Living well with breast cancer, and the latest breakthroughs
From targeted therapies and artificial intelligence to the unique challenges faced by younger women, experts at ESMO Breast Cancer 2025 say treatments are improving, but care must go further.
MUNICH — Breast cancer treatment has made remarkable progress in recent years, especially for women with advanced disease. But experts speaking at a press briefing held during the ESMO Breast Cancer 2025 congress struck a careful balance: the breakthroughs are real, but so are the gaps.
The briefing, hosted by ESMO President Fabrice André, MD, PhD, and featuring a panel of internationally renowned specialists, covered everything from new treatments and digital tools to survivorship and the growing incidence of breast cancer in younger women.
‘We don’t like to use that word very often’
When Medical News Insider asked whether the focus for many women is now more on stabilising their disease rather than offering a definitive cure, the panel acknowledged that for some with metastatic breast cancer (ie, that has spread to other parts of the body), long-term disease control is not just possible, but increasingly likely.
“With some subtypes of breast cancer, particularly for HER2-positive subtype, the treatments,” which can be different for each subtype, “now are very effective,” said Sherene Loi, MD, PhD, of the Peter MacCallum Cancer Centre in Melbourne, Australia. “So these patients can, yes, indeed, live for a very, very long time with low disease burden and potentially be cured—though we don’t like to use that word very often.”
She added that more effective therapies are enabling oncologists to go “a bit harder” at the start of treatment, with the hope of achieving longer survival. “I think we’re at the stage where the treatments are getting very effective, and we may be able to see that for a significant proportion of patients with advanced breast cancer.”
Ann H. Partridge, MD, MPH, from Dana-Farber Cancer Institute in Boston, Massachusetts, agreed: “We’re seeing more and more really long-term survivors with metastatic disease where they have no evidence of disease,” she said. “And now we’re even studying: Can we stop the therapy and just watch them, particularly in the HER2 space?”
Life goes on, but with some risk
But not all women are in active treatment. Many with early-stage breast cancer are living with the so-called “long tail” seen in the risk of recurrence following treatment.
“Those are the patients who are living with risk,” Partridge said. “With triple-negative [breast cancer, the most difficult-to-treat subtype], you’ll hear from it again in the first five years. Whereas with hormone receptor–positive breast cancer [in which high levels of oestrogen in the tumour help the cancer cells grow and spread], it can go out as far as 30 years. I think my longest recurrence is 31 years…and that's a really long recurrence time.”
“What do you do in the meantime?” she asked. “Our job as clinicians is to help patients understand they live with risk and at the same time to move forward, live their lives and do everything reasonable to mitigate that risk.”
That includes not only medical treatment but also optimising lifestyle: “Diet, exercise, weight reduction…hopefully those are going to impact on the long-term risks of both the cancer and other causes of morbidity and mortality in survivors,” Partridge added.
A new vista for immunotherapy
For years, immunotherapy, which uses the immune system to find and attack cancer cells, has been reserved for triple-negative breast cancer, a particularly aggressive form of the disease. That may be about to change.
“We published very large results of a trial [CheckMate 7FL] which looked at immunotherapy in a small subset of patients with hormone receptor—so, oestrogen receptor-positive breast cancer,” said Dr Loi. “These patients derived significant benefit with the addition of immunotherapy to chemotherapy…This was a pleasant surprise.”
Traditionally, this type of breast cancer was not thought to respond to immunotherapy. But the results, she said, may reshape future treatment strategies: “I think we’ll potentially be treating these more like triple-negative [disease];” ie, that is, with a combination of chemotherapy and immunotherapy.
And those women who respond to immunotherapy, “we know…are generally younger than your average patient with estrogen receptor–positive breast cancer,” Loi added.
The rise of breast cancer in younger women
Both Loi and Partridge flagged an urgent concern, however: the growing number of younger women who are being diagnosed with breast cancer. “This is a serious public health issue,” said Partridge. “Rates…at a young age—40 or so and under—are increasing globally. Not just the absolute numbers, but the proportions.”
These younger women tend to develop more aggressive tumours, including triple-negative and HER2-positive types. “Even then, particularly in some types of breast cancer, our youngest patients, on average, do the worst,” she said.
And the impact goes beyond biology. “They’re diagnosed at a time in life where cancer is just so not normative [plus] clinicians often haven’t seen that many young-onset patients, and so they don’t know exactly how to treat them.”
Long-term challenges
Even after successful treatment, young survivors face long-term challenges—emotionally, socially, and physically. “Even though our young patients, on average, do worse, we’re still talking about five-plus-year survival rates of at least 90%,” said Partridge. “And yet they are left with the literal and figurative scars.”
These scars affect everything from fertility and family planning to work and identity. “There’s recent research suggesting it’s safe to preserve fertility and to have a pregnancy after breast cancer,” she said. “That has profound impacts for the woman, her family and even societally, because we need to grow our generations.”
Partridge described a digital support programme developed at Dana-Farber to help young survivors navigate life after treatment. “The patient endorses the symptoms she feels, and then she’s fed information and resources that respond to that,” she explained. “We’re hoping to bring AI into that, so it’s not just what we put in, but what the wider world has that could support her.”
Detecting relapse before it happens
Liquid biopsies—blood tests that detect cancer DNA—are already used in metastatic disease to help guide treatment choices once the first-choice therapy stops working. But what about detecting relapse early in women thought to be cancer-free?
“We know we can pick up that someone is going to recur on average a year to a year and a half before it happens, and in some patients, many years prior,” said Nicholas Turner, MD, PhD, from The Royal Marsden Hospital in London, UK. “This potentially presents a major opportunity to treat them, either to defer it, or we hope, perhaps in a few [people], to prevent relapse.”
But he cautioned: “We’ve really not seen the data to support that yet…At the moment, this is only in clinical trials—not outside clinical trials in standard of care.”
No funding declared. No relevant financial relationships declared.
Liam Andrew Davenport is a medical reporter with more than 20 years’ experience covering a wide range of specialties and topics in the field.