Will surgery be a part of breast cancer treatment in the future?

The combination of smaller, screen-detected cancers, improved efficacy of systemic therapy, and increasing use of neoadjuvant therapy with rising rates of pathologic complete response has prompted interest in studying elimination of surgery for some women with breast cancer. In order to determine whether this is a high priority area for research, knowledge of the proportion of cancers cured by surgery, the morbidity of current surgical approaches to breast cancer, and patient treatment preferences must be considered. This article reviews these topics and addresses some of the concerns about elimination of surgery in the settings of patients with small amounts of non-high-grade DCIS and in those who appear to have a pathologic complete response to neoadjuvant chemotherapy.