Breast cancer is the most common cancer among Black women. It is also the second leading cause of cancer deaths among Black women. However, this new breast cancer surgery could increase the chances of survival in women with advanced breast cancer.
Women with advanced breast cancer who undergo surgery to remove the tumor after chemotherapy or another type of systemic treatment may live longer than those who don’t have surgery, a new study suggests.
The findings challenge a long-held belief that surgery confers little benefit for women with stage 4 breast cancer unless the cancer is causing pain, bleeding, or other symptoms. Stage 4 is the point at which the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
“As our systemic therapies to treat breast cancer get better and better, we have to always rethink the paradigms that we have lived by, and we may have been very right to say that surgery added very little for these patients a decade ago, but it’s time to rethink that now,” said study author Dr. Daleela Dodge, an associate professor of surgery at Penn State Cancer Institute in Hershey, Pa.
Dodge’s team analyzed a nationwide database of close to 13,000 women who had stage 4 breast cancer between 2010 and 2015. Women were treated with chemotherapy, hormone therapies and/or immunotherapies with or without surgery.
The database also included information about their hormonal and HER2 cancer status. These factors are known to affect cancer growth. Women who died within six months of diagnosis were excluded to ensure that only treatment-responsive cancers were studied.
Regardless of hormone receptor or HER2 status, women who had surgery to remove the cancer after chemotherapy or another systemic treatment were more likely to be alive five years later than patients who only received systemic treatments. Systemic treatment only is the current standard of care for stage 4 breast cancer, according to the American Cancer Society.
Women whose breast cancers were HER2-positive saw an even greater survival edge when their treatment plan included surgery, the study showed.
Women who had surgery after their other treatments fared better than those whose surgery came before systemic treatment.
Stage 4 breast cancers account for six percent of newly diagnosed breast cancers, according to the study. The five-year survival rate for breast cancer that has started to spread is much lower than it is for breast cancer that has not spread elsewhere.
“If you look at other cancers, we treat spreading disease very aggressively with surgery,” Dodge said. “In breast cancer, there has been this paradigm that you don’t perform surgery in metastatic patients, but it’s time to rethink this.”
Surgeons may remove one or both breasts (mastectomy) or just remove the tumor (lumpectomy), Dodge said. Both procedures are considered safe and involve minimal downtime and recovery, she said.
While earlier studies offered conflicting findings on the survival of patients with stage 4 breast cancer, they had limitations, Dodge said. Many of the trials were small, participants were not receiving chemotherapy or other systemic therapies and no information was available on the hormonal or HER2 status of the disease, she said.
The new study had its own limitations. The data did not indicate why surgery was performed or if surgeons knew beforehand that the cancer was at stage 4.
Dr. Stephanie Bernik, chief of breast service at Mount Sinai West Medical Center in New York City, reviewed the findings.
They offer “added evidence that there may be some benefit to surgery for women with stage 4 breast cancer,” she said.
“If you remove the metastatic disease in the colon or liver, we know those patients do better and we are hoping the same holds true with breast cancer,” Bernik said. “Patients are living longer even with stage 4 disease as we improve our therapies and some of that might include surgery.”
Researchers plan to look next at other databases to see if reported outcomes also point to benefits from surgery.
The findings were recently published in the Annals of Surgical Oncology.
RELATED: Breast Cancer Surgery: What Are Your Options?
Breast cancer surgery is a treatment method that involves removing cancerous tissue from the breast. It may also involve removing lymph nodes and, in some cases, the entire breast to prevent the spread of cancer.
The most common types include:
Lumpectomy (breast-conserving surgery): Removes only the tumor and a small margin of surrounding tissue.
Mastectomy: Removes the entire breast and sometimes nearby tissues.
Sentinel lymph node biopsy: Removes the first few lymph nodes into which a tumor drains to check for spread.
Axillary lymph node dissection: Removes several lymph nodes if cancer is found in the sentinel nodes.
Reconstructive surgery: Rebuilds the breast’s shape after a mastectomy or lumpectomy, using implants or the patient’s own tissue.
The choice depends on several factors, including:
The size and location of the tumor
Whether cancer has spread to lymph nodes
Genetic factors (e.g., BRCA mutations)
Personal preference and lifestyle
Overall health and other medical conditions
Your medical team will help you make a personalized treatment plan.
Often, yes. Surgery is commonly part of a broader treatment plan that may include:
Radiation therapy
Chemotherapy
Hormone therapy
Targeted therapy or immunotherapy
The sequence and combination depend on the stage and subtype of breast cancer.
No, reconstruction is a personal choice. Some people choose to undergo reconstruction immediately during mastectomy or later on. Others may choose not to have reconstruction at all and may use a prosthesis or go flat. All choices are valid and should be respected.
Common risks include:
Pain or tenderness
Scarring
Swelling or infection
Changes in breast shape or size
Numbness or tingling
Lymphedema (especially with lymph node removal)
Discuss potential risks with your surgeon before your procedure.
Recovery varies by surgery type:
Lumpectomy: Usually 1–2 weeks
Mastectomy: Around 4–6 weeks
With reconstruction: May take 6–8 weeks or more
Your doctor will give you recovery guidelines, including wound care, activity restrictions, and follow-up visits.
Surgery is a critical part of treatment, but may not cure breast cancer on its own. Its goal is to remove as much cancer as possible. Additional therapies help reduce the risk of recurrence. Some early-stage cancers are cured with surgery and follow-up treatments.
RELATED: These 7 Exercises Will Help Ease Your Pain After Breast Cancer Surgery
Yes, many women with early-stage breast cancer are eligible for lumpectomy followed by radiation. Clinical outcomes are often similar to mastectomy for certain cases. Your care team can help you weigh the options based on your diagnosis.
Before surgery:
Ask about your specific procedure and recovery expectations
Arrange help for post-op care at home
Discuss medications with your doctor
Stop smoking and avoid certain supplements (if advised)
You don’t have to go through it alone. Many hospitals and cancer centers offer:
Nurse navigators or care coordinators
Oncology social workers or counselors
Support groups (in-person or virtual)
Breast cancer survivor mentors
Financial or insurance navigation assistance
Consider asking:
What type of surgery do you recommend and why?
What are the potential risks and complications?
What will recovery look like?
Will I need follow-up treatment?
Can I speak with someone who has had this surgery?
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