REVIEW article

Front. Oncol.

Sec. Breast Cancer

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1507836

Part I: Consensus Statements and Expert Recommendations for HER2-Negative Early Breast Cancer in the Asia-Pacific Region: Diagnosis and Risk Assessment

Provisionally accepted
Soo Chin  LeeSoo Chin Lee1*Yeon Hee  ParkYeon Hee Park2Christian  SingerrChristian Singerr3Judith  BalmañaJudith Balmaña4Rebecca  Alexandra DentRebecca Alexandra Dent5Veronique  Kiak-Mien TanVeronique Kiak-Mien Tan5Nadia  Ayu MulansariNadia Ayu Mulansari6Mastura  MdMastura Md7Frances Victoria  F QueFrances Victoria F Que8Yen-Shen  LuYen-Shen Lu9Napa  Parinyanitikul​Napa Parinyanitikul​10Cam  Phuong PhamCam Phuong Pham11Aishah  TaibAishah Taib12Sun-Young  KongSun-Young Kong13Yoland  AntillYoland Antill14Hee  Jeong KimHee Jeong Kim15
  • 1Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
  • 2Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
  • 3Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
  • 4Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
  • 5National Cancer Centre Singapore, Singapore, Singapore
  • 6Ciptomangunkusumo National General Hospital/Universitas Indonesia, Jakarta, Indonesia
  • 7Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 8St Luke’s Medical Center, Quezon City and Global City, Manila, Philippines
  • 9National Taiwan University Hospital, Taipei, Taiwan
  • 10King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 11bachmai hospital, Hanoi, Vietnam
  • 12UM Cancer Research Institute, Kuala Lumpur, Malaysia
  • 13National Cancer Center, Goyang-si, Republic of Korea
  • 14Monash University, Melbourne, Victoria, Australia
  • 15Asan Medical Center, College of Medicine, University of Ulsan, SONGPA-GU, Seoul, Republic of Korea

The final, formatted version of the article will be published soon.

Introduction: In the Asia-Pacific region, there is increasing contention on the practical challenges involved in managing human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (eBC). This modified Delphi consensus explores gaps in genetic counselling (GC) and genetic testing (GT), and clinical risk assessment for HER2-negative eBC.Methods: An expert panel of 16 Asia-Pacific medical oncologists, geneticists, and breast cancer surgeons arrived at 33 statements. The level of statement consensus was considered high at ≥75%. A survey of 134 healthcare practitioners (HCPs) (breast cancer surgeons, geneticists, oncologists, molecular biologists/pathologists) explored the real-world practices in this region.Results: A consensus was reached for 88% of the statements (29/33) and aligned with international guidelines. Experts reached 100% consensus on offering pretest GC, obtaining consent before GT, considering first diagnosis of breast cancer (BC) as ideal time for GT, offering reflex testing for patients with likely/pathogenic germline BRCA variant, and considering patients with germline BRCA mutant early triple-negative breast cancer (TNBC) patients who do not achieve pathological complete response after neoadjuvant treatment to be at high risk of recurrence. Over 90% of experts supported germline GT for BRCA for TNBC patients irrespective of age at diagnosis or family history and prioritized tumour size and nodal status as prognostic factors for cancer recurrence. Experts reached 80%-90% consensus for using genetic risk assessment tools in low/under-resourced healthcare systems and considering patients with likely/pathogenic variants in BRCA for risk reduction surgery. Significant gaps existed between real-world practices and recommendations, particularly in offering pretest GC to patients with suspected hereditary BC and to blood relatives of patients with BRCA germline pathogenic variant BC, ideal time for GT, considering GT for early TNBC patients irrespective of age, offering post-test GC for positive results, utilizing risk assessment tools, and streamlining GC through non-geneticist HCPs.Conclusion: GT and pretest GC should be mainstreamed at the first diagnosis of BC. Risk assessment for disease recurrence should be performed at diagnosis and post-surgery for HER2-negative eBC patients. These recommendations would help standardize GC and improve GT access for clinical decisions.

Keywords: BRCA germline pathogenic variants, consensus, Early breast cancer, HER2, HR+, Triple-negative breast cancer, Recurrence

Received: 08 Oct 2024; Accepted: 02 Jun 2025.

Copyright: © 2025 Lee, Park, Singerr, Balmaña, Dent, Kiak-Mien Tan, Mulansari, Md, Que, Lu, Parinyanitikul​, Pham, Taib, Kong, Antill and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Soo Chin Lee, Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore

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