Breast cancer treatment timeline

Each person’s treatment timeline depends on their unique situation. Below, we’ll provide general estimates of how long different treatment phases can last. The lengths of time we share here are broad, and that’s because of how personalized breast cancer treatment has become. Your care team will have the most information about your treatments and needs. It’s OK to ask how long they believe each step may take.

Treatment variations

There are many breast cancer treatments approved by the FDA. Not every person diagnosed with breast cancer needs all of these treatments. The treatments you receive will depend on many factors, including features of the cancer and information about you and your needs.

Features of the cancer that can direct treatment plans include:

• The cancer stage: Breast cancer can be stage I, II, III, or IV. Staging is a way to measure the extent of cancer in the body and how serious the cancer is.
• The hormone receptor status of the cancer: Knowing whether certain hormones help the cancer grow can help determine treatment options.
• The HER2 status of the cancer: Cancers that overexpress a gene called HER2 can be treated with medicines that target HER2.
• The cancer grade: Cancer grade is how similar the cancer cells look to normal breast cells. Grade helps doctors understand how slowly or quickly the cancer cells are growing and dividing.
• Results from genomic tests and genetic tests:

  • Genomic tests, also called tumor biomarker tests, performed on a piece of cancerous tissue, look at the genes in cancer cells to help predict how cancer will respond to certain treatments.
  • Genetic tests, also called genetic testing for an inherited mutation, performed on a blood sample, check to see if you carry an inherited mutation, such as a BRCA1 or BRCA2 mutation, that raises your risk of breast cancer. Testing positive for a BRCA1 or BRCA2 mutation can affect treatment decisions.

Information about you that can direct treatment plans includes:

• Your health at the time of diagnosis: If you have other health conditions, your care team will consider how those conditions impact your body and what medicines you are already taking when they decide which cancer treatments you can get.
• Whether you’ve started menopause: Some cancer treatments are only approved for people who have already stopped having their period.
• Whether you want breast reconstruction: For example, if you need radiation therapy and you also choose to have a mastectomy with breast reconstruction, radiation may be given before reconstruction to avoid the effects of radiation on a reconstructed breast.
• Your health insurance: Navigating the health insurance industry can sometimes delay the start of certain treatments while you get required approvals.
• Where you live: While most approved breast cancer treatments are widely available in the U.S., if you live in a rural area you may need to travel further to get treatment. And if you’re considering treatment through a clinical trial, you may only be able to get the trial treatment in some areas.

How long you’re in treatment will depend on which treatments you need to effectively remove or manage the cancer.

• In early-stage breast cancer, the goal of treatment is to remove the cancer from your body and reduce the risk of breast cancer coming back. Early-stage breast cancer includes stages 0 to III. Typically, the higher the stage, the farther the cancer cells have traveled away from the breast.
• The goals for metastatic breast cancer are different. Metastatic breast cancer includes stage IV. While it’s not curable, it is treatable, and treatment is ongoing. The goal is to live as long as possible with the best possible quality of life. This means choosing treatments to control the cancer and to manage side effects, and changing those treatments as needed. You and your oncologist will work together to choose treatments that work best for you.

In general, a person diagnosed with early-stage breast cancer can be in active treatment for about one year. Active treatment includes medicines, surgeries, and therapies that work to remove the cancer from the body. It does not include long-term hormonal therapies given to help stop the cancer from coming back after treatment ends.

Below is a timeline that shows each step between finding a lump (yourself, or during a regular scan) and the end of active treatment. The lengths of time we share are for the average experience, and they may be different from your own.

Diagnosis & testing

Seeing your doctor about a lump to getting a scan of the area: 1 to 2 weeks. Typically, doctors will try to schedule mammograms to check on lumps as soon as possible. If the scheduler suggests an appointment 3 or more weeks after a doctor has checked the lump or seen a suspicious area on a first mammogram, it’s important to ask for an earlier appointment.

Confirming a lump or other suspicious area on a scan to having a biopsy: 1 to 2 weeks. It’s normal to wait up to 2 weeks for a biopsy appointment. Some cancer centers will be able to schedule you sooner. A biopsy is a procedure in which a doctor takes a sample of tissue from the lump so that it can be tested for cancer.

Waiting for biopsy results: 2 to 4 days. Some labs are busier than others, and biopsy results can take a few days. Biopsy samples are tested for breast cancer cells, and if cancer is found, the cells may also be immediately tested for information that tells your doctor what type of breast cancer you have. Some doctors choose to wait to call you with biopsy results until they have the information on type and stage.

Getting your pathology report: No more than 7 to 10 business days. Your pathology report contains information about what was found in the biopsy tissue. Once you have all of this information, you and your doctors can start making treatment decisions.

Active treatment

For people with stages I to III breast cancer, active treatment starts with either surgery or neoadjuvant (pre-surgery) treatment. Pre-surgery treatments like chemotherapy or hormonal therapy can help shrink the tumor to allow for a lumpectomy instead of mastectomy. Pre-surgery treatment also shows your doctors how well the cancer responds to the treatment given. Not everyone receives neoadjuvant treatment. If you do not need neoadjuvant treatment, the first step of active breast cancer treatment is surgery.

Biopsy followed by neoadjuvant treatment

Date of biopsy to the start of neoadjuvant (pre-surgery) treatment: 1 to 4 weeks. In some cases, people need chemotherapy or targeted therapy before surgery. After your biopsy, it can take 1 to 2 weeks to meet with a medical oncologist to discuss neoadjuvant treatment, and another 1 to 2 weeks after meeting them to start. It can be overwhelming to wait up to 4 weeks to start treatment once you know you have breast cancer. It’s OK to feel worried, scared, or like things are taking too long. But know that waiting a month does sometimes happen, and it is not harmful to you.

