Supportive care strategies in breast cancer

By Agata Buczak

​​Risk‑based supportive care strategies are shaping prevention, fertility preservation, and survivorship management across the breast cancer continuum​

Risk‑based supportive care strategies are increasingly informing prevention, fertility preservation, and survivorship management across the breast cancer continuum. In collaboration with the Bulgarian Joint Cancer Network (BJCN), insights from the San Antonio Breast Cancer Symposium (SABCS) 2025, presented at the licensed Best of SABCS^® 2025 meeting in Bulgaria, highlight how individualized approaches to symptom management, screening, and survivorship care aim to improve quality of life without compromising long‑term oncologic outcomes, particularly in younger patients, genetic risk carriers, and long‑term survivors.

How should hormone replacement therapy be considered in healthy BRCA1/2 variant carriers?

In healthy people carrying pathogenic germline BRCA1/2 variants who experience menopausal symptoms due to natural menopause or risk‑reducing pelvic surgery, hormonal symptom control remains a clinical concern.¹

Joanne Kotsopoulos et al. reported that oral hormone replacement therapy using estrogen alone or combined estrogen–progesterone preparations was not associated with a worsening of the cumulative incidence of invasive breast cancer.¹

How can genetic testing support risk‑based breast cancer screening in women without a personal cancer history?

In women from the general population without a personal history of breast cancer, genetic testing may contribute to more personalized screening strategies.²

In the WISDOM study, Kirkpatrick Fergus et al. showed that incorporating genetic testing into risk‑based screening frameworks enables more accurate risk stratification compared with age‑based approaches alone.²

What fertility preservation strategies should be considered in premenopausal women receiving (neo)adjuvant breast cancer treatment?

In the PREFER trial, Matteo Lambertini et al. showed that premenopausal women aged 18–45 years with stage 1–3 breast cancer were highly receptive to fertility preservation counseling when referred early to an oncofertility specialist.³ The use of gonadotropin‑releasing hormone (GnRH) analogs, with or without cryopreservation, improved ovarian function recovery and reproductive outcomes without adversely affecting progression‑free or overall survival.³

How can patient‑reported outcome monitoring support young breast cancer survivors after treatment?

In young women aged 15–39 years with stage 0–3 breast cancer who were within 3 years of completing active treatment and had no evidence of recurrence, symptom burden remains substantial.⁴

In the YES trial, Ann Partridge et al. showed that regular monitoring using validated, age‑specific patient‑reported outcome tools reduced overall disease burden, improved quality of life, and decreased the need for in‑person follow‑up visits, despite no significant changes in levels of depression, anxiety, or fatigue.⁴

Can nonpharmacologic interventions address cognitive impairment and sleep disturbance after breast cancer treatment?

In the ENHANCE trial, Jun J. Mao et al. reported that acupuncture led to significant objective improvements in cognitive impairment in patients treated for non‑metastatic breast cancer, supporting its consideration as part of multimodal survivorship care.⁵

Key takeaways

• Hormone replacement therapy may be considered for menopausal symptom control in healthy people with BRCA1/2 variants, with no observed increase in invasive breast cancer incidence
• Genetic testing supports individualized, risk‑based screening strategies in women without a personal breast cancer history
• Early oncofertility referral enables fertility preservation without compromising oncologic outcomes in premenopausal patients
• Patient‑reported outcome monitoring can reduce disease burden and follow‑up intensity in young breast cancer survivors
• Acupuncture shows objective benefit for cognitive impairment in survivors of non‑metastatic breast cancer

Read more about consensus and new recommendations from Best of 2025 SABCS^® Bulgaria.

References

1. Kotsopoulos, 2026. Menopausal hormone therapy and the risk of breast cancer in women with a pathogenic variant in BRCA1 or BRCA2. https://www.doi.org/10.1093/jnci/djaf363
2. Fiscalini, 2025. WISDOM randomized trial comparing risk-based versus annual breast cancer screening: Study cohort characteristics and design. https://www.doi.org/10.21203/rs.3.rs-7665355/v2
3. Blondeaux, 2021. The PREgnancy and FERtility (PREFER) study investigating the need for ovarian function and/or fertility preservation strategies in premenopausal women with early breast cancer. https://www.doi.org/10.3389/fonc.2021.690320
4. Dibble, 2025. Young, empowered & strong (YES): A study protocol paper for a randomized controlled trial of an mHealth symptom monitoring and self-management intervention for adolescent and young adult (AYA) breast cancer survivors. https://www.doi.org/10.1186/s12889-025-21288-4
5. Mao, 2026. Abstract GS3-04: Effects of acupuncture vs sham acupuncture and usual care on cancer-related cognitive difficulties among breast cancer survivors: The ENHANCE randomized clinical trial. https://www.doi.org/10.1158/1557-3265.Sabcs25-gs3-04

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