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Breast cancer: your treatment options in India

The commonest cancer in women worldwide, and one where the treatment plan depends far less on the size of the lump than on what the pathology report says about it.

Breast cancer is also the cancer where second opinions change the plan most often — not because the diagnosis is wrong, but because the order of treatment should frequently be different from what was first proposed.

Clinically reviewed by Dr. Annie Varughese, Consultant Medical Oncologist Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Decides the plan
Receptor status
ER, PR and HER2 from the biopsy
Breast often preserved
Yes
Conservation with radiotherapy suits many tumours
Sequence matters
Sometimes chemo first
Shrinking the tumour can allow conservation
Time in India
3 to 5 weeks
For surgery; radiotherapy adds several weeks
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What determines your treatment

Breast cancer is not one disease. The biopsy is tested for three things — the oestrogen receptor, the progesterone receptor, and a protein called HER2 — and the combination determines the entire treatment plan. A hormone-receptor-positive cancer is treated very differently from a HER2-positive one, and both differently again from a triple negative cancer.

Stage matters too: the size of the tumour, whether lymph nodes in the armpit are involved, and whether there is spread elsewhere. But two cancers of identical size can require completely different drugs depending on receptor status.

This is why a report saying only 'breast cancer, 3 cm' is not enough to advise anyone. If your pathology report does not state ER, PR and HER2, that testing needs doing before any treatment decision is made — and it can usually be performed on the biopsy material you already have.

The other decision that surprises people is the order. For many larger tumours, giving chemotherapy first shrinks the cancer and can turn a mastectomy into a breast-conserving operation. That opportunity is lost once the breast has been removed, which is why the sequence deserves a second opinion before surgery, not after.

Symptoms

Symptoms and warning signs

Common symptoms
  • A lump in the breast or armpit, usually painless
  • Change in the size or shape of the breast
  • Dimpling or puckering of the skin
  • A nipple turning inward that did not before
  • Discharge from the nipple, particularly if bloodstained
  • A rash or scaling around the nipple
  • Persistent skin redness or thickening resembling orange peel
Warning signs of an emergency
  • Fever while receiving chemotherapy
  • Sudden severe breathlessness
  • New weakness in the legs, numbness, or difficulty passing urine
  • Severe unrelenting back pain
  • A rapidly enlarging, hot, red breast
  • Confusion, excessive thirst or drowsiness

Get the receptor status before you agree to any treatment

ER, PR and HER2 are not optional extras. They determine whether you need hormone tablets for years, whether HER2-targeted therapy would substantially improve your outcome, and whether chemotherapy should come before or after surgery. If your report does not include them, ask for the testing to be done on the existing biopsy block. Starting treatment without them risks the wrong plan entirely.

Diagnosis

How it is diagnosed

The biopsy does most of the work. Imaging establishes the stage.

Initial tests

  • Core needle biopsy — provides tissue for diagnosis and for receptor testing; the central investigation
  • Mammogram and breast ultrasound — measures the tumour and checks the other breast
  • Ultrasound of the armpit, with needle sampling of any suspicious node
  • Blood tests — including liver function and full blood count

The deciding tests

  • ER, PR and HER2 testing — performed on the biopsy; determines the drug treatment
  • Breast MRI — used where the extent is unclear, in dense breasts, or before conservation in selected cases
  • CT chest, abdomen and pelvis, and bone scan or PET-CT — staging where the tumour is large or nodes are involved

What we need to give you a real opinion

The full pathology report including ER, PR and HER2, the mammogram and ultrasound reports, any staging scans, and the treatment plan you have been offered. If you can obtain the biopsy slides or paraffin blocks from the laboratory, bring them — re-examination sometimes changes the subtype, and subtype changes everything.

Options

Treatment options

Most patients need a combination, given in a specific order. The order is often where a second opinion adds the most value.

Option one

Surgery — conservation or mastectomy

Breast-conserving surgery removes the tumour with a margin and is followed by radiotherapy. For suitable tumours it gives outcomes equivalent to mastectomy while keeping the breast. Mastectomy removes the whole breast and may avoid radiotherapy in some cases, and reconstruction can often be performed at the same operation. The armpit is assessed with a sentinel node biopsy rather than clearing all the nodes, unless disease is already known to be there.

Usually appropriate whenConservation suits smaller tumours relative to breast size, or larger ones after chemotherapy has shrunk them. Mastectomy is needed for multiple tumours, very large tumours, or where radiotherapy is not possible.
Option two

Chemotherapy — before or after surgery

Given before surgery, chemotherapy shrinks the tumour, can convert a mastectomy into a conservation operation, and shows whether the cancer responds to the drugs. Given afterwards, it reduces the risk of recurrence. Whether you need it, and in which order, depends on receptor status, tumour size and node involvement.

