How to Treat Stage II (2) Breast Cancer: All You Need to Know

Summary

This video offers an in-depth look at stage 2 breast cancer, detailing the factors that define it, such as tumor size and lymph node involvement. It explores the multifaceted treatment landscape, including surgery options like lumpectomy or mastectomy, the role of chemotherapy and targeted therapy, and the importance of radiation therapy. The video also addresses the biological markers that inform treatment decisions, such as hormone and HER2 receptor status, and the potential use of multi-gene tumor assays. Additionally, it delves into the practical aspects of treatment, including side effects, management strategies, and the financial considerations of different therapies.

Takeaways

• 📏 Stage 2 breast cancer is classified based on tumor size and lymph node involvement.
• 🏥 Treatment decisions for stage 2 breast cancer consider factors beyond tumor size and lymph nodes, including the tumor's biological characteristics.
• 🔍 Surgery is often the first step, followed by chemotherapy, radiation therapy, and possibly hormonal therapy.
• 🩺 Depending on the size of the breast and tumor, a lumpectomy (removing just the tumor) might be possible instead of a mastectomy (removing the entire breast).
• 💊 Chemotherapy is recommended based on the tumor's biology, such as being estrogen/progesterone receptor negative, HER2-positive, or having a high grade.
• 🧬 A multi-gene tumor assay helps determine if chemotherapy is necessary, especially for tumors that are HER2-negative, lymph node-negative, and estrogen receptor-positive.
• 🌡 Radiation therapy may be recommended after mastectomy, especially if one to three lymph nodes are positive, and is almost always given after lumpectomy.
• 💉 Targeted therapy, such as trastuzumab (Herceptin), is used if the tumor overexpresses the HER2 protein and can last up to a year.
• 💊 Hormonal therapy is crucial for tumors that are estrogen and/or progesterone receptor positive, and is taken as a daily pill for five to ten years.
• 💰 Costs of treatment are an important consideration, with insurance often covering most treatments but out-of-pocket costs possible for certain medications.

Q & A

What is Stage 2 breast cancer?

Stage 2 breast cancer refers to a tumor that is larger than 2 centimeters or has spread to one to three lymph nodes under the arm, indicating a more advanced stage than Stage 1.

What factors are considered when making treatment decisions for Stage 2 breast cancer?

Treatment decisions for Stage 2 breast cancer consider the size of the tumor, the number of affected lymph nodes, and the tumor's biology, including hormone receptor status and HER2 status.

What are the typical treatment options for Stage 2 breast cancer?

The typical treatment options include surgery, chemotherapy with or without targeted therapy, radiation therapy, and hormonal therapy.

Can you explain the difference between a lumpectomy and a mastectomy?

A lumpectomy is a surgical procedure where only the tumor is removed, preserving the breast. A mastectomy involves the removal of the entire breast, and possibly nearby lymph nodes.

Why might a patient receive chemotherapy before surgery for Stage 2 breast cancer?

Chemotherapy before surgery, known as neoadjuvant chemotherapy, is used to shrink the tumor, making it easier to remove, and also to treat any potential cancer cells that may have spread elsewhere in the body.

What is the role of radiation therapy in treating Stage 2 breast cancer?

Radiation therapy is used to target any remaining cancer cells after surgery and to reduce the risk of the cancer returning. It may be recommended after a lumpectomy or mastectomy, depending on the specifics of the case.

How does the biology of the tumor influence chemotherapy decisions?

The biology of the tumor, such as being estrogen and progesterone receptor negative, HER2-positive, or having a higher grade, influences the likelihood of chemotherapy being recommended as it indicates the potential effectiveness of the treatment.

What is targeted therapy in the context of Stage 2 breast cancer?

Targeted therapy is a treatment that targets specific proteins or genes involved in the growth and spread of cancer cells. For HER2-positive tumors, drugs like trastuzumab (Herceptin) or pertuzumab (Perjeta) may be used.

What is the purpose of hormonal therapy in breast cancer treatment?

Hormonal therapy is used to block the effect of estrogen on breast cancer cells or to lower the amount of estrogen in the body, thereby inhibiting the growth of hormone receptor-positive cancer cells.

What are some potential side effects of chemotherapy for breast cancer?

Potential side effects of chemotherapy include fatigue, hair loss, nausea and vomiting, low white blood cell counts, and in some cases, skin changes or darkening.