Length of neoadjuvant treatment: 3 to 6 months. If you have pre-surgery hormonal therapy, it can last 6 months or more.

End of neoadjuvant treatment to surgery: 3 to 6 weeks. The break between neoadjuvant treatment and the surgery date is often the result of working within your doctors’ schedules, needing insurance approvals, or the type of treatment you receive. If you have neoadjuvant chemotherapy, it will likely be 3 to 6 weeks after finishing the chemotherapy before you have surgery. If you are taking neoadjuvant hormonal therapy, you may be able to keep taking it without needing to stop for surgery and continue taking it after surgery. If your blood cell counts are low after or you’re experiencing treatment side effects, your care team may recommend waiting for these to resolve before having surgery.

Biopsy followed by lumpectomy

Date of biopsy to lumpectomy: 1 to 3 weeks. Lumpectomy is the removal of the tumor and a small area of tissue around it.

Recovery from lumpectomy: 1 week.

Biopsy followed by mastectomy

Date of biopsy to mastectomy: 2 to 6 weeks, depending on reconstruction. Mastectomy is the removal of the whole breast or both breasts. If you choose to have mastectomy alone, it can take 2 to 4 weeks to have the surgery after your biopsy. If you want to have reconstruction at the same time that you have the mastectomy, the surgery date depends on the breast surgeon’s and plastic surgeon’s schedules. It’s common to wait 3 to 6 weeks for an appointment that will work with both teams.

Recovery from mastectomy alone: up to 3 weeks.

Recovery from mastectomy with reconstruction: timing varies. How long it takes to recover from reconstructive surgery depends on the type of reconstruction you choose. With a simple implant reconstruction, it can take 4 weeks to recover. With more complex kinds of reconstruction, such as using your own tissue, recovery can take 6 to 8 weeks or longer. Learn more about breast reconstruction.

Length of post-surgery chemotherapy: 2 to 5 months.

Length of radiation therapy: 3 to 6.5 weeks (standard) or 5 days (brachytherapy). Most people who need radiation therapy will have between 3 and 6.5 weeks of daily treatment. Some will be offered a shorter-term radiation treatment called brachytherapy, or internal radiation.

Length of targeted therapy: 1 to 1.5 years.

Length of immunotherapy: 1 year, overlapping surgery and surgical recovery.

Maintenance therapy after active treatment ends. If you have hormone receptor-positive breast cancer and were diagnosed at stages 0 to III, you’ll likely be given several years of hormonal therapy after active treatment ends. This long-term treatment works to keep the cancer from coming back and lasts anywhere from 5 to 10 years. Two other medicines can be given alongside hormonal therapy if you meet certain criteria:

• 1 year of olaparib (Lynparza), a PARP inhibitor, if you carry a BRCA1 or BRCA2 mutation.
• 2 years of abemaciclib (Verzenio), a CDK 4/6 inhibitor, if you have ER-positive, HER2-negative breast cancer and are considered high risk.

Does the length of treatment change because of the stage of breast cancer?

For the most part, the breast cancer stage won’t change how long each type of treatment is given. Which treatments you need will be based on the information about the cancer cells in your pathology report.

There are three situations in which stage impacts which treatments you may get.

• Stage 0: Also called ductal carcinoma in situ (DCIS), this type of breast cancer is confined to the ducts of the breast. People with DCIS may only need surgery and radiation therapy for active treatment.
• Stage IIIC: Stage IIIC breast cancer is often also inflammatory breast cancer, which develops quickly and affects the skin of the breast. Inflammatory breast cancer is treated differently and more aggressively than other types of early-stage breast cancer.
• Stage IV: If the breast cancer is stage IV metastatic disease, you stay on each treatment as long as it works against the cancer and your body is handling the treatment well. If a treatment stops working or you have severe side effects, you and your care team will decide on a new treatment to try.

Treatment delays

Hearing you have breast cancer can be overwhelming, and if the diagnosis is early-stage breast cancer, you may hope for the year of treatment to go by as quickly as possible. It’s important to know that the time between treatment types can sometimes get delayed by cancer-related issues or outside factors. Some reasons treatment may be delayed include:

• Managing treatment side effects: If you experience severe side effects, it’s possible your doctor will recommend you take a treatment break to ease them and to give your body rest. This can lengthen how long it takes to complete a treatment type, or it might delay the start of your next treatment.
• Coordinating schedules: When you’re planning treatments that involve more than one medical team, such as mastectomy (surgical oncology) with reconstruction (plastic surgery), it can sometimes take more time to find a date that works for everyone involved.
• Recovering from surgery: The recovery times we listed above are average experiences. If your body takes longer to heal, or if you have a complication like an infection at the surgical site, you may need more time to recover before starting your next treatment.
• Getting insurance approvals: Some health insurance plans require pre-approval before they’ll agree to pay for some aspects of medical care. It can be complicated and can take some time to manage. Many cancer centers now have financial counselors on staff who can help you figure out what your personal health plan needs.
• Pregnancy: You can be diagnosed with breast cancer at any time — even during pregnancy. Research shows that chemotherapy is safe for a baby when given in the second or third trimester. Other treatments, such as radiation and hormonal therapy, can harm the baby. If you’re pregnant and in treatment for breast cancer, you and your care team will make decisions to keep you and the baby safe.