Beyond Traditional Biomarkers: Prognostic Impact of ctDNA in the Posttreatment Setting

ctDNA has emerged as a powerful prognostic tool, especially in the adjuvant setting for breast cancer. The association between ctDNA positivity and recurrence risk is remarkably strong, with HRs reaching exceptionally high levels. This makes ctDNA one of the most predictive markers available for identifying patients at risk of metastatic relapse. In clinical practice, offering ctDNA testing involves a thorough risk-benefit discussion with patients, many of whom are well informed and actively involved in their care decisions. Although some patients opt out of testing, those who undergo it often find that a positive result confirms their already understood risk but provides a more personalized and precise measure. This information frequently guides decisions around intensifying therapy, such as modifying endocrine treatment or adding targeted agents.

Beyond medical decisions, ctDNA results can influence important life choices. Younger patients, for instance, might reconsider family planning or career paths after learning about their elevated risk from ctDNA positivity. Although prospective trials are still ongoing to determine whether treatment modifications based on ctDNA improve long-term outcomes, the information itself is meaningful for many. It empowers patients to make more informed decisions, whether related to therapy or personal planning. Moreover, the psychological impact of having such prognostic clarity cannot be underestimated, as it often motivates both patients and clinicians to adopt a more proactive approach to treatment and monitoring.

Incorporating ctDNA into existing risk stratification frameworks adds complexity but also enhances clinical insight. It serves as a valuable adjunct to traditional tools, helping identify which patients might benefit most from therapy intensification. Several ongoing studies are investigating how early interventions based on ctDNA detection can alter disease trajectories, including trials combining immunotherapy with standard treatments. Although challenges remain in optimizing how ctDNA is integrated into clinical practice, its role as a dynamic and highly predictive biomarker is increasingly recognized as essential for personalized breast cancer management.