Breast cancer stage	Classification	Surgery	Radiation	Endocrine therapy	Immunotherapy	Chemotherapy
0	In situ	Lumpectomy or mastectomy with sentinel lymph node biopsy	Yes, if lumpectomy	Estrogen receptor and ductal carcinoma in situ should receive five years of endocrine therapy:  Tamoxifen if premenopausal  Tamoxifen or aromatase inhibitor if postmenopausal	Not commonly offered	Not commonly offered
I and II	Early invasive	Commonly lumpectomy plus sentinel lymph node biopsy; mastectomy may be needed for larger tumors or because of patient choice	Yes, if lumpectomy or high-risk, node-positive disease with mastectomy	Hormone receptor–positive breast cancer should be treated with up to 10 years of endocrine therapy If premenopausal:  Five years tamoxifen  Additional three to five years tamoxifen if still premenopausal  Additional five years tamoxifen or aromatase inhibitor if now postmenopausal If postmenopausal: up to 10 years of tamoxifen or aromatase inhibitor	ERBB2-positive breast cancer should receive one year of trastuzumab (Herceptin) Certain high-risk cancers may benefit from the addition of pertuzumab (Perjeta) or neratinib (Nerlynx)	May be appropriate for hormone receptor–positive, ERBB2-positive, and triple-negative breast cancer of any stage; molecular testing helps guide addition of chemotherapy to the treatment regimen
III	Locally advanced	Commonly mastectomy plus axillary lymph node dissection	Yes, if lumpectomy or high-risk, node-positive disease with mastectomy
IV	Metastatic	Mastectomy or lumpectomy may be appropriate when tumor burden impacts quality of life	Radiation may be appropriate when tumor burden impacts quality of life	Endocrine therapy, chemotherapy, and immunotherapy may be offered to target their appropriate breast cancer subtypes with the goal of managing symptoms, extending life, and preserving quality of life