Complete and Partial Breast Cancer Remission

How the absence or reduction of cancer directs treatment and care

There are different types of breast cancer remission, namely complete remission (meaning that tests, scans, and exams are unable to find cancer in the body) and partial remission (in which a tumor is still there, but substantially reduced). Each requires a different approach to management and treatment.

Your doctor will use the term remission, rather than cure, even when breast cancer has been successfully treated and there are no signs of cancer in your body. The term accurately describes the state in which there is no evidence of cancer, but there remains a possibility that it may return.

Unlike a cured disease, which is gone and is no longer in need of surveillance, remission—whether complete or partial—suggests the need for ongoing monitoring to identify and treat a recurrence if and when it occurs.

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Complete Remission

Complete remission, also known as a complete response, means that the cancer appears to be gone after treatment. If the cancer involves a solid mass, such as what occurs with breast or lung cancer, the tumor and any remaining cancer cells will have effectively been erased. With hematologic cancers like leukemia, there would be no evidence of cancer in the blood.

Cancer remission is determined by a battery of tests, including blood tests, tissue evaluations, and imaging studies (such as a breast MRI or PET/CT scan). As valuable as these tests are, they have their limitations. Even after complete remission has been declared, there may still be cancer cells below the detection levels of these tests. Some cancer cells may lie dormant indefinitely; others may suddenly multiply months or years later, triggering disease recurrence.

Because of the potential for recurrence, many doctors will refer to complete remission as no evidence of disease, or NED.

Partial Remission

If cancer is in partial remission, also known as a partial response, it means that a solid tumor has shrunk or the number of blood-borne cancer cells has been decreased. Partial remission is usually declared when there is at least a 50% reduction in the tumor size or the number of cancer cells from the baseline value.

Like heart disease and diabetes, some cancers can be chronically managed with partial remission (among them, ovarian cancer, leukemia, and lymphoma).

This is generally not the case with breast cancer. In all but stage 4 breast cancer, efforts will be made to remove the tumor and use radiation and/or chemotherapy to get rid of all remaining cancer cells. It is only when a tumor is inoperable or has metastasized (spread to other organs) that an oncologist will aim to control the tumor rather than eradicate it.

To qualify as a complete or partial remission, the absence or reduction of cancer must last for at least one month. The absence of symptoms is neither a measure nor an indication of remission.

Treatment

The aim of treatment following cancer remission varies by whether you are trying to prevent recurrence or improve survival and quality of life. Prescribed treatments are largely based on whether you have had early-stage cancer (stages 1, 2, or 3) or stage 4 breast cancer.

Early-Stage Breast Cancer

Even if you are in complete remission, you may still need to take medicines to keep cancer from returning. Known as adjuvant therapy, the drugs are primarily used for women with estrogen-receptor-positive breast cancer. This is a type of cancer whose growth is directly influenced by the hormone estrogen.

To reduce the risk of recurrence, your doctor may prescribe drugs that suppress either the production of estrogen or the stimulation of estrogen-sensitive cells. By doing so, there is less "fuel" to promote cancer recurrence.

If you have estrogen-sensitive cancer, your doctor may prescribe tamoxifen, which binds to the estrogen receptors on cells. After three to five years, you may be switched another class of drug known as aromatase inhibitors for another five years (in part to avoid the long-term side effects of tamoxifen). Aromatase inhibitors block the enzyme used to produce estrogen in the liver, pancreas, breasts, brain, and other tissues.

Unlike tamoxifen, aromatase inhibitors are only effective in postmenopausal women or women whose ovaries are suppressed.

If your breast cancer is estrogen-receptor-negative, you may not need any medications. 

Metastatic Breast Cancer

If you have stage 4 breast cancer, you will be prescribed medications to better control the disease. While treatable, metastatic breast cancer cannot be cured. 

With that being said, recent advances in chemotherapy and immunotherapy have allowed people with stage 4 cancer to live longer without symptoms of the disease. This includes experimental adoptive cell therapy (ACT) in which your body's own cancer-fighting cells are harvested and cultured for use as immunotherapy.

A Word From Verywell

Irrespective of your cancer stage or hormone receptor status, you will need to see an oncologist on an ongoing basis to monitor your condition. This typically involves a doctor's visit every few months for the first five years, after which you may only need yearly appointments. Unless you've had a bilateral mastectomy, you would also need an annual mammogram and possibly a breast MRI.

Although there is no way to prevent breast cancer recurrence, by remaining linked to medical care, you will be better able to spot the recurrence early when it is most treatable.

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Article Sources

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  1. National Cancer Institute. Understanding Cancer Prognosis. Updated June 17, 2019.

  2. American Cancer Society. Managing Cancer as a Chronic Illness. Updated February 12, 2016.

  3. American Cancer Society. Treatment of Stage IV (Metastatic) Breast Cancer. Updated September 18, 2019.

  4. American Cancer Society. Treatment of Breast Cancer Stages I-III. Updated September 18, 2019.