Incomplete pathological response - what does this mean for surgery?


I was diagnosed with HER2+ breast cancer last August. The first MRI scan showed the tumour was 39mm. I’ve just finished 6 rounds of exhausting chemotherapy (Docetaxel, carboplatin, pertuzumab, trastuzumab). Midway scan showed the tumour had reduced to 20mm, and yesterday I found out that the final scan showed the tumour to be now 17mm. Only 3mm more shrinkage for all that suffering. I’m devastated. My understanding is that having an incomplete pathological response means that the chance of recurrence, or that it’s a late stage cancer, is increased. 

My surgeon has recommended a lumpectomy and I consented yesterday to this approach. I’m now having second thoughts based on all the reading I’ve been doing today. I know this is a personal decision but I’d be really grateful for your views and experiences.

Thanks so much for reading this.


Hi Margot

I’m so sorry you find yourself in this dilemma. You’re right, it’s far too personal a choice for anyone to express an opinion but I guess we can share our experiences.

First, ANY continued response to chemo is a good thing. The initial response is almost always going to be greater than any later response so don’t despair. It’s shrinking, that’s the important thing, and I know that even the tiniest change is measured in millimetres and 3 sounds paltry but it’s not. If it were the other way round, a 3mm increase, you’d be very anxious - so why not be pleased at continued shrinkage? Yes, it’s a LOT of hard work and suffering (you had a particularly harsh combination?) for what seems to be little return but it’s got you past the lumpectomy/mastectomy border line. 

The fact that you have now been offered a lumpectomy is surely a good sign. The surgeon must be confident s/he can secure clear margins. My diagnosis went from a confident “I’m sure there’s nothing to worry about, to lumpectomy, lumpectomy plus and eventually, within 4 weeks, mastectomy and full axillary clearance. I just wanted my breast gone. At that stage I had limited understanding and believed a lumpectomy or a reconstruction would just leave me worrying about recurrence so get rid. Of course, it’s way more complex but I actually wish I’d had a double now, just for symmetry!

You say you’ve done a lot of reading. If this has involved Google, you need to be very selective as each diagnosis is unique. You’d do better to ask the breast surgeon or oncologist what difference having a lumpectomy rather than a mastectomy will make in terms of recurrence, which seems to be your main concern, understandably (ring your breast care nurse asap to get that line of communication open). Unfortunately the tools they use as predictors are not infallible. There will always be a risk, the trick is to learn to live with it. Surgeons always assume women want their breast preserved as far as possible. This isn’t always the case but, if I were you, I would base any decision on what your practitioner(s) advise over anything you have read. They know the distinct features of your cancer, its genetic makeup, its proteins, markers, whatever. Google doesn’t, nor do academic papers or friendly forums. Possibly, you don’t either.

I hope you reach an informed decision. You’ll maybe be pleasantly surprised at how much more confident you will feel that the cancer has been dealt with once the offending breast tissue has been removed. Wishing you well xx

Thank you for this question, this is very helpful to me also.

Mine has shrunk a tad but not gone.

I am guilty of reading Google and I read today that  pCr could be where it has not gone into the breast and outside of its tumour- not just that it has gone completely???

I am having an extra chemo ( EC) hoping and praying for  PCR thinking that means to disappear completely ?