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In DCIS, the cancer cells are still only in the wall of the milk duct and have not invaded into any deeper layers of the breast.

Surgery: DCIS is typically treated with surgery to remove the cancer.

• Most often this is with a mastectomy.
• Breast-conserving surgery (BCS) might be an option if there’s enough breast tissue. If BCS is done, it is typically followed by radiation therapy to the remaining breast tissue.

Sometimes DCIS can contain an area of invasive cancer. The chance of this goes up with tumor size and how fast the cancer is growing. If your doctor is concerned you might have invasive breast cancer (not just DCIS), they might check the lymph nodes under your arm for cancer spread. Most often, this is done with a sentinel lymph node biopsy (SLNB). If cancer cells are found in the lymph node(s), it means the tumor does contain invasive cancer, so your treatment plan might change.

Adjuvant hormone therapy after surgery: If the DCIS is hormone receptor-positive (ER-positive and/or PR-positive), adjuvant hormone therapy is often advised to lower the risk of the cancer coming back. Most often, this is with tamoxifen for at least 5 years.

Early stage means the breast tumor is still relatively small, and either the cancer has not spread to the nearby lymph nodes or there is only a small amount of cancer in the lymph nodes.

Surgery: The main treatment for early-stage breast cancer is to remove it with surgery.

• Most often this is with a mastectomy.
• Breast-conserving surgery (BCS) might be an option if there’s enough breast tissue. If BCS is done, it is typically followed by radiation therapy to the remaining breast tissue.

It’s also important to check the nearby lymph nodes for cancer. If the lymph nodes under the arm are already known (or suspected) to have cancer, an axillary lymph node dissection (ALND) will likely be done to remove the nodes. If there are no signs the cancer has reached the lymph nodes, a less extensive sentinel node biopsy (SLNB) might be an option instead. If an SLNB is done and the sentinel node contains cancer, a full ALND might then be needed.

Adjuvant therapy after surgery: Hormone therapy, chemotherapy, and/or targeted therapy may be recommended as adjuvant therapy after surgery, based on the extent of the cancer found during surgery and the results of certain lab tests.

• Hormone therapy with tamoxifen is usually advised for hormone receptor-positive (ER-positive and/or PR-positive) cancers to lower the risk of the cancer coming back. Most often, this is with tamoxifen for at least 5 years.
• Adjuvant chemo might be advised as well for some larger tumors that may be more likely to spread or come back (based on features such as tumor size or the grade or growth rate of the cancer). Sometimes a gene expression test such as Oncotype DX might be an option to help determine if chemo is likely to be helpful.
• If the cancer is HER2-positive, a drug that targets HER2, such as trastuzumab (sometimes along with pertuzumab), is often advised along with chemo.

Locally advanced means the breast tumor is larger or has grown into nearby structures such as the skin or chest wall (including inflammatory breast cancer), and/or the cancer has reached many nearby lymph nodes, but it hasn’t spread to distant parts of the body.

Neoadjuvant therapy before surgery: Most often, these cancers are first treated with chemotherapy to try to shrink the tumor before surgery. If the cancer is HER2-positive, the targeted drug trastuzumab is typically given as well, sometimes along with pertuzumab.

For some men, surgery might be an option as the first treatment instead, with chemotherapy and other treatments being given after surgery as adjuvant treatments (see below).

Surgery: Surgery for these cancers is typically a mastectomy, which usually includes a full axillary lymph node dissection (ALND) to remove the lymph nodes under the arm.

Adjuvant therapy after surgery: Several types of treatment may be recommended as adjuvant therapy after surgery to lower the chances of the cancer coming back. This is based on the extent of the cancer found during surgery and the results of certain lab tests.

• Often, radiation therapy is advised after surgery. This might be to both the breast and the underarm lymph nodes, especially if many of the nodes contained cancer. If adjuvant chemo is being given, the radiation therapy is usually given afterward.
• If the cancer is hormone receptor-positive (ER-positive and/or PR-positive), adjuvant hormone therapy (usually tamoxifen) is advised for at least 5 years. Sometimes a targeted drug might be added to help the hormone therapy work better.
• If chemotherapy wasn’t given before surgery, it is typically given after surgery.
• Regardless of when chemo is started, men with HER2-positive cancers will probably get a HER2-targeted drug like trastuzumab for a total of 1 year of treatment.

Metastatic breast cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, lungs, or brain, but it can also affect other organs or tissues.

