Contemporary Approaches to Breast Cancer Management: An Evidence Synthesis Guiding Clinical Practice and Patient Care.
DOI:
https://doi.org/10.37376/benunivmedj.v2i2.7402Keywords:
Breast neoplasms, evidence-based oncology, multidisciplinary care, precision medicine, adjuvant therapy, clinical guidelines, patient-centered careAbstract
Background: Breast cancer remains the most frequently diagnosed cancer globally, though its management varies significantly across regions. This systematic review integrates recent evidence across six domains to delineate best practices for comprehensive care.
Methods: A systematic literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL (2010–2024), in line with PRISMA 2020 reporting standards. Eligible studies were screened by two reviewers. Quality was assessed using validated tools appropriate to study design, including Cochrane RoB 2.0, Newcastle-Ottawa Scale, AMSTAR-2, and AGREE II. Evidence was synthesized narratively and appraised using the GRADE framework.
Results: Key advances include the application of molecular profiling in tailoring therapy, treatment de-intensification for selected low-risk groups, escalation for aggressive subtypes, and improved multidisciplinary decision-making. Hypofractionated radiotherapy has shown comparable efficacy with reduced side effects, while genomic testing helps identify patients who can safely avoid chemotherapy. Targeted therapies have substantially improved outcomes in specific subgroups. Unique strategies are needed for elderly, male, and pregnant patients, and oligometastatic disease is increasingly approached with curative intent.
Conclusion: Precision medicine has redefined breast cancer treatment, emphasizing individualized and integrated multidisciplinary strategies. Implementation frameworks that minimize disparities and maximize both survival and quality of life outcomes are necessary to put this evidence into practice.
References
Harbeck N, Gnant M. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2017;389(10074):1134-50.
Waks AG, Winer EP. Breast cancer treatment: a review. Jama. 2019 Jan 22;321(3):288-300.
Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E, ESMO Guidelines Committee. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2019 Aug 1;30(8):1194-220.
Gradishar WJ, Anderson BO, Abraham J, Aft R, Agnese D, Allison KH, Blair SL, Burstein HJ, Dang C, Elias AD, Giordano SH. Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2020 Apr 1;18(4):452-78.
Morrow, M., Van Zee, K.J., Solin, L.J., Houssami, N., Chavez-MacGregor, M., Harris, J.R., Horton, J., Hwang, S., Johnson, P.L., Marinovich, M.L. and Schnitt, S.J., 2016. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Journal of Clinical Oncology, 34(33), pp.4040-4046.
Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, White J, Harris JR. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Practical radiation oncology. 2017 Mar 1;7(2):73-9.
Denduluri N, Chavez-MacGregor M, Telli ML, Eisen A, Graff SL, Hassett MJ, Holloway JN, Hurria A, King TA, Lyman GH, Partridge AH. Selection of optimal adjuvant chemotherapy and targeted therapy for early breast cancer: ASCO clinical practice guideline focused update. Journal of Clinical Oncology. 2018 Aug 10;36(23):2433-43.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021 Mar 29;372.
Chen X, Xu D, Li X, Zhang J, Xu W, Hou J, Zhang W, Tang J. Latest overview of the cyclin-dependent kinases 4/6 inhibitors in breast cancer: the past, the present and the future. Journal of Cancer. 2019 Oct 21;10(26):6608.
Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model incorporating familial and personal risk factors. Stat Med. 2020;39(30):4720-4732.
Marinovich ML, Hunter KE, Macaskill P, Houssami N. Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. JNCI: Journal of the National Cancer Institute. 2018 Sep 1;110(9):942-9.
Lee K, et al. Abbreviated versus full-protocol MRI for breast cancer screening: a systematic review and meta-analysis. Clin Breast Cancer. 2023;23(1):e1-e10.
Manna ED, Serrano D, Aurilio G, Bonanni B, Lazzeroni M. Chemoprevention and lifestyle modifications for risk reduction in sporadic and hereditary breast cancer. Healthcare. 2023;11(16):2360.
