PATH 1: Early Stage Breast Cancer

PATH 2: Neoadjuvant Therapy

PATH 3: Pregnancy During Breast Cancer


PATH 5: Metastatic Stage 4

Neoadjuvant (Pre-surgery) Therapy

In some cases, women will be given systemic therapies (chemotherapy or hormone therapy) before they have surgery. This may be done for a number of reasons, such as shrinking the tumour for a less-severe operation (i.e. you may be eligible for a lumpectomy rather than a mastectomy, if that is your choice), treating cases of inflammatory breast cancer that cannot currently be operated on, or to begin treating the rest of the body and prevent metastases (spreading of cancer cells). Your care team will determine the right form of therapy for you.

On this page, you'll find information about neoadjuvant therapy (NAT) and who receives it.


Neoadjuvant therapy (NAT) refers to chemotherapy or hormone therapy that is given prior to cancer-related surgeries. Similar to post-operative (adjuvant) therapy, it is administered to kill fast-growing cancer cells and prevent them from metastasizing (spreading) through the body.

You may receive NAT prior to surgery to downstage/downsize the tumour, control early metastases or for early assessment of the pathologic complete response for future treatment

Who receives NAT?

Patients who have the following breast cancers may be considered for NAT:
Locally-advanced breast cancer (LABC): High-grade tumours (T3, T4) have resulted in the cancer spreading to other areas of the breast, including nearby lymph nodes. NAT will downstage the tumour to control further metastases. Patients with LABC will generally undergo mastectomies; however, NAT can downsize the tumour prior to surgery and potentially make lumpectomy an option. 
Inflammatory breast cancer (IBC): Cancer cells may block the lymph nodes and cause inflammation, which can make the area inoperable. NAT is given to downsize the tumour for an easier operation.
Early stage (>- 2 cm) breast cancer: Patients with stage I to II breast cancer may receive NAT to downsize the tumour so that they have the option of lumpectomy over mastectomy. 
Triple negative or Her-2+ breast cancer: Studies have shown that these aggressive breast cancers are more likely to spread and/or recur. NAT will offer early control over metastases and downstage the tumour, which can improve overall survival and recurrence-free survival.

How is it administered?

Neoadjuvant chemo is administered the same way that post-operative chemo is: orally, intravenously, topically, subcutaneously (under the skin), topically as a cream or intramuscularly (injected into the muscle).

Neoadjuvant hormone therapy is only given to women with ER or PR+ breast cancers. It is administered orally, subcutaneously or intramuscularly.

The type of NAT you receive will depend on your situation. Your care team will collaborate to decide on the most effective option for you.

What are the side effects of NAT?

NAT has the same side effects as adjuvant therapy. For chemotherapy, this may include early menopause, hair loss and fatigue. For hormone therapy, this can include weight gain or osteoporosis, among other things. There are many options for symptom management that your care team can discuss with you to make the process more tolerable. 


To determine if NAT is right for you, your care team will consider all of your initial diagnosis results, including:
  • Biomarker status to assess if the tumour is hormone-receptor positive, Her2+/- or triple negative
  • Mammogram and breast ultrasound results
  • Imaging on chest and bone scan to assess metastases status
  • Fine needle biopsy may be performed on suspicious lymph nodes as well
You may undergo a clip marker procedure to insert a small, radio-opaque clip into the tumour. This allows the care team to find the tumour during surgery or through x-rays in the case that it is undetectable after downsizing.


You may be feeling uncertain about chemotherapy or hormone therapy after having heard about the side effects. To manage this anxiety, try to prepare yourself as best you can. 

You may also consider trying complementary therapies to help you manage stress and physical symptoms. Your care team can provide advice on the best options for you. 


Your medical oncologist will be responsible for administration and monitoring of NAT. They will coordinate with the rest of your team (e.g. your surgeon and radiation oncologist) to determine the next steps after this treatment.

You may also meet with a fertility specialist at this time to discuss preservation options, if that's what you choose.