Approaches to eBC Diagnosis and Risk Stratification

Author(s):

Kevin Kalinsky, MD, MS,Virginia Kaklamani, MD

Panelists discuss how the NCCN guidelines for risk stratification in HR+/HER2– early-stage breast cancer (eBC) guide clinical decision-making, exploring real-world adherence to these guidelines, the complexity of risk stratification in various clinical scenarios, and the role of clinical factors, biomarkers, and advanced testing methodologies (including RSClin N+, next-generation sequencing [NGS], fluorescence in situ hybridization [FISH], immunohistochemistry [IHC], and circulating DNA [ctDNA]) in defining “high-risk” patients and guiding treatment strategies.

EP: 1.Introduction and HR+/HER2– eBC Overview

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EP: 2.Approaches to eBC Diagnosis and Risk Stratification

Video content above is prompted by the following:

What are the key NCCN guidelines for risk-stratifying patients with HR+/HER2–eBC?
- How closely does overall real-world practice follow these guidelines?
- What clinical scenarios make risk stratification complex?
Can you please describe your approach to diagnosing and stratifying HR+/HER2– breast cancer at an early stage?
- How do you define “high-risk” in this setting?
- How do clinical factors play a role in risk stratification?
- When and how do you evaluate nodal involvement in patients with breast cancer?
- What biomarkers do you typically test for in eBC? (HR, PR, HER2, others?)
- What testing methodologies are most used?
  - How do they differ, and what can you learn from each? (NGS, FISH, IHC, panels, etc)
  - Do you ever check ctDNA?
- How do various testing results guide your treatment approach?