Not everyone with breast cancer needs chemotherapy. The treatment recommendations will vary depending on a person’s age, tumor stage, tumor size, and personal preference, among other factors.

Doctors will take many factors into account when considering if a person with breast cancer needs chemotherapy. For some, chemotherapy may help to kill cancer cells before or after surgery or to prolong life. For 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.

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According to the American Cancer Society, some people with breast cancer do not need chemotherapy, particularly if it has not spread to another part of the body.

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 2022 study also suggest that some postmenopausal people with cancer that has spread to nearby lymph nodes may be able to skip chemotherapy.

The study specifically focused on people with cancer that was hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-).

In premenopausal people with this type of cancer, chemotherapy was beneficial in all cases, regardless of the cancer stage or other factors.

Doctors decide if 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 impact a doctor’s recommendations for treatment.
  • Tumor receptors: During the diagnostic process, doctors determine if the breast cancer tumor has receptors for estrogen or progesterone. If it does, it is known as a hormone receptor positive (HR+) 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-, is known as triple negative breast cancer. This means the cancer will not respond to hormone therapy, so chemotherapy may be necessary to destroy all cancer cells.
  • Risk of future cancer: For people with HR+ and HER2- breast cancer, the Oncotype DX test can provide an Oncotype DK 21-Gene Recurrence Score. 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 indicate 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. Those 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 impact on outlook for those with early stage breast cancer that responds well to other treatments.

A 2018 study of 10,273 females with HR+, HER2-, and axillary node-negative breast cancer found that 70% did not get any added benefit from chemotherapy. Most participants had mid-range 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, which 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, and how likely it is to return.

While some people can skip chemotherapy without a negative outcome, others, such as people with triple-negative breast cancer that may not respond to current hormone therapy, should consider the potential negative consequences of skipping chemotherapy.

Aside from chemotherapy, the potential options for breast cancer at stages 1–3 include:

  • surgery to remove tumors
  • radiation, 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 breast cancer that is HER2- with a BRCA gene mutation

Stage 4 breast cancer can also involve these treatments, but systemic drugs are the main option, as these can target cancer that has spread elsewhere in the body.

As research into treatments for breast cancer continues, researchers develop more targeted treatments to help people enter remission and survive longer.

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, stage, and 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 should speak with a doctor about whether chemotherapy is likely to benefit them.