Systemic (drug) therapy: Medicines are typically the main treatment for metastatic breast cancer in men. Which ones are used and in what sequence depends on many factors. For example:

• If the cancer is hormone receptor-positive (ER-positive and/or PR-positive) and it doesn’t seem to be growing quickly, hormone therapy (most often tamoxifen) might be tried first. Sometimes a targeted drug called a CDK4/6 inhibitor might be added to help the hormone therapy work better (although it can also have more side effects).
• If the cancer is hormone receptor-negative or if it seems to be growing quickly, chemotherapy will most likely be the first treatment.
• If the cancer is HER2-positive, a HER2-targeted drug will likely be given along with chemo.
• If the cancer cells have certain other gene or protein changes, other targeted drugs might be tried.

Local treatments for advanced breast cancer: Radiation therapy and/or surgery may also be useful in certain situations, such as:

• If the breast tumor is causing an open wound in the breast (or chest)
• To treat a small number of metastases in a certain area, such as the brain
• To help prevent bone fractures
• If an area of cancer spread is pressing on the spinal cord
• To treat a blood vessel blockage in the liver
• To relieve pain or other symptoms

If your doctor recommends such local treatments, it’s important to understand their goal, whether it is to try to cure the cancer or to prevent or treat symptoms.

In some cases, regional chemo (where drugs are delivered directly into a certain area, such as the fluid around the brain or into the liver) may be useful as well.

Supportive or palliative care: Treatment to help prevent or relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with radiation therapy and/or medicines to strengthen the bones, such as bisphosphonates or denosumab.

If advanced cancer progresses during treatment

Treatment for advanced breast cancer can often shrink or slow the growth of the cancer, sometimes for many years. But after a time, it may stop working. Further treatment at this point depends on several factors, including previous treatments, the type of cancer and where it is, as well as a man's age, general health, and desire to continue getting treatment.

Progression while on hormone therapy: For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy is sometimes helpful. Another option might be using a hormone drug along with a targeted therapy drug. If this isn't helpful, chemo is usually the next step.

Progression while on chemotherapy: For cancers that are no longer responding to one chemo regimen, trying another may be helpful. Many different chemo drugs and combinations can be used to treat breast cancer. However, each time a cancer progresses during treatment it tends to become harder to treat.

Other types of medicines, such as antibody-drug conjugates (ADCs) or other targeted drugs, might be options in certain situations.

Immunotherapy might be another option if the cancer cells have certain gene or protein changes.

Progression while getting HER2 drugs: HER2-positive cancers that no longer respond to trastuzumab may respond to other drugs that target the HER2 protein (sometimes along with chemo or hormone therapy drugs). Several options might be available.

Because current treatments are very unlikely to cure advanced breast cancer, if you are in otherwise good health, you may want to think about taking part in a clinical trial testing newer treatments.

You can also read about living with later-stage cancer in Living with Advanced and Metastatic Cancer.

For some men, breast cancer may come back after treatment – sometimes years later. This is called a recurrence. Recurrence can be local (in the same breast or in the surgery scar), regional (in nearby lymph nodes), or in a distant part of the body.

(If cancer is found in the opposite breast but nowhere else in the body, it is not a recurrence—it's a new breast cancer that requires its own treatment.)

Treating local recurrence

Local recurrence includes cancer coming back in the breast or chest wall near the mastectomy scar. A local recurrence with no evidence of distant metastases might still be cured. Treatment depends on the type of breast cancer, exactly where it recurs, and what other treatments have been given already.

The treatment for local recurrence may be further surgery followed by radiation therapy. However, if the area has already been treated with radiation, it might not be possible to give more radiation without damaging nearby tissues.

Hormone therapy, chemotherapy, HER2-directed targeted therapy (such as trastuzumab), or some combination of these may be used after surgery and/or radiation therapy.

Treating regional recurrence

When breast cancer comes back in nearby lymph nodes (such as those under the arm or around the collar bone), it is typically treated by removing the lymph nodes, followed by radiation treatments, or possibly by radiation therapy alone.

Systemic treatment (such as hormone therapy, chemotherapy, targeted therapy, or some combination of these) may be used after surgery and/or radiation therapy.

Treating distant recurrence

When breast cancer comes back in distant parts of the body, it’s usually treated the same way as cancer that was already metastatic when first diagnosed (see above). The only difference is that treatment may be affected by which treatments have already been tried.

Considering a clinical trial

Recurrent breast cancer can sometimes be hard to treat. If you are in otherwise good health, you may want to think about taking part in a clinical trial testing a newer treatment.