How does the cost of treatment for Stage 2 breast cancer impact patients?

The cost of treatment can be a significant concern for patients. Insurance typically covers most treatments, but out-of-pocket expenses, including for medications and deductibles, can vary. Patient assistance programs may be available for those who cannot afford their medications.

Outlines

00:00

🏥 Understanding Stage 2 Breast Cancer

The speaker introduces the topic of stage 2 breast cancer, explaining the staging criteria based on tumor size and lymph node involvement. They clarify that a tumor larger than 2 centimeters or one to three positive lymph nodes can classify a cancer as stage 2. The paragraph discusses the initial steps in treatment, typically starting with surgery, followed by chemotherapy with or without targeted therapy, and often radiation therapy. The importance of considering the tumor's biology in treatment decisions is highlighted, with a focus on factors like tumor size, lymph node status, and the potential for breast conservation or mastectomy.

05:00

💊 Treatment Options for Stage 2 Breast Cancer

This section delves into the specifics of treatment options for stage 2 breast cancer, including the potential for chemotherapy to shrink tumors prior to surgery, thus possibly allowing for breast conservation. It also discusses the role of radiation therapy, which may be recommended post-mastectomy or after lumpectomy, and the significance of lymph node status in this decision. The paragraph further explores the criteria for chemotherapy recommendations, such as tumor biology, receptor status, and the use of multi-gene tumor assays to guide treatment decisions.

10:00

🧪 Side Effects and Costs of Treatment

The speaker addresses the side effects and costs associated with chemotherapy, including fatigue, hair loss, low white blood cell counts, and the need for white cell boosters. They emphasize the importance of discussing treatment costs with healthcare providers and the potential for out-of-pocket expenses for medications to manage side effects. The paragraph also outlines the process of chemotherapy administration, the role of medical oncologists, and the impact of chemotherapy on daily life, including the recommendation to have a driver post-treatment.

15:01

🌟 Radiation Therapy and Targeted Therapy Insights

This paragraph focuses on the process and side effects of radiation therapy, emphasizing its precision and the importance of simulation for treatment planning. It discusses the relatively short duration of radiation therapy sessions compared to chemotherapy and the potential for skin reactions at the treatment site. The paragraph also covers targeted therapy, including its administration alongside chemotherapy and its role in treating HER2-positive tumors. The speaker provides insights into the side effects of targeted therapy and the importance of discussing any reactions with healthcare providers.

💪 Hormonal Therapy and Its Importance

The final paragraph discusses hormonal therapy for hormone receptor-positive breast cancer, detailing its function to block estrogen from reaching residual cancer cells. It outlines the side effects, such as hot flashes, night sweats, leg cramps, and sexual side effects, and the rare but serious risks like blood clots and bone thinning. The speaker stresses the importance of adherence to hormonal therapy, despite potential side effects, and the availability of patient assistance programs for those facing financial barriers to treatment.

Keywords

💡Stage 2 Breast Cancer

Stage 2 breast cancer refers to a classification of breast cancer based on the size of the tumor and the involvement of lymph nodes. In the video, it is explained that a tumor larger than 2 centimeters or the presence of cancer in one to three lymph nodes under the arm categorizes the cancer as stage 2. This stage is significant as it influences the treatment decisions, including the type of surgery and the need for additional therapies like chemotherapy.

💡Tumor Size

Tumor size is a critical factor in determining the stage of breast cancer. The video mentions that a tumor larger than 2 centimeters (comparable to the size of two lima beans end to end) is classified as a T2 tumor, which is a defining characteristic of stage 2 breast cancer. Understanding tumor size is essential for planning treatment, as larger tumors may require more aggressive interventions.

💡Lymph Nodes

Lymph nodes are small, bean-shaped structures that are part of the body's immune system and are located throughout the body. In the context of breast cancer, the involvement of lymph nodes is a significant factor in staging. The video explains that having one to three positive lymph nodes indicates a stage 2 tumor, regardless of the tumor's size, and influences the decision for additional treatments like radiation therapy.

💡Surgery

Surgery is a common initial treatment for stage 2 breast cancer. The video discusses two types of surgical procedures: lumpectomy, where only the tumor is removed, and mastectomy, which involves the removal of the entire breast. The choice of surgery depends on the tumor size and the patient's individual circumstances, and it sets the stage for further treatment options.

