Picture two women, the same age, told the same thing in the same week: stage 2 breast cancer. Both lumps are about 3 cm. One starts chemotherapy within the month and has her operation about five months later. The other has her operation first, and may never need chemotherapy at all.
Same stage. Completely different plan. What decides it is three short lines on the pathology report: the grade, the hormone receptors and HER2. By the end of this post, you'll know which of those two women you're more likely to be, from your own report.
Watch the video
Just Diagnosed With Stage 2 Breast Cancer? What Happens Next
This post is the written version of my video. If you'd rather watch, it covers the same ground, with the two women's plans side by side.
Watch on YouTube →What stage 2 actually means
Stage 2 means the cancer is in the breast, and perhaps in a few lymph nodes in the armpit, and it hasn't spread anywhere else in the body. Usually it's one of two things: a cancer between 2 and 5 cm with clear lymph nodes, or a smaller one that has reached 1 to 3 lymph nodes in the armpit. There are a couple of other combinations, but those two are the common ones.
Most women hear "stage 2" and think it means halfway to stage 4. It doesn't work like that. The stage describes where the cancer is today. It isn't a timetable.
But the stage you're given now is often only an estimate from the scans. The final stage comes from the pathology after your operation, and it can move up or down.
So what does it mean for your chances? In England, about 90 in 100 women diagnosed with stage 2 are alive five years later (NHS England, women diagnosed 2016–2020). In Australia, it's about 95 in 100 (AIHW, women diagnosed 2011). New Zealand doesn't publish a stage 2 figure on its own. Across every stage together, 91 in 100 New Zealand women are alive at five years (Te Rēhita Mate Ūtaetae, 2003–2019).
These are averages across thousands of women and every type of breast cancer, so they can't tell you your own number. Your own number depends on three lines further down the report.
The three lines that decide your treatment
The grade is how different the cancer cells look from normal breast cells. Grade 1 looks quite like normal tissue and tends to grow slowly. Grade 3 looks very different and tends to grow faster. Grade 2 sits in between.
The hormone receptors. Think of receptors as locks on the outside of the cancer cell. Oestrogen is a key that fits the ER lock, the oestrogen receptor, and PR, the progesterone receptor, usually travels with it. About 7 in 10 breast cancers are hormone receptor positive. That's good to have, because a tablet can block that key for five to ten years after your other treatment.
HER2 is a different lock. When a cancer has far too many of them, it gets told to grow over and over. That's HER2-positive, about 1 in 7 breast cancers. On its own it's a faster-growing type. But it's also the type with a drug made for it: trastuzumab, or Herceptin, funded in New Zealand for a year.
But if all three are negative (no oestrogen, no progesterone, no HER2), that's triple negative, about 1 in 10 (shares from American Cancer Society data, US). There's no lock for a tablet or a targeted drug to use. So chemotherapy does most of the work, and it often works well.
So, back to those two women. The one who started with chemo has HER2-positive or triple negative cancer.
Why chemo can come before surgery
If your cancer is stage 2 and it's HER2-positive or triple negative, you'll usually be offered chemotherapy before your operation. We call that neoadjuvant chemotherapy.
Most women's first reaction is: why not take it out now? Surely that's safer? It's a fair question. But when the trials compared chemo first with surgery first, women had the same chance of the cancer coming back elsewhere in the body, and the same survival (EBCTCG, Lancet Oncology 2018).
So if survival is the same, why do it? Because chemo first gives three things surgery first can't:
- It can shrink the cancer, so the operation can be smaller. Sometimes that's the difference between losing the breast and keeping it, and if the lymph nodes clear, the armpit operation can be smaller too.
- We can see it working. The cancer is still there to feel and to scan.
- The operation tells us what to do next. For around half of women with these two types, there's no cancer left at all by the time of surgery. That figure varies a lot with the type and the drugs (KEYNOTE-522, NeoSphere, TRAIN-2). If some cancer is left, the treatment afterwards changes to a different drug, which lowers the chance of it coming back (KATHERINE; CREATE-X).
In New Zealand: what's funded for early breast cancer
- Trastuzumab (Herceptin): funded, for a year.
- Trastuzumab emtansine (Kadcyla): funded if HER2-positive cancer is still found at your operation after chemo first.
- Pertuzumab, a second HER2 drug given with Herceptin before surgery: funded only for advanced breast cancer, not early.
- Pembrolizumab (Keytruda), an immunotherapy for triple negative cancer: funded only for advanced cancer, not yet for early. Some women pay for it themselves.
- Oncotype DX, a test on the cancer that helps decide about chemo: not publicly funded.
Checked 7 November 2026. Funding changes, so ask your own team what applies to you. In the UK and the US, more of these are routinely available.
Now the other woman. If your cancer is ER-positive and HER2-negative (the most common kind), surgery usually comes first. Whether you need chemotherapy is decided afterwards, from the grade, the lymph nodes, your age, whether you're still having periods, and sometimes a test on the cancer itself. For a lot of these women, the answer is no chemo at all.
But for both women, the next big question is the same: can I keep my breast?