Chintamani. Approach to a Suspected Case of Breast Cancer. InBreast Cancer: Comprehensive Management 2022 Jan 31 (pp. 87-101). Singapore: Springer Nature Singapore.
Weiss A, King TA, Hunt KK, et al. Incorporating Biologic Factors into the American Joint Committee on Cancer Breast Cancer Staging System: Review of the Supporting Evidence. Surg Clin North Am. 2018;98(4):687-702.
Kim KM, et al. Accuracy of abbreviated breast magnetic resonance imaging for breast cancer detection: a systematic review and meta-analysis. Eur J Radiol. 2025;182:110779.
Xiang W, Rao H, Zhou L. A meta-analysis of contrast-enhanced spectral mammography versus MRI in the diagnosis of breast cancer. Thorac Cancer. 2020;11(6):1423-1432.
Schmid P, Cortes J, Pusztai L, et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med. 2020;382(9):810-821.
Panceri SS, Mutz F, Cardoso VB, Carneiro RV, Oliveira-Santos T, Badue C, De Souza AF. Detecting cancerous tissue in mammograms using deep neural networks. In2021 International Joint Conference on Neural Networks (IJCNN) 2021 Jul 18 (pp. 1-8). IEEE.
Brush J, Boyd K, Chappell F, Crawford F, Dozier M, Fenwick E, Glanville J, McIntosh H, Renehan A, Weller D, Dunlop M. The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation. Health Technology Assessment (Winchester, England). 2011 Sep;15(35):1.
Litière S, Werutsky G, Fentiman IS, Rutgers E, Christiaens MR, Van Limbergen E, Baaijens MH, Bogaerts J, Bartelink H. Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. The lancet oncology. 2012 Apr 1;13(4):412-9.
Morrow, M., Van Zee, K.J., Solin, L.J., Houssami, N., Chavez-MacGregor, M., Harris, J.R., Horton, J., Hwang, S., Johnson, P.L., Marinovich, M.L. and Schnitt, S.J., 2016. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Journal of Clinical Oncology, 34(33), pp.4040-4046.
Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, Ollila DW, Hansen NM, Whitworth PW, Blumencranz PW, Leitch AM. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. Jama. 2017 Sep 12;318(10):918-26.
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927-933.
De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Annals of surgical oncology. 2016 Oct;23(10):3247-58.
Song Y, Wang L, Huang W, Guo S, Wu X, Zheng H. Comparison of nipple sparing and skin sparing mastectomy with immediate reconstruction based on patient reported outcomes. Scientific Reports. 2025 Apr 29;15(1):14989.
Brunt AM, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, Chan C, Churn M, Cleator S, Coles CE, Goodman A. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. The Lancet. 2020 May 23;395(10237):1613-26.
Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, Bhattacharya IS, Brunt AM, Ciurlionis L, Chan C, Donovan EM. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. The Lancet. 2017 Sep 9;390(10099):1048-60.
Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer Jr CE, Dees EC, Goetz MP, Olson Jr JA, Lively T. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. New England Journal of Medicine. 2018 Jul 12;379(2):111-21.
Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Chia SK, Dhesy-Thind S. 21-gene assay to inform chemotherapy benefit in node-positive breast cancer. New England Journal of Medicine. 2021 Dec 16;385(25):2336-47.
Von Minckwitz G, Procter M, De Azambuja E, Zardavas D, Benyunes M, Viale G, Suter T, Arahmani A, Rouchet N, Clark E, Knott A. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer. New England Journal of Medicine. 2017 Jul 13;377(2):122-31.
Pusztai L, Denkert C, O’Shaughnessy J, Cortes J, Dent R, McArthur H, Kümmel S, Bergh J, Park YH, Hui R, Harbeck N. Event-free survival by residual cancer burden with pembrolizumab in early-stage TNBC: exploratory analysis from KEYNOTE-522. Annals of Oncology. 2024 May 1;35(5):429-36.
Pan H, Gray R, Braybrooke J, Davies C, Taylor C, McGale P, Peto R, Pritchard KI, Bergh J, Dowsett M, Hayes DF. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. New England Journal of Medicine. 2017 Nov 9;377(19):1836-46.
