Fast Five Quiz: Assessing Early Breast Cancer

Medscape

24-07-2025

Breast cancer screening, prevention, and management decisions are made on the basis of several factors related to family history, patient history, and, if a diagnosis of breast cancer is made, tumor type. Upon diagnosis, the determination of risk for recurrence and prognosis, as well as patient disease stage, health, and preferences, informs management strategies regarding neoadjuvant treatment, breast-conserving surgery, the type of radiation therapy used, if any, and whether adjuvant treatment should be initiated.
Do you know the key aspects of risk assessment and their implications in early breast cancer? Test your knowledge with this quick quiz.
Although all breast cancer types might recur despite early diagnosis and treatment, those defined as triple-negative breast cancer are considered high-risk for recurrence. Patients with this subtype usually have a significant risk for disease recurrence.
Hormone receptor (HR)-positive tumors, which express estrogen receptors (ERs) and/or progesterone receptors (PRs), are generally defined as luminal-like, typically less aggressive, and having a more favorable prognosis. HER2-positive breast tumors are biologically aggressive tumors, but recurrence outcomes have dramatically improved with anti-HER2-targeted therapies.
Learn more about breast cancer risk factors.
On average, individuals harboring a germline BRCA1 mutation have up to a 72% risk of developing breast cancer by age 80 years; for those with a germline BRCA2 mutation, the risk is up to 69%.
Because of the high lifetime risk for breast cancer in individuals with germline BRCA mutations, both US and European guidelines recommend considering prophylactic surgery, such as double mastectomy.
Learn more about BRCA1 and BRCA2 mutations.
According to the European Society for Medical Oncology, decisions about adding chemotherapy to adjuvant endocrine therapy are individualized on the basis of patient and disease factors, including results of genomic assays. Data have shown that most cases of small ER-positive, PR-positive, HER2-negative, or node-negative breast cancer generally have a good prognosis with endocrine therapy alone and usually do not require adjuvant chemotherapy.
Although assessment of response to neoadjuvant endocrine therapy or chemotherapy is generally used in the setting of locally advanced breast cancer (particularly when the size and/or location of the tumor preclude breast-conserving surgery), patients with very small, early, HER2-negative, HR-positive cancer types are usually treated with surgery first, followed by radiation therapy and consideration of adjuvant therapy with an endocrine regimen, chemotherapy, or both.
Ki-67 is an indirect measure of cell proliferation. Although a high Ki-67 score is often considered a marker for a poorer prognosis in early breast cancer, it cannot predict the benefit of chemotherapy as a single measure owing to many limitations.
Learn more about breast cancer treatments.
The risk for recurrence of a HER2-positive tumor is generally dependent on tumor size, the presence of positive axillary lymph nodes, tumor grade, and other histologic and patient factors. Before the development of effective anti-HER2 therapies, such as trastuzumab, novel anti-HER2 TKIs, or antibody-drug conjugates, HER2 positivity was associated with poor prognosis. The degree of HER2 positivity (ie, immunohistochemistry [IHC] 2+/fluorescence in situ hybridization amplified vs IHC 3+) is generally not correlated with recurrence risk, although it might be associated with greater responsiveness to anti-HER2-targeted therapies. Patients with early-stage, HER2-positive tumors with clinically positive lymph nodes are usually candidates for neoadjuvant systemic treatment with chemotherapy and pertuzumab plus trastuzumab.
Age alone usually does not indicate if a patient may be considered for neoadjuvant systemic treatment, but data have shown that younger age (≤ 50 years) has been linked to disease recurrence in this population "across all treatments." The number of live births before age 40 years alone usually does not indicate if a patient may be considered for neoadjuvant systemic treatment as well.
Learn more about family history and genetic risk factors for breast cancer.
A diagnostic companion test for germline BRCA status is needed to select patients for PARP inhibitors in many countries. Such status can help determine how certain patients will respond to this treatment, as patients with germline BRCA mutations tend to have heightened sensitivity to PARP inhibitors and other DNA-damaging agents. Further, detecting these mutations in select patients and treating them with PARP inhibitors has been shown to improve progression-free and distant-disease-free survival, and they have become "a crucial treatment for breast cancer with BRCA mutations."
For example, in 2022, the European Medicines Agency and the US FDA approved adjuvant olaparib, a PARP inhibitor, for the treatment of patients with deleterious or suspected deleterious germline BRCA mutation and a diagnosis of HER2-negative, high-risk, early-stage breast cancer treated with neoadjuvant or adjuvant chemotherapy.
Ki-67 measurement, MRI findings alone, and a diagnostic companion test for ERBB2 (HER2) are usually not required when selecting adjuvant therapy with a PARP inhibitor in this setting.
Learn more about PARP inhibitors for breast cancer.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.