falsefalse

ASCO 2025: Optimizing Breast Cancer Surveillance With ctDNA Testing: Transforming Early Detection and Recurrence Monitoring - Episode 2

Molecular Residual Disease Detection and Surveillance Protocols in Practice

, , ,

Panelists discuss how circulating tumor DNA (ctDNA) testing for molecular residual disease (MRD) offers a sensitive tool for detecting early breast cancer recurrence before clinical symptoms appear while emphasizing the importance of shared decision-making, patient education, and clinical trial referral in the absence of standardized guidelines for managing ctDNA-positive results.

Video Player is loading.
Current Time 0:00
Duration 0:00
Loaded: 0%
Stream Type LIVE
Remaining Time 0:00
 
1x
  • Chapters
  • descriptions off, selected
  • captions off, selected

    MRD monitoring through ctDNA testing represents a significant advance in posttreatment breast cancer surveillance. This technology detects trace amounts of tumor DNA in the bloodstream after definitive therapy, even when there is no radiographic evidence of disease. The idea is to identify recurrence at a molecular level—potentially months before symptoms or imaging findings appear. Clinicians are increasingly incorporating ctDNA into their practices as a more sensitive and specific alternative to outdated tools such as tumor markers, though its clinical use is still evolving alongside the supporting evidence base.

    Before using ctDNA monitoring, it’s essential to have detailed conversations with patients about the implications of both positive and negative results. A positive ctDNA test does not automatically mean visible metastasis but indicates a higher risk of recurrence. When ctDNA is detected, clinicians often pursue diagnostic imaging and may consider therapeutic changes, such as modifying endocrine therapy or introducing treatments such as CDK4/6 inhibitors in hormone receptor–positive patients. Despite the promise, no formal guidelines exist yet for acting on ctDNA positivity, so referral to clinical trials remains an important strategy for many patients.

    Psychologically, ctDNA testing introduces both reassurance and anxiety. Some patients are eager to know about any recurrence as early as possible, whereas others prefer not to monitor until symptoms arise. The test is highly prognostic but not yet fully predictive, meaning it signals risk but doesn’t clearly guide treatment. Still, early studies suggest it may help tailor interventions more effectively. Importantly, the dialogue around ctDNA needs to be framed with empathy and clinical judgment, emphasizing the goal of catching recurrence at a treatable stage and empowering patients to engage meaningfully in their surveillance strategy.

    x