Tailoring treatment to cancer risk and patient preference: the 2025 St Gallen International Breast Cancer Consensus Statement on individualizing therapy for patients with early breast cancer.

BACKGROUND

Breast cancer is a global disease affecting millions of individuals. Ongoing advancements in multidisciplinary management of breast cancer patients warrant discussion and integration into standard treatment plans.

DESIGN

The St Gallen Breast Cancer Consensus conference is an international, biennial meeting where experts make treatment recommendations for state-of-the-art care of early stage breast cancer.

RESULTS

Important innovations in the 2025 St Gallen recommendations include updated guidance on genetic testing; endorsement of hypofractionated, and ultra-hypofractionated, radiation therapy schedules for larger numbers of patients; recommendation for platinum-based chemotherapy in triple-negative breast cancer, and use of biological risk markers to consider anthracyclines in other breast cancer subtypes; avoidance of sentinel lymph node surgery in many patients with low-risk, estrogen receptor (ER)-positive cancers; use of immunotherapy in triple-negative and certain ER low-positive tumors; guidance for re-irradiation and systemic therapy in the setting of local-regional recurrence; criteria to guide treatment of oligometastatic breast cancer; and important recommendations for improving survivorship by minimizing neuropathy symptoms and addressing sexual health concerns of breast cancer patients.

CONCLUSIONS

International, multidisciplinary guidance for early breast cancer is evolving and offers patients better outcomes, improved treatment choices, and greater concern for patient preferences and survivorship needs.