Not everyone with breast cancer needs chemotherapy. Treatment recommendations vary depending on a person’s age, tumor stage and size, and personal preferences, among other factors.
Doctors take many factors into account when considering whether a person with breast cancer needs chemotherapy. In some cases, chemotherapy may help to kill cancer cells before or after surgery or to prolong life. In others, surgery alone may completely remove any growths.
People can also choose to skip chemotherapy if they want to, but depending on the situation, this may affect a person’s outlook. Discussions with doctors, with support from loved ones, are important to determine the right treatment.
This article discusses whether it is possible to skip chemotherapy for breast cancer, who might be able to, what happens when a person skips chemotherapy, and other treatments.
According to the
In these situations, surgery and another therapy, such as radiation or hormone therapy, can be enough to remove all of the cancerous cells.
The early results of a
The study specifically focused on people with cancer that was hormone receptor-positive (HR-positive) and human epidermal growth factor receptor 2-negative (HER2-negative).
In premenopausal people with this type of cancer, chemotherapy was beneficial in all cases, regardless of the cancer stage or other factors.
Doctors decide whether a person with breast cancer needs chemotherapy on the basis of many factors, such as:
- Cancer size and stage: If the breast cancer is small, has not spread elsewhere, and is completely removable with surgery, a person may not need chemotherapy.
- Lymph nodes: If cancer has spread to any nearby lymph nodes, this may affect a doctor’s recommendations for treatment.
- Tumor receptors: During the diagnostic process, doctors determine whether the breast cancer tumor has receptors for estrogen or progesterone. If it does, it is known as an HR-positive tumor, which may mean hormone therapy is a treatment option rather than chemotherapy.
- HER2 status: Cancer that has no estrogen or progesterone receptors and is HER2-negative is known as triple-negative breast cancer. This means the cancer
will notTrusted Source respond to hormone therapy, so chemotherapy may be necessary to destroy all cancer cells. - Risk of future cancer: For people with HR-positive and HER2-negative breast cancer, the Oncotype DX test can provide an
Oncotype DX 21-Gene Recurrence ScoreTrusted Source . This determines which breast cancers are more likely to come back and which are more responsive to chemotherapy. An Oncotype DX score above 26 typically means the person may benefit more from chemotherapy after surgery. - Ki-67 score: Ki-67 is a biomarker that doctors can test for. Its presence means cells are rapidly dividing and growing. Measuring Ki-67 expression
can indicateTrusted Source how fast cancer is proliferating. Faster-growing cancers can require more intensive treatment. - Individual health and choice: People with low general health or certain health conditions may not be able to have chemotherapy. Others may choose not to have chemotherapy, even if this affects their chance of survival.
No, not in all cases. People with early stage breast cancer may only receive breast-conserving surgery and radiation. Some people may also receive hormone therapy or targeted therapy drugs.
Skipping chemotherapy may have no effect on outlook for those with early stage breast cancer that responds well to other treatments.
A 2018 study involving 10,273 females with HR-positive, HER2-negative, and axillary node-negative breast cancer found that 70% of them did not get any added benefit from chemotherapy. Most participants had midrange scores for recurrence, which means they had a medium chance of the cancer coming back.
Some of the participants received chemotherapy and hormone therapy, while others received only hormone therapy. The results showed little difference in survival rate after treatment.
However, this will not apply to everyone. Chemotherapy is a whole-body treatment that kills cancer cells anywhere in the body. This is why doctors recommend it for cancer that has spread to the lymph nodes or beyond. They may also recommend it for aggressive or more difficult to treat tumor types.
People with these types of cancer may need chemotherapy to treat cancer that is not treatable with surgery or other drugs. In these situations, chemotherapy can help with getting into remission, prolonging a person’s life, or reducing their cancer symptoms.
Without chemotherapy, later stage or aggressive cancers can continue to spread and grow, which can have a wide range of effects on the body. This may include pain and additional tumors.
Some people can survive breast cancer without chemotherapy, but the chances depend on the type of cancer, the stage, how well other treatments work, and how likely it is to return.
Some people can skip chemotherapy without a negative outcome. Others,
Aside from chemotherapy, the potential options for breast cancer at stages 1 to 3
- surgery to remove tumors
radiationTrusted Source , including external beam radiation and brachytherapy- hormone therapies, such as tamoxifen or aromatase inhibitors
- immunotherapy drugs for triple-negative breast cancer
- targeted drugs, such as olaparib or talazoparib, for people with a BRCA gene mutation and breast cancer that is HER2-negative
Stage 4 breast cancer can also involve these treatments, but systemic drugs are the
As research into treatments for breast cancer continues, researchers develop more targeted treatments to help people enter remission and survive longer.
Below are some answers to common questions about chemotherapy for breast cancer.
Do I need chemo if the lymph nodes are clear?
In some cases, people with breast cancer that has not spread to any lymph nodes, nor elsewhere,
However, this depends on the type and size of the cancer and the other treatment options that are available. People need to speak with their doctor if they want to know whether they need chemotherapy.
At what stage of breast cancer do you need chemotherapy?
Doctors
However, in some cases, doctors may recommend chemotherapy at earlier stages, particularly for people with triple-negative or HER2-positive breast cancer.
What is the survival rate for untreated breast cancer?
A 2024 preprint study found that survival rates for people with breast cancer who did not receive treatment were significantly lower than those who did.
Across all tumor types and stages, the treated group had an overall 10-year survival rate of 61.7%, while the untreated group’s was 27.4%.
For people who received their diagnosis at stage 1, the treated group had a 78.2% overall 10-year survival rate, while the untreated group’s was 41.7%.
These figures cannot predict the course of the disease, though. How long a person survives will depend on how quickly their cancer grows or spreads.
What if I refuse chemo for breast cancer?
Any adult that can make informed decisions has the right to refuse medical treatment. This includes chemotherapy for breast cancer.
People need to think carefully about what this will mean for them. Depending on the situation, refusing chemotherapy may affect the likelihood of entering remission or the risk of the cancer coming back.
A doctor can discuss how likely chemotherapy is to be effective in each case and what the advantages and risks of avoiding it may be.
Not everyone with breast cancer necessarily needs chemotherapy. In fact, some studies have shown that for particular groups of people with certain types of cancer, chemotherapy has no additional benefit over surgery and hormone therapy.
However, this depends on the type, subtype, and stage of cancer as well as the size of the tumor. Small, early stage tumors may respond well to treatments other than chemotherapy, but a doctor will need to weigh up a person’s unique situation to make this recommendation.
People who would like to know more can speak with a doctor about whether chemotherapy is likely to benefit them.
