July 25, 2018

Many Women Can Skip Chemo for Early-Stage Breast Cancer

New research weighs chemotherapy risk vs. benefits

Many Women Can Skip Chemo for Early-Stage Breast Cancer

A large breast cancer study has confirmed what doctors in recent years have suspected: Thousands of women with a common type of early-stage breast cancer will no longer need to undergo chemotherapy after surgery.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The New England Journal of Medicine recently published results of the National Cancer Institute study involving more than 10,000 women with hormone-receptor-positive, HER2-negative breast cancer. The study found that postmenopausal women with a low to middle risk of recurrence score, as determined by a common genomic test (Oncotype DX), only needed anti-estrogen therapy after surgery.

“This means a large number of patients can safely avoid chemotherapy. That’s a huge advantage,” says oncologist Jame Abraham, MD, Director of Cleveland Clinic’s Breast Oncology Program.

The challenges of chemotherapy’s effects

In treating breast cancer, doctors typically have given chemotherapy after a lumpectomy or mastectomy. Known as adjuvant treatment, this is meant to help reduce the chance of recurrence.

When patients receive it after surgery, the chemotherapy treatment typically lasts from three to six months, depending on what type of drugs doctors use.

“But chemotherapy comes with a lot of side effects, both short-term and long-term,” Dr. Abraham says.

Common temporary side effects include:

  • Nausea and vomiting.
  • Hair loss.
  • Loss of appetite.
  • Mouth sores.
  • Bruising or bleeding.
  • High risk of infection.

Doctors sometimes have to hospitalize patients to get these problems under control. “Chemo is not easy; it’s not fun,” Dr. Abraham says.

More about the study and assessing risk

For this major study, researchers enrolled women ages 18 to 75 with hormone-receptor positive, HER-2 negative breast cancer. Doctors used a genomic test (Oncotype DX) that looks at 21 genes to determine each woman’s risk of recurrence on a scale of 0 to 100.

Doctors have been using the test for about 10 years. In general, a recurrence score of less than 18 is considered low, and a recurrence score higher than 31 is considered high. Typically, patients with a recurrence score of less than 18 are treated only with endocrine therapy, and those with scores higher than 31 receive both chemotherapy and endocrine therapy.

However, for this study, researchers considered recurrence score numbers less than 11 as low (and limited treatment to anti-estrogen therapy), while they treated anyone with a score higher than 25 with chemotherapy.

In particular, the study researchers wanted to better understand the role of chemotherapy in patients in the middle range (with scores of 11-25); these were considered as the intermediate risk group.

The recent study results resolved questions about the role of chemotherapy in patients with a scores of 11-25, Dr. Abraham says. After nine years, women who fell in this range, who had only received hormone therapy, had a similar rate of cancer-free survival as women who received both chemotherapy and hormone therapy.


“Also, post-menopausal patients can safely avoid chemotherapy if they have a number less than 25,” Dr. Abraham says.

The only exception is for women who are pre-menopausal or age 50 or younger. The study recommends that doctors evaluate the benefit of chemotherapy for these women who fall in the 16 to 25 recurrence score range.

The recent study results are one more step toward helping doctors and patients practice personalized healthcare, Dr. Abraham says. “We can really individualize treatment and make sure we are prescribing the right treatment for the right purpose.”

Related Articles

Female asleep on couch on backyard deck next to laptop and glasses
February 22, 2024
Does Breast Cancer Treatment Make You Tired?

The answer is yes — but there are things you can do to help boost your energy

person scratching at their itchy skin on their chest
January 2, 2024
Is Itchy Skin a Sign of Cancer?

Anything from minor irritations and chronic diseases to, yes, cancer can cause persistent itching

Female swimmer in the water at edge of a pool
November 30, 2023
Can Exercise Reduce Your Risk of Breast Cancer?

Physical activity and weight management can minimize your chances of getting the disease

bowl of soy-based cubes with hand
November 29, 2023
Can Soy Cause Breast Cancer?

Research consistently shows that soy-based foods do not increase cancer risk

person applying deodorant
October 19, 2023
Can Deodorant Cause Cancer?

Research doesn’t show a link between the personal hygiene product and breast cancer

doctor talking about breast health
October 3, 2023
Myths Explained: Breast Cancer Symptoms

Lumps may move and you may feel pain, but breast discharge typically isn’t a sign of cancer

foods with vitamin D and supplements
October 3, 2023
Vitamin D and Breast Cancer: Are They Linked?

If you’ve been diagnosed with breast cancer, having a normal range of vitamin D can help

Person took swab test and is inserting swab back into tube.
September 28, 2023
At-Home DNA Test for Breast Cancer Risk Has Limitations

If you’re of Ashkenazi Jewish descent, these tests are still an important resource

Trending Topics

glass of cherry juice with cherries on table
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try

Exercise and diet over three months is hard to accomplish.
Everything You Need To Know About the 75 Hard Challenge

Following five critical rules daily for 75 days may not be sustainable

Person in foreground standing in front of many presents with person in background holding gift bags.
What Is Love Bombing?

This form of psychological and emotional abuse is often disguised as excessive flattery