Should Patients With Metastatic Breast Cancer Have Surgery?

Roughly 10 percent of breast cancer patients already have metastatic cancer by the time they are diagnosed. Metastatic disease is advanced cancer that has spread from the original (primary) site to other areas of the body. Oncologists (doctors specializing in treating cancer patients) typically treat metastatic patients with chemotherapy, hormonal therapy, or targeted therapy, which targets a certain protein in the cancer cells. They generally do not surgically remove the primary tumor unless it’s to remove dead or dying tissue, or if the tumor is especially fast growing.

Pros and Cons of Surgery

Oncologists do not agree on the best way to manage local breast tumors in the case of metastatic disease; studies have found mixed results on the benefits of removing these primary tumors.

"Deciding if a patient with Stage IV breast cancer should undergo primary removal of the cancer in the breast is not easy," says Stephanie Bernik, MD, Chief of Surgical Oncology at Lenox Hill Hospital in New York City. "There have been mixed reports as to whether or not there is a benefit to surgery in the setting of metastatic disease." Some studies have shown a survival benefit in patients who have responded well to forms of treatment like chemotherapy. On the other hand, surgically removing the primary breast tumor may help patients by reducing the overall amount of cancer in the body and preventing seeding, the idea that metastatic (spreading) cancer cells can fuel primary tumor growth. However, some animal studies suggest that removing primary tumors may actually enhance the growth of metastatic tumors, though it’s important to note that researchers have not yet observed this finding in humans.

Latest Studies

The most recent studies do not support surgically removing local breast tumors in cases of metastatic disease: A clinical trial with patients found that even after a positive initial response to other treatments, removing the breast tumor and nearby lymph nodes did not increase survival time.

Another study found that patients with metastatic breast cancer were more likely to experience complications shortly after surgery compared to patients who had less advanced breast cancer. The most common complications included infection, bleeding, and respiratory, vein-related, or cardiac problems. In a review of 68,000 women over seven years, researchers found a mild increase in complications associated with surgery. They suspect that patients with metastatic breast cancer have other conditions in their body that predispose them to medical difficulties following surgery.

So, what do these studies mean for patients with metastatic breast cancer?

Factors, such as age, extent of disease, and co-existing conditions play a role in whether individual patients might benefit from surgery to remove primary tumors.

"Until there is clear data [on the benefits of surgery—or lack thereof], each patient should speak with their medical oncologist and breast surgeon to try to determine if they are a surgical candidate," Bernik says. "A patient needs to examine the pros and cons of the surgery before making decisions about their therapy."

Rajiv Datta, MD, of South Nassau Communities Hospital, Oceanside, NY, reviewed this article.


Stephanie Bernik, MD, Chief of Surgical Oncology at Lenox Hill Hospital in New York City. Email September 30, 2014. 

Mulcahy, Nick. "How Safe Is Surgery for Metastatic Breast Cancer?Medscape. May 1, 2014. 

"Patients With Metastatic Breast Cancer May Not Benefit From Surgery and Radiation After Chemotherapy." American Association of Cancer Research. December 11, 2013. 

Newman, Lisa A., MD, MPH. "Breast Surgery for Stage IV Breast Cancer." Medscape Medical News. Accessed June 6, 2014.  

"Surgical Removal of Primary Tumor for Metastatic Breast Cancer." National Cancer Institute. February 21, 2013. 

Helwick, Caroline. "Surgery for Metastatic Breast Cancer Associated With High Complication Rate." The ASCO Post. May 2, 2014. 

"What You Need to Know About Breast Cancer: Treatment." National Cancer Institute. Posted September 26, 2012.