Non-Surgical Breast Cancer Treatment: Avoiding the Knife

Patient Expert

A recent Norwegian study presents data showing that up to 40% of breast cancers would disappear on their own in time - completely without treatment. And recent advances in chemotherapy have shown great success in shrinking tumors chemically, rather than removing them surgically. Add to that new studies showing removal of cancerous lymph nodes surgically doesn't improve outcomes, and it makes you wonder: can I treat my breast cancer without undergoing surgery?

Physical removal of tumors has been used as a first-line treatment for breast cancer since ancient Egyptian times, when the treatment for tumors of the breast was to burn them off. Surgery came into common practice in the 1700s; no painkillers, no anesthesia, just a woman biting down hard to stifle screams as a surgeon cut open her breast.

Thankfully, breast cancer surgery today bears little resemblance to crude techniques used in the past.

Even as recently as 40 years ago, radical mastectomies removed not just the breast, but chest muscles as well, often leaving women disfigured, and with reduced strength for everyday activities.

Today, surgeons do their best to remove only the tumor itself. Using breast conservation surgery (lumpectomy), they painstakingly cut out a breast tumor with just the couple of millimeters of non-cancerous tissue around it, striving for "clean margins."

Or if the cancer is widespread throughout the breast, they may take just the breast tissue, leaving skin intact (skin-sparing mastectomy) - or even the nipple intact (nipple-sparing mastectomy).

If a total mastectomy is called for, the chest muscles are no longer involved. And reconstructive surgery to rebuild the missing breast is often performed. Women are able to perform all their normal activities (work, sport, chores), often with the figure they've always had - or close to it.

Despite advances in surgery, however, you still may be hesitant to go that route.

Assuming your cancer was diagnosed via biopsy, you've already had surgery. But maybe the biopsy experience has awakened in you a deep-down fear of surgery, any kind of surgery. Perhaps you've had terrible experiences with anesthesia in the past; or other health issues simply make surgery more risky for you than it is for most women.

Whatever the reason, if you want to treat breast cancer without surgery, it's possible; though in most cases not advisable - if you want to eliminate cancer from your body as fully as possible.

Wondering about skipping the surgery your doctor has advised you to have? Here are some things to consider.

What type/stage is your cancer?
Women with non-invasive (in situ) cancer - DCIS or LCIS - have a type of breast cancer that's so early, some doctors have stopped referring to it as cancer, calling it instead a "pre-cancer." It's possible the cancer will become invasive, and then spread; but it might not.

A recent Norwegian study collected data showing that as many as 66% of both invasive and non-invasive breast cancers may be termed "pseudo-cancers:" cancers which, if left on their own, would grow, then shrink, then disappear over the course of a couple of years. It would stand to reason that for non-invasive cancers, the disappearance rate might be even higher.

The study results, while unexpected and striking, are just that: study results. No clinical trial with placebo has been performed; obviously, it would be a challenge to recruit a large body of women willing to leave a cancerous tumor in their breast.

And oncologists haven't rushed to embrace a "wait and see" approach to breast cancer, even non-invasive breast cancer. With surgery the long-proven way to stop cancer's spread, who wants to buck the tide? Especially when leaving a tumor in the breast could result in death.

Still, if you've been diagnosed with a very early cancer, and you're considering foregoing surgery, the outlook might - MIGHT - not be as dire as you would have thought.

Do you have a type of tumor that might respond to chemotherapy completely enough that surgery is unnecessary?
Advances in chemotherapy and other targeted therapies provide doctors with an ever-increasing body of knowledge around just which drugs are most effective at battling just which types of breast cancer.

For instance, the drug trastuzumab (Herceptin) was basically unknown 15 years ago. Today, it's routinely given to fight HER2-neu positive (HER2+) breast cancer, and is a key reason why more women with HER2+ breast cancer are surviving longer.

Better, more targeted chemo drugs is one reason that, during the past 5 years, it's become more common to prescribe chemotherapy prior to surgery, particularly in women with large tumors. The goals are twofold: to see if a particular chemo regimen works on a particular tumor; and if so, to shrink that tumor prior to surgery, resulting in less aggressive surgery.

Is there a possibility that chemo prior to surgery will completely eliminate a tumor, making surgery unnecessary?

Well, there's always a possibility; but this isn't the usual result. In most cases the tumor will shrink, but seldom does it disappear.

Still, if you're dead set against surgery, identify and meet with an oncologist as soon as you're diagnosed. S/he can help you determine the risk of undertaking a course of chemo, and NOT following it up with surgery.

Are you avoiding surgery because you're afraid of lymphedema?
Many women have read about lymphedema, and are almost as afraid of this side effect of surgery as they are of cancer. Lymphedema is swelling of the arm, due to the surgical removal of underarm lymph nodes. It can certainly affect day-to-day life, making it difficult to use your arm. It can also result in hospitalization and, if left untreated, cellulitis, a severe and life-threatening infection.

It's common for the surgeon to perform a sentinel node biopsy, removing one or two underarm lymph nodes at the same time s/he performs breast surgery; determining whether cancer has traveled beyond the breast to those underarm nodes is critical information the oncologist uses to develop an effective treatment plan.

But if cancer is discovered in those initial (sentinel) nodes, is it really necessary to remove more of the underarm nodes, to see just how far it's spread?

A recent study on lymph node removal says no, it isn't. It appears survival rates for women with regional breast cancer (i.e., cancer that's spread from the breast to underarm lymph nodes) aren't affected by the number of lymph nodes removed.

As a result of that study, it's estimated that going forward, 60% to 70% of breast cancer patients with cancer in their lymph nodes - nearly 50,000 American women, every year - may be encouraged to opt out of further surgery, and its potential pain and suffering.

So, if your surgeon says your sentinel node biopsy shows cancer in one node, and advises further lymph node removal - ask him/her the question: is this really necessary?

You won't be avoiding surgery completely. But cutting back on the amount of surgery, with its inherent risks of infection and side effects, is always worth considering.