Usually appropriate whenLarger tumours, involved nodes, triple negative or HER2-positive disease. Increasingly given before surgery where any of these apply.
Option three

Hormone therapy

For hormone-receptor-positive cancers, tablets taken for five to ten years that substantially reduce recurrence. Tamoxifen or an aromatase inhibitor depending on whether you have been through the menopause. Inexpensive, taken at home, and one of the most effective treatments in the whole of oncology.

Usually appropriate whenThe cancer is ER or PR positive — which is the majority of breast cancers.
Option four

HER2-targeted therapy and radiotherapy

HER2-positive cancers are treated with targeted antibody therapy alongside chemotherapy, which transformed the outlook for this subtype. Radiotherapy follows conservation surgery in almost all cases, and follows mastectomy where the tumour was large or nodes were involved. Radiotherapy requires you to remain in India for the whole course.

Usually appropriate whenHER2 testing is positive; radiotherapy after conservation, or after mastectomy in higher-risk disease.
The decision

How the choice is made

Receptor status first

ER, PR and HER2 decide which drugs are used and for how long. Nothing else on this page can be settled until they are known.

Then tumour size relative to the breast, and node status

This determines conservation versus mastectomy, and whether chemotherapy should come before surgery to create the option of conservation.

Then what you can continue at home

Hormone tablets are taken at home for years. Many chemotherapy regimens can also be given locally once the protocol is set. Radiotherapy cannot — it needs daily attendance for several weeks.

If a mastectomy has been proposed for a tumour that might be conserved after chemotherapy, that is worth a second opinion before you consent. The opportunity does not come back.

Urgency

How urgent is your case

Usually safe to plan travel
  • Recently diagnosed, well, and planning treatment
  • Completed local investigations and seeking a plan
  • Stable between chemotherapy cycles with no fever
  • Seeking surgery after chemotherapy given at home
Needs local assessment before travel
  • Fever or infection during chemotherapy
  • Severe breathlessness or chest pain
  • New leg weakness or difficulty passing urine
  • Uncontrolled pain requiring urgent management
  • Confusion or severe drowsiness

We will tell you which column you are in

Breast cancer is rarely an emergency measured in days, and a few weeks spent getting the plan right is time well spent. Inflammatory breast cancer — a rapidly enlarging, red, hot breast — is the exception and needs prompt specialist assessment.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Full pathology report including ER, PR and HER2
  • Mammogram and breast ultrasound reports
  • Any staging scans — CT, bone scan or PET-CT
  • The treatment plan you have been offered

Also helpful

  • Biopsy slides or paraffin blocks if you can obtain them
  • Blood test results
  • Details of any chemotherapy already given, with drug names and number of cycles
  • Your age and whether you have been through the menopause
Send my reports for review See published cost ranges
Questions

Questions patients ask

Not necessarily. Breast-conserving surgery followed by radiotherapy gives outcomes equivalent to mastectomy for suitable tumours, and chemotherapy given before surgery can shrink a larger tumour enough to make conservation possible. If mastectomy has been recommended, it is reasonable to ask whether chemotherapy first might change that — and it is a question worth asking before you consent.

That the cancer is negative for the oestrogen receptor, the progesterone receptor and HER2. It means hormone tablets and HER2-targeted drugs will not work, so chemotherapy is the main drug treatment, usually given before surgery. It tends to affect younger women and behaves more aggressively, which makes prompt, correct treatment particularly important.

It depends on the size of the tumour, whether nodes are involved and the receptor status. Chemotherapy before surgery is increasingly preferred for larger tumours, triple negative and HER2-positive disease, because it shrinks the tumour, may allow conservation, and shows whether the cancer is responding. For small, hormone-positive, node-negative cancers, surgery first is usually right.

Often yes. Immediate reconstruction using an implant or your own tissue is performed routinely in Delhi NCR and avoids a second operation. Whether it is advisable depends on whether radiotherapy is planned afterwards, since radiation affects reconstructed tissue. Discuss it before the operation, not after.

Typically five years, and ten in higher-risk cases. They are taken at home, they are inexpensive, and they are among the most effective treatments available for hormone-positive breast cancer. Stopping early materially increases the risk of recurrence.

Yes, if the laboratory will release them. Re-examination by a specialist breast pathologist occasionally changes the subtype or the grade, and receptor testing can be repeated on the same material if it was not done or the result is uncertain. The slides and blocks belong to you and are usually released on request.

RelatedOn this site
Cancer treatment in IndiaRead → Cancer treatment costRead → Gynaecological cancerRead → Blood cancersRead → All treatmentsRead →
Contact

Send us your reports

Send the pathology report with ER, PR and HER2, plus your scans and the plan you have been offered. A breast cancer specialist will review all three.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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