By New research suggests that some women with early-stage breast cancer may not need radiation therapy after surgery. The findings, published in The New England Journal of Medicine, indicate that women at intermediate risk can safely forgo radiation without affecting survival, signaling a shift toward more personalized and less aggressive treatment options.
For decades, radiation has been a cornerstone of breast cancer therapy. Yet as diagnostic tools and treatment methods advance, doctors are beginning to reconsider its necessity, especially in early-stage cases where the cancer is less likely to spread or return.
According to a new international study, radiation to the chest wall showed no improvement in overall survival among women who had already received modern anti-cancer medications, lymph node removal, and mastectomy.
The research — among the most comprehensive of its kind — followed more than 1,600 women with early-stage breast cancer for nearly 10 years. Participants were considered at intermediate risk, meaning they either had aggressive tumors without lymph node involvement or Stage II cancer with one to three affected lymph nodes.
Radiation May Not Add Benefit for Some Patients
Dr. Ian Kunkler, lead author and principal investigator of the multinational study, explained that most participants had not received chemotherapy before surgery — a factor that further reduces the need for radiation.
“The findings reinforce a trend toward de-escalating radiotherapy in lower-risk groups,” Dr. Kunkler said. “With modern anti-cancer treatments, the risk of recurrence is very, very low — sufficiently low to avoid radiotherapy in most patients.”
After a median follow-up of 9.6 years, survival rates were almost identical: 81.4% for those who received radiation therapy and 81.9% for those who did not. The duration of disease-free survival and the spread of cancer to other parts of the body were also unaffected by radiation.
While radiation reduced the risk of chest wall recurrence, overall recurrence rates were minimal. Of the 29 women who experienced a recurrence, 20 had not undergone radiation (2.5%) and nine had (1.1%).
Clarifying Treatment for Intermediate-Risk Women
Experts say these findings clarify treatment guidelines for women who fall between the low- and high-risk categories.
“It was clear that low-risk patients didn’t need radiation and high-risk patients still do,” said Dr. Harold Burstein, a medical oncologist at the Dana-Farber Cancer Institute and professor at Harvard Medical School, who was not involved in the study. “That left open the question for the intermediate group — whether adding radiation would help. This study suggests these women don’t need it.”
The Medical Research Council, the European Organization for Research and Treatment of Cancer, and the Breast International Group conducted the trial.
Potential Side Effects and Surgical Challenges
While radiation remains crucial for high-risk patients, it can cause side effects that occasionally persist for years. Short-term symptoms include swelling, pain, and skin irritation similar to sunburn. In rare cases, it can lead to lung inflammation or lymphedema, a chronic condition causing arm swelling.
Radiation can also alter skin texture, making it less elastic and more prone to scarring. This can complicate breast reconstruction, both immediately after mastectomy and in later surgeries.
Researchers cautioned that radiation therapy might still be necessary for patients at higher risk of recurrence or metastasis.
Read more: The Major Cause of Breast Cancer Almost Everyone Ignores
Correction (November 6, 2025):
An earlier version of this article misstated the day the study was published. It was released on Wednesday, not Thursday.
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