💡Chemotherapy

Chemotherapy is a systemic treatment used in stage 2 breast cancer to kill cancer cells throughout the body. The video describes how chemotherapy is often given before radiation therapy and is determined based on the tumor's biology. It may be recommended for patients with certain tumor characteristics, such as being estrogen and progesterone receptor negative or HER2-positive.

💡Radiation Therapy

Radiation therapy is a treatment method that uses high-energy rays to kill cancer cells. According to the video, radiation therapy may be offered to many patients with stage 2 breast cancer, especially after a lumpectomy. It is also recommended after mastectomy for patients with one to three positive lymph nodes. Radiation therapy is an outpatient procedure that aims to target the areas where cancer cells might remain.

💡Hormonal Therapy

Hormonal therapy is a treatment for breast cancer that involves the use of medications to block the effects of hormones that can promote the growth of cancer cells. The video explains that hormonal therapy is given to patients whose tumors are estrogen and/or progesterone receptor positive. This treatment can last for five to ten years and is taken in the form of a daily pill.

💡Targeted Therapy

Targeted therapy is a type of cancer treatment that targets specific abnormalities in cancer cells. In the video, it is mentioned that for stage 2 breast cancer, targeted therapy may include drugs like trastuzumab (Herceptin) and pertuzumab (Perjeta), which are given to patients with HER2-positive tumors. This therapy is usually administered over a year and works alongside chemotherapy.

💡Multi-gene Tumor Assay

A multi-gene tumor assay is a test that examines the tumor's genetic makeup to determine its 'personality' and predict how it might respond to treatment. The video explains that this assay is used for tumors that are HER2 negative, lymph node negative, and estrogen receptor positive. The results of this test can influence whether chemotherapy is recommended.

💡Cost of Treatment

The cost of treatment is an important consideration for patients with breast cancer. The video touches on the financial aspect of treatments like chemotherapy, radiation therapy, and hormonal therapy, emphasizing that while insurance may cover some costs, patients might face out-of-pocket expenses for medications or treatments. It also suggests discussing costs with healthcare providers and exploring patient assistance programs.

Highlights

Explanation of stage 2 breast cancer and its significance.

Description of tumor size and lymph node involvement in stage 2 breast cancer.

Importance of tumor size alone in determining stage 2 breast cancer.

Role of lymph nodes in staging breast cancer and treatment decisions.

The typical sequence of treatments for stage 2 breast cancer.

Options for surgery in stage 2 breast cancer, including lumpectomy and mastectomy.

Potential for chemotherapy to shrink tumors and alter surgical requirements.

Indications for radiation therapy following mastectomy or lumpectomy.

The influence of tumor biology on treatment decisions for stage 2 breast cancer.

Criteria for recommending chemotherapy based on tumor characteristics.

The role of multi-gene tumor assays in treatment planning.

Targeted therapy options for stage 2 breast cancer, including trastuzumab and pertuzumab.

Duration and side effects of targeted therapy.

Hormonal therapy's role in treating hormone receptor-positive breast cancer.

Details on the administration and side effects of hormonal therapy.

Importance of adherence to hormonal therapy in treatment outcomes.

Cost considerations and insurance coverage for breast cancer treatments.

Practical advice for managing side effects and treatment costs.

Encouragement for patients to engage with their healthcare team about treatment options.

Transcripts

hi in this video i'll be talking about

stage 2 breast cancer

i'll start by explaining what stage 2

breast cancer is

then i'll talk about the different

treatments and how we make decisions

about treating stage 2 breast cancer

[Music]