Lumpectomy or mastectomy
For most stage 2 cancers you have a choice: remove the cancer with a rim of healthy tissue around it (a wide local excision, or lumpectomy), or remove the whole breast (a mastectomy).
Most women assume a mastectomy is the safer choice. But for survival, it makes no difference. Two big trials followed women for 20 years, and a lumpectomy plus radiation gave the same survival as a mastectomy (NSABP B-06; Milan trial, NEJM 2002).
A mastectomy is recommended when:
- the cancer is large compared with the size of the breast, even after chemo
- there's cancer in more than one part of the breast
- radiation isn't possible
- the edges still aren't clear after a second operation
- you carry a gene change such as BRCA and want to lower your risk
- it's what you want. That's a good enough reason.
Those are the same reasons I use in my own clinic.
What about removing the other breast as well? Without a gene change, taking the healthy breast hasn't been shown to improve survival (Cochrane review, 2018). Some women still choose it, and that's yours to decide, with the numbers in front of you.
The lymph nodes are checked at the same operation, usually by taking only the first one or two: a sentinel node biopsy. But if the nodes had cancer in them before chemo, it depends on how well they responded: either a sentinel node biopsy or a limited axillary dissection, where more of the nodes are taken.
Choosing a mastectomy doesn't always mean you avoid radiation, though.
Where radiation fits, and how long it all takes
If you keep your breast, you'll almost always have radiation afterwards. In New Zealand that's usually three to four weeks of short daily treatments, and some women can have a shorter course of one to two weeks. The one-week course comes from a trial called FAST-Forward (Lancet 2020).
After a mastectomy, if cancer was found in your lymph nodes, or the cancer was large, you may still be offered radiation to the chest wall and the armpit, to lower the risk of the cancer coming back.
Put together, it's usually one of two orders:
- Chemo first for about four to six months, then the operation, then radiation.
- The operation first, then chemo if you need it, then radiation.
If your cancer is hormone positive, the tablets start after the radiation and carry on for five to ten years. If it's HER2-positive, the targeted drug runs for a year in total.
If you might want children one day, ask about fertility before chemo starts. It has to happen first. In New Zealand, fertility preservation before cancer treatment is publicly funded for eligible women. Ask your team for a referral at your first appointment.
And the waiting. Right now it probably feels as though every day counts. But you have time to read your report, ask your questions and get a second opinion if you want one: days to a couple of weeks, not months. In New Zealand, the target is to start treatment within 31 days of the decision about your treatment (Health NZ).
You're allowed to take a few days to understand your own report.
Find your three lines, then take four questions
Ask for a copy of your pathology report and find those three lines: grade, ER and PR, and HER2. If ER is positive and HER2 is negative, you're more likely to be the woman who has her operation first. If HER2 is positive, or all three are negative, you're more likely to be the one who starts with chemo.
Then take these four questions to your first appointment:
- Is my cancer hormone positive, HER2-positive, or triple negative?
- Will I have chemotherapy, and is it before or after surgery? Why?
- Can I keep my breast? And if not, why not?
- Will I need radiation either way?
Two women. Same stage, two different plans. Now you know where yours comes from.
You have time. Ask the question. Then make the decision yourself.
The video
Just Diagnosed With Stage 2 Breast Cancer? What Happens Next
The whole thing on YouTube, if you'd rather watch, or want to send it to a friend who's just been told.
Watch on YouTube →Read next
- What Is Invasive Lobular Breast Cancer? The Type That Doesn't Always Make a Lump
- Have Dense Breasts? Here's What to Do Next
Sources
- Stage 2 survival in England, 90 in 100 at five years: Cancer Research UK, survival for breast cancer (NHS England, diagnosed 2016–2020).
- Stage II survival in Australia, 95% at five years: Cancer Australia / AIHW, relative survival by stage at diagnosis (diagnosed 2011).
- New Zealand survival, all stages: Te Rēhita Mate Ūtaetae, 30,000 voices (2022).
- Subtype shares: American Cancer Society, Breast Cancer Facts & Figures 2024.
- Chemo before or after surgery: Early Breast Cancer Trialists' Collaborative Group, Lancet Oncol 2018;19:27–39.
- No cancer left after chemo first: Schmid et al., KEYNOTE-522, NEJM 2020; NeoSphere, Lancet Oncol 2012; TRAIN-2, Lancet Oncol 2018.
- Changing treatment if cancer is left: von Minckwitz et al., KATHERINE, NEJM 2019; Masuda et al., CREATE-X, NEJM 2017.
- Lumpectomy and mastectomy: Fisher et al., NSABP B-06, NEJM 2002; Veronesi et al., Milan trial, NEJM 2002.
- Removing the other breast: Carbine et al., Cochrane Database Syst Rev 2018.
- One-week radiation: Murray Brunt et al., FAST-Forward, Lancet 2020.
- New Zealand funding: Pharmac, Kadcyla for early breast cancer (2022); Breast Cancer Foundation NZ, targeted therapy; Breast Cancer Foundation NZ, Keytruda (October 2025).
- Treatment timing target: Health NZ, health targets.
This article is general information, not personal medical advice. If you've been diagnosed with breast cancer, please talk through your own plan with your treating team.