Advancements in Breast Cancer Treatment Prioritize Biology Over Surgery

Molecular interception, neoadjuvant therapies, and monitoring for minimal residual disease are transforming the standard of care.

Mar. 3, 2026 at 2:55am

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The landscape of breast cancer treatment is undergoing a dramatic shift, moving away from surgery-first approaches and towards biology-driven strategies that prioritize systemic treatments before surgery. This evolution is fueled by advancements in neoadjuvant therapies, minimal residual disease (MRD) monitoring, and a deeper understanding of the disease at a molecular level, enabling clinicians to tailor therapy to the individual patient's response.

Why it matters

These advancements in breast cancer treatment have the potential to reduce toxicity, enable surgical de-escalation, and ultimately improve outcomes for patients. However, access to these advanced testing and treatment options remains a significant challenge, particularly in underserved communities.

The details

Key drivers of this shift include the concept of 'molecular interception,' which allows for the detection of cancer DNA fragments (ctDNA) in the blood before traditional symptoms appear. This enables clinicians to move away from calendar-based treatment schedules and towards biological monitoring. Neoadjuvant treatments, such as chemotherapy, endocrine therapy, and advanced antibody-drug conjugates (ADCs) and checkpoint inhibitors, are becoming the standard of care, addressing microscopic disease that may have already spread. The success of neoadjuvant therapies has also led to the 'Watch and Wait' protocol, where surgery is delayed or avoided in patients who achieve a complete response to these treatments.

  • Breast cancer treatment has been undergoing a dramatic shift in recent years.
  • Advancements in neoadjuvant therapies, MRD monitoring, and molecular understanding of the disease have accelerated in the past decade.

The players

Patrick Borgen, MD

A physician at Maimonides Medical Center who specializes in the treatment of breast cancer.

Henry Kuerer, MD

A physician at MD Anderson Cancer Center who is advocating for proceeding directly to radiation therapy after a complete response on imaging, potentially eliminating the need for surgery.

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What they’re saying

“We must not let individuals continue to damage private property in San Francisco.”

— Robert Jenkins, San Francisco resident

“Fifty years is such an accomplishment in San Francisco, especially with the way the city has changed over the years.”

— Gordon Edgar, grocery employee

What’s next

Researchers are exploring the use of multiple core biopsies to assess for residual disease, but this is an invasive procedure. Trials are also underway to determine the optimal timing and application of MRD and ctDNA testing.

The takeaway

The shift in breast cancer treatment towards biology-driven strategies has the potential to reduce toxicity, enable surgical de-escalation, and ultimately improve outcomes for patients. However, access to these advanced testing and treatment options remains a significant challenge, particularly in underserved communities.