so stage refers to where the tumor is in

the body

the size of the tumor in the breast and

then the number of lymph nodes

or lymph glands under the arm that have

cancer in them

one can have a stage two breast cancer

just based on tumor size alone

if the tumor is bigger than two

centimeters it's only about this

big so two lima beans end to end that's

a t2

tumor and that makes the tumor stage two

you can also have a tumor with a smaller

tumor size but the lymph nodes are

positive one to three lymph nodes

positive

mean that this is a stage two tumor

regardless of how small the tumor is

when we make treatment decisions about

stage two breast cancer we look at

things

other than just the size of the tumor

and the lymph nodes so if you've been

told you have stage two breast cancer

that's actually not a lot of information

for you in terms of the

type of treatment you'll be offered so

let's start with how things usually go

usually people get surgery first and

then chemotherapy

with or without targeted therapy

radiation therapy will be offered to

many patients

and we also give hormonal therapy so

i've mentioned all the different

treatment types and then

the biology of the tumor helps us make

decisions about what type of treatment

we consider

when you have surgery for stage 2 breast

cancer

depending on the size of the breast and

the size of the tumor

you can very likely keep the breast

meaning you don't have to have a

mastectomy which is removal of the

entire breast

in other words you can have a lumpectomy

where we remove

just the tumor itself now if you can't

feel it

how is it a lumpectomy well we'll call

that a wide local excision

the tumor can't be felt so

if you have a small breast and a larger

tumor

in a small breast a mastectomy might be

the best thing for you

removal of the whole breast here's

another option

you can have chemotherapy first to

shrink the tumor

and then it might be possible for you to

have a lumpectomy instead of a

mastectomy

so if you hear about getting

chemotherapy before surgery

we're trying to shrink the tumor as well

as treat the rest of the body which i'll

get to in just a second

so depending on the number of lymph

nodes involved

and the type of surgery you have you may

be offered radiation therapy

even if you have removal of the breast

so we recommend

radiation therapy after mastectomy

in people who have one to three positive

lymph nodes

so just having a mastectomy doesn't mean

you'll need radiation therapy

if you have stage two breast cancer and

the lymph nodes are negative

you'll have radiation therapy if you

have a lumpectomy

and not necessarily if you have a

mastectomy there are always exceptions

and i won't go into those now but you

can read more about those

on our yerba blog so we talked about

surgery and then who would get radiation

therapy if you're a candidate for

chemotherapy

in other words if the biology of your

tumor the personality if you will

indicates that chemotherapy will work

you'll actually get chemotherapy before

radiation therapy

chemotherapy decisions are made on the

basis of not only the stage

but the biology and i'll just briefly

describe those here

if the tumor is estrogen and

progesterone receptor

negative we are more likely to recommend

chemotherapy

that means there's no hormone receptors

on the tumor

chemotherapy is more likely to work if

the tumor is

her2-positive and has this protein

or expression of the gene for her2

human epidermal growth factor receptor

we're more likely to recommend

chemotherapy we also give targeted

therapy in that case

if the tumor has a higher grade

that means the tumor is more active and

looks more disorganized

we're more likely to give chemotherapy

and as i mentioned if the lymph nodes

are positive

you're more likely to get chemotherapy

there's also a special test called

a multi-gene tumor assay

that means your tumor is sent to look at

sort of its

personality in more detail we only do

that in tumors that are her2 negative

and lymph node negative and er positive

estrogen is after positive

if that rescue recurrent score comes

back low

you won't need chemotherapy if it comes

back higher

chemotherapy is more likely to work so

i've talked about surgery

radiation therapy which follows

chemotherapy

i've talked about chemotherapy and i

mentioned targeted therapy so i'll just

tell you a little bit about that

targeted therapy and stage two breast

cancer

includes trastuzumab the brand name you

may have heard is herceptin

and per choosing app the brand name you

may have heard for that

is pergetta if your tumor has the her2

protein

or overexpression of the gene that makes

her two

we will give targeted therapy targeted

therapy

usually goes for up to a year depending

on how you're doing on it

chemotherapy along with targeted therapy

and then you finish out that year of

targeted therapy

hormonal therapy decreases the amount of

estrogen

getting to any residual cancer cells in

the body it doesn't always lower

estrogen

but some of the medications do and this

you'll take for five to ten years

depending on how you tolerate the

medicine

and also features of your tumor that's a

decision you and your doctor will make

so there are lots of different things to

think about in treating sage

to breast cancer i talked about a lot of

different treatment types what i'd like

to do now is go through each treatment

what

you can expect when you get these

different treatment modalities

in terms of what to expect on that day

of treatment

over the whole time and then side

effects and how you might manage those

i'm also going to cover costs

because costs of treatment are very

important and things you may not have

heard about or think about

