Remission, No Evidence of Disease, and Cancer-Free: What Do They Mean?

When cancer treatment works and tumor cells die, medical professionals may use one of several words to describe what’s happening. These include the terms “remission,” “no evidence of disease,” and “cancer-free.” But what do these words actually mean? If a doctor uses one of these words to describe your cancer status, could the disease come back?

Because different people may use these words in different ways, it’s important to ask your care team exactly what they mean if they say you’re in remission, have no evidence of disease, or are cancer-free. 

According to the National Cancer Institute, remission is a “decrease in or disappearance of signs and symptoms of cancer.” Essentially, if you’re in remission, it means you’re getting better.

There are two main types of remission: partial and complete remission. 

Partial remission means that some but not all signs and symptoms have gone away. You still have cancer, but you’re getting better. Cancerous tumors must be at least 50% smaller, or tumor cells must not appear to be growing, to be in partial remission. 

If you’re told that you’re in complete remission, this means that all signs and symptoms related to cancer have disappeared. For instance, imaging tests such as MRI or CT scans will show no signs of tumors and tests of your blood will be normal. However, cancer may still be present in your body, and it may recur. Your cancer care team will schedule regular check-ups to make sure the cancer has stayed in remission and hasn’t come back.

If you’re in complete remission after surgery for breast cancer (for instance, your surgeon tells you that all evidence of the cancer in your breast has been removed), you may have to continue with some type of therapy to try to keep you in remission. This is called adjuvant therapy. Whether your medical team recommends adjuvant therapy will depend on the type of breast cancer you were diagnosed with. Adjuvant therapy for breast cancer may include chemotherapy, radiation, hormonal therapy, antibody therapy, or a combination of these therapies. For instance, doctors often recommend that people with estrogen receptor-positive breast cancer take hormonal therapy for five to 10 years after they’ve completed other breast cancer treatments.

You’re more likely to remain in remission if you treat the cancer before it spreads. Less aggressive cancers are also more likely to remain in remission than fast-growing cancers. Remission can last for a short or long time, on the scale of months to the rest of your life. For many people, it’s an important turning point in their cancer journey, even if it doesn’t last forever.

Some medical professionals may not use the term remission. Allegra Matook, PA-C, MSPAS, a physician assistant of breast and gynecologic cancer at the Brown University Health Cancer Institute, doesn’t say remission because she doesn’t want people to mistakenly believe that their cancer can’t recur.

No evidence of disease (also called NED by doctors) is often used to mean the same thing as complete remission. In this situation, no tests can detect cancer. But — as with complete remission — it’s possible that there are some cancer cells left in the body, and that the cancer could recur.

Some clinicians, like Matook, may prefer saying there’s no evidence of disease, rather than that you’re in remission. Others may want to wait for some amount of time, even years, after you have no evidence of disease to say that you’re in remission. And some may say that you’re in remission as soon as your tests show no evidence of disease.

Oncologists may say that a person is cancer-free, or cured of cancer, if they are in complete remission for at least five years. However, not all doctors agree with this definition and some find it misleading, since breast cancers may recur or spread after five years. That’s because there’s no way to confirm if a person is entirely cancer-free: “stray” cancer cells can remain in the body and can’t always be picked up by tests. However, if a doctor says you’re cancer-free, that means they believe that there’s no cancer left in your body.

Still, some medical professionals like Matook may not say that you’re cured or cancer-free because they can’t be 100% sure. Even if your doctor says you’re cancer-free, you may someday have a recurrence.

Some organizations, such as the National Cancer Institute, say that you’re a cancer survivor the moment you get diagnosed, and you will continue to be a survivor throughout your life. This is also the definition that Matook and her colleagues use. “We do that because we focus on survivorship tenets like lifestyle changes throughout the process of their treatment,” she says. For instance, physical activity and a healthy diet can help survivors improve their health and quality of life at various stages of treatment and survival.

Other clinicians say that breast cancer survivorship starts when you’re done with treatment and begin the maintenance and surveillance stages of care. This definition may be better for some people who don’t feel like the term “cancer survivor” fits them while undergoing treatment. 

No matter when other people begin to refer to you as a cancer survivor, you can describe yourself this way at whatever point feels right to you — or not at all.

The risk of breast cancer coming back depends on many factors, including the type of breast cancer first diagnosed, the treatments you received, genetics, and more. For instance, most recurrences of triple-negative breast cancer occur within five years of the original diagnosis, while studies show that people with estrogen receptor-positive breast cancer may experience a recurrence decades later.

Your doctor can help you get an idea of your personal risk of recurrence, Matook says. “I think you need to plan for the worst, but hope for the best,” she adds. “Try to enjoy your life and do things that make you happy, and continue with your regular screenings and surveillance. Listen to your doctors about what advice they have to decrease the risk of recurrence.”