotherapy and other treatments be given before breast cancer surgery. This is called neoadjuvant therapy.

There are a number of reasons why neoadjuvant chemotherapy may be offered to you.

What is neoadjuvant chemotherapy?

With neoadjuvant chemotherapy, you are likely to be given the same chemotherapy drugs that you would be given if you have chemotherapy after your surgery. The aim of treatment is to shrink the tumour in the breast, along with any other breast cancer cells that may be present elsewhere in the body, by killing those cancers cells.

There are some benefits in having neoadjuvant chemotherapy, but it is not for everyone. You may want to consider your options carefully.

Why might neoadjuvant chemotherapy be recommended for me?

Neoadjuvant chemotherapy may be recommended:

  • To reduce the size of your breast cancer (tumour) if it is too big to be removed in an operation
  • If you have inflammatory breast cancer
  • To reduce the size of the tumour so that you can have breast conserving surgery (lumpectomy) instead of mastectomy
  • To reduce the size of the tumour so that a smaller amount of tissue can be removed – this may give you a better cosmetic outcome
  • To give you time to have genetic testing if you have a strong family history of breast cancer – you may decide to have a different type of surgery if you are found to have an inherited breast cancer gene mutation
  • To delay surgery if you are pregnant so that you can deliver your baby as near to full term as possible (certain breast cancer chemotherapy drugs have been found to be safe in pregnancy)
  • To give you time to consider your surgical options, including breast reconstruction

Other neoadjuvant therapies

If your breast cancer is hormone receptor positive (ER+), you may be offered hormone therapy before your surgery (also known as neoadjuvant hormone therapy). The aim of neoadjuvant hormone therapy is also to shrink your breast cancer prior to surgery and control any cancer in lymph nodes or elsewhere in the body.

Hormone therapy is given as an oral medication (tablet). The most common hormone therapy medications are tamoxifen, letrozole, anastrozole and exemestane. If you are premenopausal, you may also be offered an injection (goserelin) to stop the ovaries from making oestrogen. This may be given alone or in combination with tablet hormone therapy.

You may be offered Herceptin if your cancer is HER2-positive.

More information

  • Breast Cancer Trials has a decision aid to help women make decisions about whether neoadjuvant chemotherapy is right for them. It is designed to be read with a doctor, so if you are interested in neoadjuvant therapy you can ask your doctor to go through the decision aid with you.
  • For more information about chemotherapy, including potential side effects and questions to ask your doctor, please visit the chemotherapy page