when a certain treatment's recommended

so we talked about

surgery and that'll be covered in

another one of our videos

but basically surgery unless you have

reconstruction

following a mastectomy is a one day

procedure so it's outpatient most of the

time

if you have your lymph nodes removed

because they're positive or because we

want to figure out if they're positive

the recovery times a little bit longer

because you have an incision

under your arm and what you'll find with

that is your range of motion is a little

decrease don't be afraid to ask for a

physical therapy consultation

to try to improve your range of motion

as soon as possible

what to expect with chemotherapy

chemotherapy is given as an outpatient

in a treatment center

we're trying to treat cells that may

have escaped the tumor before you were

even diagnosed

and spread to other parts of your body

what that means

is that we give treatment to go through

your whole system and the best way to do

that is through a vein

so if you're getting chemotherapy this

is what it looks like

you've already had your consultation

with the kind of doctor

that gives chemotherapy called a medical

oncologist or just an oncologist for

short

you'll understand what treatment will be

given to you

and what to expect but i'm going to give

you a little bit of a preview

you will go to the treatment center

again this is all outpatient

you'll have an iv put into your arm

usually on the side other than your

surgery

or you might have a port which is a

semi-permanent

iv that goes under the skin on your

chest

you don't need a port unless your veins

have been difficult in the past most

people don't need to get a ports one

more procedure and it leaves another

scar

it's a pretty safe procedure but again

wouldn't it be nice to avoid that

when you get to the treatment center and

they put that iv in

the pharmacist or nurse will create your

chemotherapy based on your height and

your weight so it's specialized for you

it's different for every person

and then that medicine will go into the

vein after you've been given

some other medicine to decrease the risk

of side effects

specifically nausea and vomiting

so those medications you'll get before

you get the chemotherapy

the chemotherapy will go in either as an

iv push

through a syringe a small bag or a

larger bag over a longer period of time

the very longest chemotherapy is six

hours

most chemotherapy is much shorter but i

tell my patients plan to be there for a

whole day

that way you're not planning things you

have to get to right afterwards

we do recommend you have a driver for

your chemotherapy

not necessarily because of the

chemotherapy but the medicines we give

to prevent side effects can make you a

little drowsy

also getting chemotherapy is a big deal

and you don't want to be driving

after such a major event in your life

once the chemotherapy is over

the iv comes out of your arm or the port

and you go home

the cost of chemotherapy are usually

covered by insurance

you may have out of pocket costs for the

medicines that you take at home

to prevent nausea both before and after

chemotherapy

so it's important to talk to your doctor

about the cost of treatment

side effects of chemotherapy i'm gonna

they're different for everyone

if you want to learn more about this you

can go to your personalized yerba report

to learn more about the chemotherapy you

might be given and what to expect but in

general

i tell people to expect some fatigue and

that actually gets worse with each

treatment ask for help with things that

you can ask for help for

we also see hair loss with most

chemotherapy

and it's something to talk about what to

expect we also have another video

about hair loss with chemotherapy that

goes into this in much more detail

that can be one of the hardest things

with chemotherapy is losing your hair

we also see low white cell counts which

means that you may get a white cell

booster

along with your chemotherapy the

following day

and that keeps your white cells up so

that you can stay on

track with your chemotherapy and

there are other side effects that

different people can get mouth sores are

pretty uncommon

if you have darker skin let's say you're

a black person

or mediterranean descent you may notice

some darkening or spots on your palms

darkening of the nail beds and even

darkening of the tongue

and gums that all goes away after

chemotherapy and your hair will grow

back too

so i've covered how chemotherapy is

given what to expect

side effects and some of the costs of

treatment as well

next i'm going to talk about radiation

therapy if radiation therapy is part of

your treatment plan

you will first have something called a

simulation

that's the longest appointment in that

appointment

the physicist and the radiation

oncologist the type of cancer doctor

that gives

radiation therapy will work very

carefully to make sure that radiation is

given to the areas that need it

for example the breast in particular

chest wall if you've had a mastectomy

and the neighborhood lymph nodes what we

try to do with that planning

is use a cat scan to make sure we only

radiate the areas that need radiation

therapy

and not the normal tissues so you can

understand why it takes a long time we

want to get this right

now after that simulation or treatment

planning appointment

your radiation therapy is actually much

shorter

than for example chemotherapy radiation

therapy you'll be in and out you'll come

in

you'll change into a gown you'll get

your treatment and go home it takes

about as long

as getting an x-ray or a series of

x-rays you can drive yourself

there is no nausea with radiation

therapy

so we don't give you medications before

radiation therapy

