Statement: Patients whose breast cancer has spread into both the skin and the chest wall are eligible for the secondary trial, but not the primary trial.
Primary_evidence: DISEASE CHARACTERISTICS:   Histologically confirmed infiltrating carcinoma of the breast meeting any of the following criteria:   T1-3, any N disease   Proven ductal carcinoma in situ   Unresected disease   Planned mastectomy as definitive surgical procedure   Known or suspected metastatic disease allowed provided mastectomy is planned   Nonpalpable tumor allowed (e.g., initial T2-3 tumor that responded to preoperative therapy)   No inflammatory breast cancer or other T4 features   Successful baseline ductogram   Baseline nipple aspiration procedure must identify a duct productive of nipple aspirate fluid   No severe nipple retraction   Hormone receptor status not specified   PATIENT CHARACTERISTICS:   Female patients   Menopausal status not specified   ECOG performance status 0-2   Absolute neutrophil count 1,500/mm^3   Platelet count  100,000/mm^3   Hemoglobin  9.0 g/dL   Creatinine  2 times upper limit of normal (ULN)   Bilirubin  2 times ULN   AST and ALT  2.5 times ULN   Not pregnant or nursing   Negative pregnancy test   Fertile patients must use effective contraception   No significant history of severe allergy to iodinated contrast material or debilitating anxiety that may not allow for a ductogram   PRIOR CONCURRENT THERAPY:   See Disease Characteristics   Prior preoperative chemotherapy, trastuzumab (Herceptin®), or hormonal therapy allowed provided it was completed 7-14 days prior to study treatment   No prior radiation therapy, excisional biopsy, breast reduction, areolar surgery, or breast implant (present or past history of implant that was removed)   No other prior procedure that may have altered the breast ductal system in the ipsilateral breast   No other concurrent chemotherapy, radiotherapy, endocrine therapy, or biologic agents for breast cancer   No other concurrent investigational drugs   Concurrent bisphosphonates allowed
Secondary_evidence: Inclusion Criteria:   Histologically confirmed, HER2-positive advanced and/or metastatic breast cancer not amenable to curative therapy   At least one measurable lesion according to RECIST   Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1   Baseline left ventricular ejection fraction (LVEF) at least 50% Exclusion Criteria:   Pregnant, lactating, or women of childbearing potential who are not surgically sterile or not willing to use adequate contraceptive methods   Previous treatment with Herceptin or other anti-HER therapies, or any previous chemotherapy for advanced or metastatic disease   Past medical history significant for any cardiac or central nervous system (CNS) disorders   Poor hematologic, renal, or hepatic function   Chronic corticosteroid therapy