New research from The University of Texas MD Anderson Cancer Center suggests that some women with early-stage breast cancer may not need surgery if they respond extremely well to chemotherapy and radiation.
This finding, published in JAMA Oncology, could lead to major changes in how certain breast cancer patients are treated.
For over 100 years, surgery has been a standard treatment for breast cancer. After chemotherapy, doctors typically remove any remaining tumor with surgery, even if imaging shows no sign of cancer.
But thanks to more effective chemotherapy and advanced testing methods, researchers are now questioning whether surgery is always necessary — especially for patients whose cancer seems to completely disappear after treatment.
In this study, researchers followed 31 women who had a pathologic complete response (pCR). This means that after receiving pre-surgery chemotherapy and a special biopsy, no trace of cancer was found in their breast tissue.
These women then received radiation therapy but did not undergo surgery. After five years — a key milestone for cancer recovery — all 31 women were still cancer-free, and none had died.
“This is the first modern study to test skipping surgery in a very specific group of breast cancer patients,” said Dr. Henry Kuerer, the lead researcher and a professor of breast surgical oncology. “The fact that none of the women had cancer come back after five years is very exciting and shows that a no-surgery approach might be safe in some cases.”
Globally, around 2.3 million women are diagnosed with breast cancer each year. Treatments usually include some combination of chemotherapy, surgery, and radiation.
But improved chemotherapy drugs are now helping more women reach pCR — especially those with aggressive types of cancer like triple-negative or HER2-positive breast cancer, which were the focus of this study.
The trial included 50 women over the age of 40 who had either triple-negative or HER2-positive early-stage breast cancer. After receiving standard chemotherapy, they were evaluated using imaging and an image-guided vacuum-assisted core biopsy (VACB).
This biopsy takes samples from the tumor area using a needle guided by imaging tools. If no cancer was found in the biopsy, the patient did not have surgery and instead went straight to radiation treatment.
Of the 50 women, 31 were found to have pCR and skipped surgery. The average age of participants was 62, and no serious side effects or deaths occurred during the study. After a median follow-up of 55.4 months (over 4.5 years), all 31 women remained free of cancer.
Although these results are very promising, the researchers are cautious. The study was small, and while five years is an important benchmark, longer-term follow-up is needed. The trial is now being expanded to 100 patients, and further research is ongoing in South Korea to test if the same approach works for a broader group of patients.
This research offers a glimpse into what breast cancer treatment could look like in the future — more personalized and less invasive. The idea that surgery might not always be necessary challenges a long-standing tradition in cancer care.
For many patients, avoiding surgery would mean keeping their breast, avoiding scars, and recovering faster, both physically and emotionally.
The key to making this possible is accurately identifying which patients no longer have cancer after chemotherapy. The image-guided biopsy method used in the study seems reliable for spotting pCR, but it must be used with care. If even a small amount of cancer is missed, skipping surgery could risk allowing the disease to come back.
The study’s biggest strength is its detailed follow-up. All 31 patients stayed cancer-free for over five years, a time frame often used to measure cancer cure rates. However, its main limitation is the small number of participants. Larger studies will be needed to confirm that this approach is safe and effective for more people.
If further trials confirm these findings, skipping surgery could become a new option for certain breast cancer patients — helping them heal with fewer side effects and less trauma. But for now, surgery remains the standard treatment, and patients should always discuss their options with their medical team.
If you care about breast cancer, please read studies about how eating patterns help ward off breast cancer, and soy and plant compounds may prevent breast cancer recurrence.
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The research findings can be found in JAMA Oncology.
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