ASCO 2025: Optimizing Breast Cancer Surveillance With ctDNA Testing: Transforming Early Detection and Recurrence Monitoring - Episode 1
Evolving Standard-of-Care Treatment Strategies Across Breast Cancer Subtypes
Panelists discuss how current breast cancer surveillance remains largely symptom-driven and reactive, often missing early metastatic recurrence, and how circulating tumor DNA (ctDNA) testing offers a promising shift toward proactive, personalized monitoring by enabling earlier detection of molecular residual disease (MRD) and guiding timely therapeutic interventions.
Current practices for breast cancer surveillance after initial treatment vary significantly, often depending on the subtype of the disease and individual risk factors. The standard approach remains largely symptom-driven, where recurrence is typically detected when patients present with new or worsening symptoms, such as bone pain or neurologic issues. This reactive method often results in identifying metastatic disease at a more advanced stage, which can be emotionally and physically challenging for patients. Routine breast imaging and scheduled follow-ups—ranging from every 3 to 6 months initially to annually after 5 years—are part of current monitoring but still leave gaps in early detection.
One of the major challenges with traditional surveillance is that it can feel inadequate to both patients and clinicians. Many recurrences occur distantly rather than locally, and often not until symptoms are significant. The lack of routine systemic surveillance tools has made early intervention difficult. However, the development of ctDNA testing offers a promising alternative. By detecting MRD before clinical symptoms emerge, ctDNA could provide a critical lead time for therapeutic intervention. Early detection of recurrence through blood-based biomarkers may allow clinicians to tailor therapies more precisely and intervene sooner.
There is growing interest in using ctDNA testing to stratify risk and guide adjuvant therapy decisions. Ongoing trials are evaluating how molecular surveillance might prompt treatment changes, such as adding CDK4/6 inhibitors for hormone receptor–positive disease, immunotherapy for triple-negative breast cancer, or HER2-targeted agents for HER2-positive cases. This evolving landscape reflects a shift toward more proactive and personalized care. As new data continue to emerge, ctDNA surveillance has the potential to transform how recurrence is detected and managed, with the ultimate goal of improving outcomes and quality of life for breast cancer survivors.
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