Although breast cancer treatment usually starts with surgery, there are some situations in which your doctor may recommend chemotherapy first. For example, if you have a large tumor and small breasts, chemotherapy may shrink the tumor enough to make a lumpectomy possible. Having chemotherapy as the first treatment for breast cancer may destroy cancer in the lymph nodes, which may help some women avoid having their lymph nodes removed. For women with some types of advanced breast cancer such as inflammatory cancer, having chemotherapy as the first step in treatment is standard to be sure all the cancer cells can be removed surgically. In studies involving thousands of women, this has been shown to be just as safe as having surgery first.