so what about the costs of radiation

therapy

the radiation therapy is covered by

insurance but if you have a high

deductible

plan it might make sense to see if you

can get all your treatment the same year

as your surgery and chemotherapy before

the next

calendar year kicks in and that

deductible starts all over again

radiation oncologists are used to

questions about that what you want to

avoid is any delay between chemotherapy

for example

and starting radiation therapy try to

get your usually six weeks of radiation

therapy and before the end of the

calendar year

side effects include some fatigue

which despite the fact that it's not

going through your whole system

radiation therapy can cause you'll also

notice skin changes where the radiation

is

so around the breast and the lymph nodes

you may get some burning some pinkness

it may actually be bad enough that your

skin sort of comes

off talk to your radiation oncologist

and the nurses about those side effects

because we do have ways

of decreasing the pain or discomfort

serious pain is pretty rare

this all goes away and starts to heal

about two weeks after the end of

radiation therapy

if you don't have a lot of skin side

effects don't worry it's still working

you will not get hair loss with

radiation therapy to the breast

and surrounding areas

okay targeted therapy which again we

give along with chemotherapy

goes for a year your first treatments

will be along with the chemotherapy

and after that when chemo is done you'll

finish out a year

of targeted therapy it's given the same

way chemotherapy is given through a vein

and now it's given every three weeks

once the chemo is over

before that we try to time it along with

your chemotherapy

targeted therapy side effects are much

less than we think about with

chemotherapy your hair will start to

grow in

your fatigue should get better you're

still a patient you're still being seen

in the treatment center

you won't see your doctor as often which

is kind of nice

and the treatment course is a lot

shorter so it doesn't take as long

you can drive yourself most of the time

if you have a reaction

to targeted therapy and we give you

medicine before your targeted therapy

you may want to have a driver talk to

your oncologist about that

and to the nurses the last thing i'm

going to talk about in terms of what to

expect

is with hormonal therapy this again is

given to people whose tumors are

estrogen

and or progesterone receptor positive

hormonal therapy is given as a pill

and you take this once a day for five to

ten years there are several different

kinds

of hormonal therapy but basically what

these medicines do

is block the estrogen in your body

whether you're pre

or postmenopausal from getting to any

residual or remaining cancer cells

in other parts of your body side effects

with hormonal therapy depend on which

drug you get

and depend on you personally but

basically

the sort of top ones we talk about are

hot flashes or

night sweats people with tamoxifen can

get

leg cramps we also think about sexual

side effects such as

vaginal dryness or discomfort and then

finally there are rare but serious side

effects which differ according to the

drug so tamoxifen

rarely causes blood clots in the legs

and rarely causes an increased risk of

uterine cancer

cancer of the uterus endometrial cancer

again it's very rare

and it's caught early but it's something

to know about you don't have a uterus

not something to worry about with the

aromatase inhibitors which actually

decrease the amount of estrogen in your

body by blocking production of estrogen

the side effects you should know about

with this are thinning of the bones

without

estrogen in your body your bones can get

a little thinner now we have ways of

treating you and monitoring for that

which we'll go over

in another video and that you can see on

our yerba blog

and also in your personalized yerba

report

but this is important to know about the

other thing is there appears to be a

slightly higher risk of cardiovascular

disease with the aromatase inhibitors so

that's something you'll want to be

followed for

if you have a high cholesterol get that

treated exercise do all the right things

you can for your heart regardless of

whether or not you've had breast cancer

the costs of hormonal therapy are

covered by insurance

if you can't afford your medicine you

can ask your doctor

or the rest of your medical team to help

you get patient assistance

which the pharmaceutical companies will

actually provide the medication to you

at a lower cost the generics are just as

good as the brand name so

ask for the generics the generic version

of the medications they're a lot less

expensive

if you get side effects or if you have

concerns about cost with hormonal

therapy

talk to your teen it turns out a lot of

women come

off hormonal therapy because of the side

effects i told you about and never tell

their doctor in fact they may not even

return to their oncologist's office

hormonal therapy is essential in the

treatment of hormone receptor breast

cancer

a lot of people think i've been through

chemotherapy i've been through targeted

therapy surgery

radiation therapy hormonal therapy is

not that important it's actually in many

cases

more effective than chemotherapy or

targeted therapy

so do make sure you've done everything

you can to stay on it

and work with your doctor if you're not

tolerating one medicine we can switch to

the other

if you're going through treatment for

stage 2 breast cancer

you can learn more about your own

treatment remember at your own

personalized report on yearbook.com

and if you'd like this video why don't

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