Neoadjuvant therapy

Sometimes drug treatments for early breast cancer are given before breast cancer surgery. This is called neoadjuvant therapy.  

If you have neoadjuvant therapy, it means your treatment may start with chemotherapy, targeted therapy, hormone-blocking therapy or immunotherapy usually given for several months before surgery.

Some treatments may continue after surgery. 

There are some benefits in having neoadjuvant therapy, but it is not for everyone. You may want to consider your options carefully. Talk to your doctor about the pros and cons of neoadjuvant therapy. You may find the Neoadjuvant Patient Decision Aid from Breast Cancer Trials helpful in discussions with your treating doctor. 

When neoadjuvant therapy may be recommended  

Neoadjuvant therapy may be recommended: 

• To reduce the size of the tumour so that you can have breast conserving surgery (lumpectomy) instead of removal of the whole breast (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. 
• If you have a fast-growing breast cancer such as inflammatory breast cancer, triple negative breast cancer  or HER2-positive breast cancer. 
• To reduce the number of lymph nodes that need to be removed from the armpit (axilla) – you may be able to have a sentinel lymph node biopsy that removes 1-3 nodes rather than more extensive axillary lymph node dissection.
• 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 determine how effective systemic therapy (e.g. chemotherapy, targeted therapy, immunotherapy or hormone-blocking therapy) is in treating your breast cancer.
• To provide more information about the risk of the cancer coming back (recurrence).
• To allow you to be eligible to participate in a neoadjuvant clinical trial.