Over the last decade, treatment approaches for patients with early-stage breast cancer have become increasingly nuanced. While clinical parameters such as tumour size, grade, lymph node status, and pathological factors such as hormone receptor expression continue to guide treatment decisions, they do not always reflect the true nature of the tumour’s underlying biology.
A key challenge for clinicians managing early-stage hormone receptor-positive breast cancer is that two patients may have identical clinical and pathological features, yet require entirely different treatment approaches. As a result, clinicians are often faced with a dilemma: which patients are likely to benefit from chemotherapy, and which can safely avoid it?
Conventional pathology remains the cornerstone of breast cancer diagnosis. It provides critical information about the tumour type, grade, receptor status and stage, forming the foundation of treatment planning. However, these findings alone may not fully explain how a tumour is likely to behave. Prognostic testing has emerged as an important tool to address the dilemma that clinicians face. It complements conventional pathology by providing additional insights into tumour biology and risk of recurrence. A prognostic test looks at the underlying biology of the tumour by using validated biomarkers along with a combination of clinical parameters to predict the likelihood of recurrence. They help determine how aggressively a particular tumour is likely to behave and whether adding chemotherapy would provide the patient any meaningful benefit. This information allows clinicians to personalize treatment decisions and reduce unnecessary chemotherapy without compromising on the outcomes and quality of life of the patients.
Context of the problem – Magnitude and Burden
Breast cancer is the most common cancer among women in India and continues to pose a significant health challenge. It accounts for 28.8% of all cancers diagnosed in Indian women, with an estimated 216,108 cases reported in 2022. The incidence of breast cancer continues to rise, underscoring the need for effective strategies across the continuum of care.
Encouragingly, increased awareness and implementation of screening and early detection initiatives have led to a greater proportion of cancers being diagnosed at an early stage, contributing to a 15% reduction in overall breast cancer mortality. Beyond early diagnosis, the availability of targeted treatment, advances in precision oncology – including biomarker-based prognostic testing with personalised use of chemotherapy have transformed breast cancer management. These advances enable clinicians to personalise treatment, improving both survival outcomes and quality of life while minimising treatment-related toxicity in breast cancer patients.
From a one-size-fits-all approach to personalised treatment
Breast cancer treatment has evolved significantly over the past decade. Today personalised medicine is no longer just a buzzword – it is a reality that is helping patients receive treatment tailored to the biology of their cancer rather than relying solely on traditional clinicopathological features or free online tools. For oncologists managing early-stage hormone receptor-positive breast cancer, prognostic tests can help you make the right decision by removing uncertainty. There are a number of international prognostics tests as well as Indian tests that are currently in use. Choosing a test developed using samples from Indian breast cancer patients and clinically validated in Indian patient cohorts provides evidence that is more relevant to the patients being treated here, enabling more confident treatment decisions.
In many Western countries, multigene prognostic testing has become an integral part of decision-making and is incorporated into treatment guidelines. In India, however, awareness of prognostic testing remains limited, with the high cost of Western assays having restricted their widespread adoption. As a result, many patients continue to receive chemotherapy based solely on conventional clinicopathological factors, without even knowing that additional testing may help refine their treatment plan. As personalised care becomes increasingly important, the adoption of prognostic tests is an important step towards precision oncology in India.
Why this matters
Although the two cancers look almost identical under the microscope and are classified at the same clinical stage, their underlying biology can be different. That biological difference translates into fundamentally different treatment recommendations.
The goal of modern breast cancer care is simply not to treat every patient aggressively – it is to treat each patient appropriately. Empowering patients and clinicians with access to evidence-based prognostic testing enables more personalised treatment decisions, helping avoid unnecessary chemotherapy while ensuring that those who are most likely to benefit receive it. Because informed choices lead to better care.