Risk-oriented therapy of early breast cancer – a summary for clinical oncologists

The treatment of breast cancer has undergone a significant paradigm shift in the last few decade. Personalized treatment plans are now part of the standard of care, including risk-adapted therapy escalation or de-escalation. More refined molecular characterization, evolving systemic treatment regimens, and the continuous evolution of radiotherapeutic technologies have enabled a reduction in the extent of surgical interventions without compromising oncological outcomes. The aim of this summary is to outline the main therapeutic decision points used in daily practice. Consistent with the multidisciplinary therapeutic approach to early and locally advanced breast cancer, this article also briefly addresses radiotherapeutic and surgical perspectives. Initial risk assessment for breast cancer incorporates tumor size, nodal status, histological subtype, tumor biological characteristics (ER, PR, HER2 expression, grade, Ki-67 proliferation index, TILs), gene-expression profiles (e.g. Oncotype DX/21-gene assay results), patient age, and hereditary mutations, response to neoadjuvant chemotherapy. These variables collectively influence subsequent management strategies.