Primary Systemic Therapy for Breast Cancer
Medicines given before surgery can shrink the cancer, show its response and guide later treatment.
The key things to know
- Treatment before surgery is part of an integrated plan.
- Imaging response usually does not replace surgery and pathology.
Understanding neoadjuvant treatment
Primary or neoadjuvant systemic therapy is given before an operation. It may involve chemotherapy, endocrine or targeted treatment, and sometimes immunotherapy depending on subtype. Its use reflects a planned treatment strategy; it does not mean surgery has been abandoned or that treatment cannot help.
Testing and planning
A biopsy confirms the cancer and receptors, with imaging to assess extent. A small marker may be placed in the tumour or an involved node before it shrinks, helping later surgery. Fertility, medical history and treatment goals should be discussed before starting.
Following the response
The team checks response through examination and planned imaging. A lump disappearing on examination or a scan does not prove every cancer cell is gone, so surgery and pathological assessment usually remain important. An unexpected response may lead to a revised plan.
What comes next
The surgical pathology report helps select any additional medicines and radiotherapy. Keep a clear record of the treatment coordinator, appointments and contact numbers. Serious symptoms during treatment need prompt assessment rather than waiting for the next response scan.
Take these questions to your appointment
- Why is medicine before surgery recommended for me?
- How will surgical findings change my later treatment?
Sources & review
This is original educational content based on the sources below, not reproduced textbook material. Website supervisor: Dr. Nizar Ismail. Individual medical review of this article is pending.
This information cannot replace diagnosis or a personal treatment plan. Consult your care team about symptoms or decisions about your treatment.