HR+/HER2– Breast Cancer: Diagnosis and Treatment Guide

What is HR-Positive/HER2-Negative Breast Cancer?

Hormone receptor (HR)–positive HER2-negative breast cancer is the most common form of breast cancer. It means the cancer cells grow with help from estrogen or progesterone but do not have high levels of the HER2 protein. Because of this, hormone-blocking treatments play a major role in care. These cancers often grow more slowly than other types, which gives doctors multiple effective approaches.

Your care team will consider the stage of cancer, your age, menopausal status, tumor size, if lymph nodes are involved and whether the cancer has spread. Some tumors are tested to estimate how likely the cancer is to return, giving important information that helps personalize treatment. Every plan is designed to treat the cancer thoroughly while maintaining quality of life.

How is HR-Positive/HER2-Negative Breast Cancer Diagnosed?

Diagnosis usually starts with a mammogram or other imaging such as ultrasound or MRI when a lump or breast change is found. A biopsy is needed to confirm cancer and test whether the tumor has hormone receptors and HER2.

Doctors also study whether the cancer has spread to lymph nodes or other areas using scans or node evaluation during surgery. Some patients have genomic tumor testing to understand the cancer’s behavior and whether chemotherapy may help. All of this information helps your oncologist select the safest and most effective treatment path.

Questions to ask:

• What type of biopsy did I have?
• What do hormone receptor and HER2 results mean for my care?
• Will I need additional imaging or tumor tests?

What are the Treatment Options for Stage 1 Breast Cancer?

Stage 1 means the tumor is small and has not spread to lymph nodes.

Frontline

Treatment usually starts with surgery. A lumpectomy removes the tumor while preserving most of the breast, often followed by radiation to lower the chance of cancer returning in the breast. A mastectomy removes the entire breast and may not require radiation unless risk factors are found. Hormone therapy is recommended for most patients for several years to block hormones that help cancer grow.

Second-line

Chemotherapy may be used if tests show a higher chance of cancer returning later. Hormone therapy can be adjusted if side effects occur or if the original choice is not working well.

Third-line and beyond

If cancer returns locally or in the breast again, treatment may involve additional hormone therapy, surgery, radiation or targeted medicines. Your care team will review all options to prevent further spread.

What to discuss:

• Breast-conserving surgery versus mastectomy
• Whether genomic tests are recommended
• Plans for long-term hormone therapy

What are the Treatment Options for Stage 2 Breast Cancer?

Stage 2 means the tumor is larger or has spread to a small number of nearby lymph nodes.

Frontline

Depending on the tumor’s features, treatment may begin with surgery or chemotherapy. If the tumor is large or lymph nodes are involved, chemotherapy before surgery (called neoadjuvant therapy) may shrink the cancer to make surgery easier and provide early treatment to the whole body. Radiation usually follows surgery. Hormone therapy is standard to prevent the cancer from coming back.

Second-line

If chemotherapy was not used before surgery, it may be given afterward if needed. Some patients may receive targeted therapy to reduce the risk of future recurrence if certain tumor features are present.

Third-line and beyond

If cancer returns elsewhere in the body or near its original site, additional hormone therapy, targeted therapy or clinical trial options may be offered.

Questions to ask:

• Should chemotherapy be before or after surgery?
• Will radiation be needed?
• How long will hormone therapy last?

What are the Treatment Options for Stage 3 Breast Cancer?

Stage 3 means the cancer has spread to multiple lymph nodes or nearby tissues but not to distant organs.

Frontline

Treatment often begins with chemotherapy to shrink the tumor and treat cancer cells throughout the body. Surgery then removes the tumor and affected lymph nodes. Radiation therapy targets any remaining cancer cells in the chest area. Long-term hormone therapy is used to help prevent cancer from returning.

Second-line

If cancer returns locally, other hormone therapy options may be tried. Some patients may receive additional targeted therapies if their tumor has features linked to higher risk.

Third-line and beyond

If the cancer spreads farther, treatment follows strategies similar to metastatic disease. Clinical trials may also be considered to access newer medicines.

What to discuss

• Reconstruction options if a mastectomy is needed
• Support for managing treatment side effects
• Plan for follow-up and survivorship after therapy

What are the Treatment Options for Metastatic Breast Cancer?

Metastatic breast cancer has spread beyond the breast and nearby lymph nodes to places like bone, liver, lung or brain. Treatment aims to control the cancer, relieve symptoms and protect quality of life.

Frontline

Hormone therapy plus a targeted therapy called a CDK4/6 inhibitor

Second-line

If the cancer grows again, a different hormone therapy or targeted therapy may be used. Chemotherapy may be offered if hormone therapies stop working, symptoms worsen or the cancer grows quickly.

Third-line and beyond

More chemotherapy options and newer targeted treatments may be available based on tumor testing, including medicines that can focus on specific genetic changes. Clinical trials can offer access to emerging therapies.

What Side Effects Can Occur During Treatment?

Side effects depend on your treatment plan and can vary from person to person. Hormone therapy may cause hot flashes, mood or sleep changes and joint or muscle discomfort. Bone health can change over time, so you may need scans or medicine to protect bones. Chemotherapy may lead to hair loss, nausea, fatigue, low blood counts and increased infection risk. Radiation may cause breast soreness, fatigue or skin irritation.

Communication is key. Report any symptoms early. Your team has tools such as medicines, physical therapy, nutrition support and counseling to help you stay comfortable and active during treatment.

Questions to ask your doctor:

• What side effects are most common with my treatment plan?
• When should I call the clinic if something feels wrong?
• What support services are available?

What Should Patients Know During Their Breast Cancer Treatment and Beyond?

A breast cancer diagnosis can feel overwhelming, but you have a team committed to helping you through each step. HR-positive/HER2-negative breast cancer has many effective treatments at every stage. Staying informed, asking questions and having a support system are important parts of care.

Bring a notebook or trusted person to appointments if that helps. Let your team know what matters most to you, whether it is staying active, managing work or focusing on life goals. Your voice shapes your care plan.

“Breast cancer is such an important part of our world, unfortunately. Almost anybody you talk with — friends, colleagues — everyone’s been touched by this disease, either in their own family or a friend. It’s just, unfortunately, such a huge part of our culture. So I think for patients and people to understand, even as aware as we are, we can be more aware," Dr. Sheldon Feldman, chief of breast surgery and oncology at Montefiore Medical Center, said in an interview with CURE.

Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

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