When Jessica Collier of Stockbridge, Georgia, received a diagnosis of stage IV triple-negative breast cancer in May 2025, an oncologist told her she was treatable, not curable. “Which was devastating,” she says.
Follow-up scans showed lesions in her liver and spleen, as well as several suspicious lymph nodes. Her doctor suggested a treatment plan including chemotherapy, and depending on how far her cancer had spread, immunotherapy.
But treatment was delayed, and Collier wasn’t getting clear answers about what would happen next or when.
“That’s when I completely lost faith in my original oncologist,” she says. “We’re looking to [doctors] to have all the answers, especially in a scary situation.”
Any breast cancer diagnosis can be a lot to handle, especially when it comes to understanding your treatment options. There are lots of moving parts, including surgery, medications, radiation, and new therapies. It can be hard to know if you’re on the right path or if there may be better options.
If you have already started breast cancer treatment or are rethinking your current plan, you’re not alone. This guide will help you make sense of your current treatment journey, explain how standard and emerging therapies may fit in, and help you know how to ask the right questions.
Breast Cancer Treatment Isn’t One-Size-Fits-All
Every breast cancer treatment journey is unique. It’s based on different factors, including:
- The stage and grade of your cancer
- Whether you have specific biomarkers (molecules that can tell doctors how well you’ll respond to a particular treatment)
- Your general health
- Your preferences
Phases of the Breast Cancer Treatment Journey
There are three main phases of treatment for breast cancer:
- Treatment before surgery (called preoperative or neoadjuvant therapy)
- Surgery
- Post-surgery (called adjuvant treatment)
Both standard and emerging therapies may fit into each phase of treatment, depending on your needs and treatment goals.
Presurgery Phase (Neoadjuvant Therapy)
You’ll have neoadjuvant therapy before surgery to remove a breast tumor. The goal is to shrink tumors for easier removal during surgery, or destroy them so you don’t need surgery at all.
Standard neoadjuvant treatments
There are a few types of neoadjuvant therapies for treating inflammatory breast cancer, early-stage ER-positive breast cancer, and some forms of HER2-positive and triple-negative breast cancer. They include:
- Chemotherapy: This kills cancer cells and stops them from growing.
- Hormone therapy: This blocks hormones that cancer cells rely on to grow.
- Radiation therapy: This uses high doses of radiation to kill cancer cells.
Your doctor may suggest one therapy or a combination of them. Neoadjuvant therapies can last weeks to up to a year.
Emerging and new therapies
Researchers continue to make breakthroughs in presurgical treatments for breast cancer. Some recent advances include:
Targeted therapy. Often combined with chemotherapy, this therapy uses drugs to pinpoint specific molecules inside or on cancer cells and stop the cells from growing. A newer type of targeted therapy called antibody-drug conjugates (ADCs) treats challenging forms of breast cancer by combining a monoclonal antibody (lab-made protein) with a powerful drug to kill cancer cells.
Immunotherapy. This treatment works by helping your immune system spot and attack cancer cells. You’ll likely have it in combination with chemotherapy.
Surgery
After neoadjuvant treatment, the next step in your treatment journey is surgery to remove breast tumors. This usually happens one month after the presurgery phase.
Standard breast cancer surgeries
Types of breast cancer surgery include:
Breast-conserving surgery. Also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy, this surgery involves the removal of the cancer and some surrounding tissue, but not your breast.
Total mastectomy. This surgery removes your entire breast, along with some lymph nodes if they have cancer cells.
Emerging and new therapies
Advances in technology and techniques are making breast cancer surgery less invasive and more effective, improving the quality of life. New therapies include:
Wireless localization. When a tumor is too small to feel, surgeons locate it by inserting a wire into the breast on the day of surgery to help guide them. Now, some surgeons use wireless magnetic or implantable options, which result in shorter surgery prep times and more precise tumor removal with less discomfort.
Cosmetic options. In the past, removing the entire breast was common, but today, doctors personalize surgery based on tumor size, location, and your preference. Oncoplastic surgery preserves breast shape and avoids scarring, while autologous breast reconstruction uses your own tissue from another part of your body to rebuild your breast.
Other surgery advances. Other recent therapies include delivering radiation during surgery, which directly targets the tumor and lowers the need for a mastectomy. Doctors also now use nerve blocks to ease pain without relying on opioids. And lymphatic mapping identifies which lymph nodes drain the breast so surgeons can avoid damaging them.
Postsurgical Phase (Adjuvant Treatment and Beyond)
The final phase of your treatment journey after surgery is adjuvant treatment. The goal is to kill any remaining cancer cells in your body and to lower the chance of the disease returning.
Standard adjuvant treatments
Adjuvant treatment may look similar to neoadjuvant (presurgery) therapies and often includes:
- Chemotherapy for three to six months
- Hormone therapy, which can last years
- Radiation therapy for three to seven weeks
Another option is antibody therapy. This treatment involves using antibodies (proteins your immune system makes) to detect and kill cancer cells while leaving normal cells unharmed. You can take antibody therapy for up to a year. Your doctor will create an adjuvant treatment plan based on your health history, lab results, and medical scans.
Emerging and new therapies
New and emerging adjuvant therapies show promise in the future of breast cancer care. They include:
Cancer vaccines. Researchers are still studying cancer vaccines for breast cancer in clinical trials. Still, they show promise in training your immune system to spot and attack potential cancer cells that may remain after surgery. Personalized mRNA vaccines for breast cancer are tailored to your immune system.
PARP inhibitors. This type of targeted therapy blocks a protein in cells called poly ADP-ribose polymerase (PARP), which helps repair damaged DNA. PARP inhibitors work well to treat breast cancer caused by the BRCA gene mutation.
Talking to Your Doctor About Emerging Therapies
If you’re ready to talk to your health care team about new breast cancer treatments, here’s how to start the conversation:
- Before your appointment, write down your questions to help remember them.
- Invite a friend or family member to accompany you to your appointment to take notes and offer support.
- Ask about all your treatment options, including standard treatment, emerging therapies, and clinical trials.
- Ask about the pros and cons of each treatment, including side effects.
- Ask about your chance of recovery with each treatment and if the cancer could return.
After a disappointing experience with her first oncologist, a friend urged Jessica Collier to get a second opinion. More testing at City of Hope revealed the lesions in her liver and spleen were due to an inflammatory disease. Her new oncologist suggested a treatment plan that included chemotherapy, immunotherapy, a mastectomy, and radiation after surgery.
Although she ended up having standard treatments, Collier encourages others with breast cancer to get a second opinion and explore new treatments.