Tutt AN, Garber JE, Kaufman B, Viale G, Fumagalli D, Rastogi P, Gelber RD, de Azambuja E, Fielding A, Balmaña J, Domchek SM. Adjuvant olaparib for patients with BRCA1-or BRCA2-mutated breast cancer. New England Journal of Medicine. 2021 Jun 24;384(25):2394-405.
Johnston SR, Harbeck N, Hegg R, Toi M, Martin M, Shao ZM, Zhang QY, Martinez Rodriguez JL, Campone M, Hamilton E, Sohn J. Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2−, node-positive, high-risk, early breast cancer (monarchE). Journal of Clinical Oncology. 2020 Dec 1;38(34):3987-98.
Biganzoli L, Battisti NM, Wildiers H, McCartney A, Colloca G, Kunkler IH, Cardoso MJ, Cheung KL, De Glas NA, Trimboli RM, Korc-Grodzicki B. Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG). The Lancet Oncology. 2021 Jul 1;22(7):e327-40.
Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. The lancet oncology. 2015 Mar 1;16(3):266-73.
Hassett MJ, Somerfield MR, Baker ER, Cardoso F, Kansal KJ, Kwait DC, Plichta JK, Ricker C, Roshal A, Ruddy KJ, Safer JD. Management of male breast cancer: ASCO guideline. Journal of Clinical Oncology. 2020 Jun 1;38(16):1849-63.
Loibl S, Schmidt A, Gentilini O, Kaufman B, Kuhl C, Denkert C, von Minckwitz G, Parokonnaya A, Stensheim H, Thomssen C, Van Calsteren K. Breast cancer diagnosed during pregnancy: adapting recent advances in breast cancer care for pregnant patients. JAMA oncology. 2015 Nov 1;1(8):1145-53.
Sessa C, Balmaña J, Bober SL, Cardoso MJ, Colombo N, Curigliano G, Domchek SM, Evans DG, Fischerova D, Harbeck N, Kuhl C. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline☆. Annals of Oncology. 2023 Jan 1;34(1):33-47.
Boutros C, Tarabaih M, El-Zaart A, et al. The impact of systemic therapy on survival of patients with isolated locoregional recurrence of breast cancer: A systematic review and meta-analysis. Breast. 2018;37:156-165.
Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Hart L, Campone M, Petrakova K, Winer EP, Janni W, Conte P. Overall survival with ribociclib plus letrozole in advanced breast cancer. New England Journal of Medicine. 2022 Mar 10;386(10):942-50.
Jerusalem G, Park YH, Yamashita T, Hurvitz SA, Modi S, Andre F, Krop IE, Gonzàlez Farré X, You B, Saura C, Kim SB. Trastuzumab deruxtecan in HER2-positive metastatic breast cancer patients with brain metastases: a DESTINY-Breast01 subgroup analysis. Cancer discovery. 2022 Dec 2;12(12):2754-62.
Bardia A, Hurvitz SA, Tolaney SM, Loirat D, Punie K, Oliveira M, Brufsky A, Sardesai SD, Kalinsky K, Zelnak AB, Weaver R. Sacituzumab govitecan in metastatic triple-negative breast cancer. New England journal of medicine. 2021 Apr 22;384(16):1529-41.
Palma DA, Olson R, Harrow S, Gaede S, Louie AV, Haasbeek C, Mulroy L, Lock M, Rodrigues GB, Yaremko BP, Schellenberg D. Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial. The Lancet. 2019 May 18;393(10185):2051-8.
Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Annals of Oncology. 2017 Aug 1;28(8):1700-12.
Cortes J, Cescon DW, Rugo HS, Nowecki Z, Im SA, Yusof MM, Gallardo C, Lipatov O, Barrios CH, Holgado E, Iwata H. Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial. The Lancet. 2020 Dec 5;396(10265):1817-28.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Benghazi University Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright©2024University of Benghazi.
This open Access article is Distributed under a CC BY-NC-ND 4.0 license
Copyright
