Is Surgery Essential in Breast Cancer Treatment?

A New Approach: Can Early-Stage Breast Cancer Be Treated Without Surgery?

Breast cancer surgery, used for more than a century, may no longer be necessary for every patient. Findings from a notable study at MD Anderson Cancer Center in the United States suggest that, with appropriate patient selection, chemotherapy and radiotherapy may achieve successful outcomes in early-stage breast cancer without surgery.

Why Does It Matter?

Approximately 2.3 million women worldwide are diagnosed with breast cancer each year. Surgery has long been the cornerstone of local treatment, but modern systemic treatments have substantially increased pathological complete response (pCR) rates. These advances open the door to new treatment paradigms in which surgery might be omitted entirely for some patients.

• NOTE: A pathological complete response (pCR)means that, in a patient with cancer, neoadjuvant (preoperative) treatment is followed by no remaining tumor cells on microscopic examination of surgically removed tissue. This generally indicates an excellent treatment response and is a favorable marker for long-term survival.

100 Percent Survival Without Surgery at 5-Year Follow-Up!

The findings were published on March 28, 2025, in JAMA Oncology . According to this phase II study led by MD Anderson breast surgical oncologist Prof. Henry Kuerer:

• Over a median follow-up of 55.4 months (approximately 4.6 years) , none of the patients achieving a pathological complete response after neoadjuvant chemotherapy experienced recurrence.
• These patients received radiotherapy alone, without surgery.
• Overall survival: 100%.
• All 31 patients with a pathological complete response remained disease-free at five years.

The absence of recurrence over five years demonstrates the considerable potential of nonsurgical breast cancer treatment. Our highly sensitive tumor-detection approach allowed us to safely omit surgery in these patients.

How Was Nonsurgical Treatment Performed?

This multicenter study examined 50 women. Their characteristics were:

• Mean age: 62
• 21 patients had triple-negative breast cancer, 29 patients had HER2-positive breast cancer.
• After standard chemotherapy, all patients were assessed for a residual breast lesion smaller than 2 cm .
• Patients underwent image-guided vacuum-assisted biopsy .
• If biopsy detected no tumor cells, indicating a pathological complete response, surgery was omitted and whole-breast radiotherapy was given.

Results:

• A pathological complete response was identified in 31 patients.
• No serious biopsy complications or treatment-related deaths occurred.

This biopsy approach successfully identified tumor response with high accuracy, enabling it to take the place of surgery.

What Is the Study Based On?

This is the first modern prospective clinical investigation of nonsurgical breast cancer treatment. It builds on the same team's findings published in 2022 in The Lancet Oncology, with approximately 2 years of follow-up.

Future Perspectives: Are We Moving Toward a Nonsurgical Era?

This promising approach signals an important shift in breast cancer care:

• Nonsurgical treatmentmay offer substantial cosmetic and psychological advantages for suitable patients.
• However, experts emphasize that larger studies with longer follow-up are needed before it becomes standard practice.
• Enrollment has now increased to 100 participants, and another study using similar protocols is underway in South Korea.

Nonsurgical breast cancer treatment could become a new standard for suitable patients, a potentially revolutionary advance allowing women to preserve their bodies. However, more clinical data are needed before widespread use.

Conclusion

The study suggests that future breast cancer care can include less invasive, more personalized approaches . In particular, for triple-negative and HER2-positive early-stage disease with high response rates, a nonsurgical treatment algorithm is becoming feasible. Precise image-guided biopsy combined with appropriate patient selection can achieve excellent oncological outcomes without surgical intervention.