Even With Metastatic Breast Cancer, Some Patients Should Say No to Surgery and Radiation

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When it comes to cancer, sometimes less is more.

Once cancer has spread, doctors often throw everything they have at the tumors — surgery, chemotherapy and radiation. But for the five to 20 percent of breast cancer patients who are diagnosed for the first time with cancer that has already metastasized, chemotherapy alone gives them the same survival benefit as chemotherapy plus surgery and radiation to target tumors in the lymph nodes.

That conclusion, presented at the 2013 San Antonio Breast Cancer Symposium, confirms what some breast cancer experts had already suspected. But the results come from the first trial to put the idea to the test, comparing women who were treated with additional surgery and radiotherapy, and those who were not.

Researchers from Tata Memorial Hospital in Mumbai, India, recruited 305 women between 2005 and 2013, all of whom had metastatic breast cancer and had responded to six cycles of chemotherapy. The women were split into two groups. One group of 173 women received additional surgery and radiation treatment, and 177 did not. The women who received surgery had partial or total removal of their breasts and lymph nodes followed by radiotherapy.

After just over two and a half years, the scientists found no overall difference in survival between the two groups; in fact, there was a slight, but not significantly significant, increase in risk of death for the women undergoing surgery and radiation. The lack of difference remained strong even after the scientific team adjusted for the types of breast cancer the women had, and the extent to which their cancer had spread to other organs. The findings should provide more confidence to both doctors and patients who choose not to go under the knife or receive radiation in an effort to prolong their lives, since the evidence suggests that the added measures don’t provide significant benefit, and may only expose the women to more complications.

“I’m sure a lot of oncologists … will feel a lot more comfortable looking at these results,” said Dr. Rajendra Badwe, director of the Tata Memorial Hospital in a statement.


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One reason for this difference may be that just being in the hospital more, which would happen at least with the surgery part of the treatment, will most likely lead to more women dying of infections while in the hospital.