For decades, surgery has been considered the cornerstone of treatment for early-stage breast cancer. However, groundbreaking new research from The University of Texas MD Anderson Cancer Center suggests that for some patients, surgery may no longer be necessary. The latest findings, published in JAMA Oncology, indicate that patients who achieve a complete response to neoadjuvant chemotherapy and standard radiation can remain disease-free without undergoing surgical intervention.
The results of this Phase II clinical trial have ignited discussions among oncologists and surgeons worldwide. With a median follow-up of 55.4 months, all 31 patients who had a pathologic complete response (pCR) after chemotherapy and radiation remained free of breast cancer, and the overall survival rate stood at 100%. These findings, which are also being presented at the 2025 Society of Surgical Oncology Annual Meeting, highlight the possibility of a future where breast surgery may not be required for all early-stage cancer patients.
A Breakthrough in Breast Cancer Management
Breast cancer affects an estimated 2.3 million women globally each year, and for over a century, surgery has been the standard treatment for nonmetastatic invasive disease. However, advancements in chemotherapy have significantly increased the rates of complete tumor eradication before surgery. This study builds upon earlier research that questioned whether surgery was always necessary when no remaining cancer could be detected after pre-surgical treatment.
Led by Dr. Henry Kuerer, a professor of Breast Surgical Oncology at MD Anderson, this study is the first modern prospective trial examining surgery omission in early-stage breast cancer patients who had a strong response to chemotherapy. The results suggest that a combination of precise diagnostic tools and targeted radiation could effectively replace the need for surgery in certain cases.
“The absence of detectable breast cancer recurrences at the five-year mark highlights the tremendous potential of this surgery-free approach,” said Dr. Kuerer. “Our innovative, precise method of detecting cancer in these patients has successfully demonstrated that we can treat them while avoiding surgery.”
A Closer Look at the Study and Its Participants
The trial enrolled 50 women over the age of 40 who had early-stage triple-negative or HER2-positive breast cancer—two aggressive subtypes that often require intensive treatment. The mean age of participants was 62, with 21 patients diagnosed with triple-negative breast cancer and 29 with HER2-positive disease.
To be eligible for surgery omission, patients needed to have a residual breast lesion smaller than two centimeters following standard chemotherapy, as determined by imaging. Instead of proceeding directly to surgery, they underwent an image-guided vacuum-assisted core biopsy (VACB). If no cancer was detected in the biopsy sample, surgery was omitted, and patients instead received whole-breast radiotherapy.
Out of the 50 participants, 31 were found to have a pathologic complete response, meaning no cancer remained in their breast tissue. These patients did not undergo surgery and were instead monitored closely. The results were remarkable—no cases of cancer recurrence were reported among them after five years.
A New Era of Personalized Breast Cancer Treatment
The implications of this research are profound. Traditionally, surgery has been a non-negotiable part of breast cancer treatment, but these findings suggest that for some patients, it may not always be necessary. By using precise biopsy techniques and stringent histologic processing, oncologists may be able to identify patients who can safely avoid surgery without increasing their risk of recurrence.
Advancements in chemotherapy and immunotherapy have played a critical role in making this possible. In recent years, pCR rates have improved dramatically, meaning more patients are achieving complete tumor eradication before surgery. The ability to combine these high response rates with advanced biopsy techniques and radiation therapy could revolutionize how breast cancer is treated.
Expanding the Research for Greater Confidence
While these findings are promising, researchers acknowledge that further studies are needed before this approach becomes a standard of care. The current study had a relatively small sample size and a limited follow-up period. To address these limitations, the trial has now been expanded to include 100 patients, and additional research is being conducted in South Korea.
The ultimate goal is to determine whether this non-surgical approach can be applied more broadly across different breast cancer subtypes and patient populations. If confirmed through larger trials, the elimination of surgery could significantly improve the quality of life for thousands of women each year.
“These continued promising results suggest that eliminating breast surgery for invasive breast cancer could become the new standard of care, offering women the opportunity to preserve their bodies,” said Dr. Kuerer. “While we are hopeful that this approach will become routine, further clinical trials are necessary before this is a standard therapy.”
Balancing Innovation with Patient Safety
While the prospect of avoiding surgery is exciting, oncologists stress the importance of careful patient selection. Not all breast cancer patients will be candidates for this approach, and rigorous diagnostic criteria must be met to ensure that skipping surgery does not compromise long-term outcomes. The use of image-guided biopsies and molecular testing will be critical in identifying those who can safely benefit from this treatment strategy.
Additionally, patient preferences must be considered. Some women may feel more comfortable undergoing surgery to ensure that all traces of cancer are removed. Others may prefer to avoid surgery if it is not medically necessary. Shared decision-making between doctors and patients will be essential in determining the best course of treatment on a case-by-case basis.
A Glimpse into the Future of Cancer Care
The idea that some breast cancer patients may never need surgery is a dramatic shift in the field of oncology. If larger trials confirm these findings, this approach could redefine how early-stage breast cancer is treated, reducing the physical and emotional burden associated with surgery.
As research continues, oncologists and patients alike are watching closely. The hope is that in the near future, breast cancer treatment will be even more personalized, allowing women to receive the most effective therapies with the least invasive interventions. While surgery will likely remain an essential part of treatment for many patients, this study offers hope that, for some, a path to recovery may not require the operating room at all.
Reference: Henry M. Kuerer et al, Selective Elimination of Breast Surgery for Invasive Breast Cancer, JAMA Oncology (2025). DOI: 10.1001/jamaoncol.2025.0207