WHAT YOU NEED TO KNOW NOW
Neoadjuvant chemotherapy (NAC) refers to the delivery of chemotherapy before your cancer surgery. We have seen that the outcomes (like survival and recurrence rates) are the same between similar patients who get chemotherapy before surgery compared to those who have chemotherapy after surgery.
Traditionally, NAC was recommended for a group of patients with “locally advanced breast cancer.” In more recent years, even patients without locally advanced breast cancer, but who we know will receive chemotherapy as part of their treatment plan, may still be referred for NAC. Many young patients start their breast cancer treatments with neoadjuvant chemotherapy.
Your care team may recommend NAC for a number of reasons. The most common reasons include a large tumour size (more than five centimetres) and any evidence that many lymph nodes are already affected. Conditions such as inflammatory breast cancer or advanced disease that cannot be treated surgically first (e.g. tumours stuck to the skin or muscles) are other situations where you would need NAC.
More recently, we have found that triple negative (ER-, PR-, and Her2-) or Her-2 positive cancer (ER-PR-Her2- and ER-PR-Her2+) typically have very good responses to NAC, and therefore are more commonly referred for chemotherapy first compared to estrogen positive tumours.
Finally, in some cases NAC may be given in order to help shrink the tumour and allow you to have a lumpectomy rather than needing a mastectomy if this is your preference.
Although in some cases NAC can lead to complete disappearance of the tumour on imaging (like MRI), surgery is still required to make sure all of the cancer cells are truly gone.
Imaging is often done at the end of NAC in order to determine how the disease has responded to the treatment and to plan for your surgery. Surgery usually occurs round four to six weeks after your last chemotherapy cycle. Radiation will happen about four to six weeks after surgery.
NAC with other treatments
The chemotherapy treatments may affect your fertility; this is something you should discuss with your health care team. There are some options to try and preserve fertility (such as egg and embryo preservation) that can be addressed before starting your treatment.