Precision medicine needs integrated multidisciplinary efforts for prevention and management of breast cancer

Precision Medicine (Pr-M) is a multifaceted approach to medical treatment which considers individual characteristics of each patient, including their genetic profiles and environmental and lifestyle factors. The genetic profile with variable mutations affects hereditary risks for a particular cancer as well as the patient outcome. For instance, mutations in genes like BRCA1 and BRCA2 would affect the initial age of screening for females in that particular family tree, and a mutation in TP53 would determine the associated risk of other malignancies in the patient.^[1,2] This information has been utilized to decide upon the need for a specific imaging modality for screening purposes.

Advances in cellular and molecular analysis have enabled early detection and the development of personalized treatment plans along with targeted therapeutics. In the realm of immunotherapy, immune checkpoint inhibitors like pembrolizumab have gained approval for the treatment of metastatic breast cancer.^[3] Precision radiotherapy represents another innovation, utilizing advanced imaging techniques to accurately target cancerous tissues. This minimizes damage to surrounding healthy tissue and reduces side effects, improving both patient survival and quality of life.

Pr-M holds immense potential with several emerging areas like spatial genomics, single-cell sequencing, and multi-omics approaches. Liquid biopsy represents a transformative non-invasive method to monitor cancer progression and critical insights into tumor genetics by analyzing circulating tumor DNA (ctDNA) and other biomarkers in blood samples. It also offers a more sensitive method to detect early recurrence and improve post-treatment surveillance. The Pr-M paradigm is evolving to move beyond detection alone; it increasingly focuses on providing prognostic and predictive insights. One promising development in this area is radiogenomics, which correlates imaging features with underlying genetic profiles to reveal patterns that can help anticipate disease progression and therapeutic response. However, interpreting these complex patterns requires continuous collaboration between pathologists, molecular biologists, radiologists, and data scientists.

Despite these advancements, the complete potential of Pr-M cannot be achieved without addressing the key challenges. Socio-economic disparities remain one of the foremost hurdles. Other than this, healthcare infrastructure, lack of access to clinical trial availability for personalized treatment, and a lack of standardization in the molecular testing and treatment approaches continue to hinder widespread implementation. These gaps may be addressed by collective efforts from all the stakeholders, like public-private partnerships, government-led national programs, and academic-industry collaborations. Pr-M holds the capacity to transform the treatment landscape of breast cancer, particularly for triple-negative breast cancer and metastatic breast cancer. The ultimate goal is to shift the approach of cancer care from reactive to proactive and from generalized to individualized treatment. The French and Danish genomic medicine programs show how national planning, funding, and teamwork across specialties can help make advanced medical care available to more people.^[4]

Advanced innovations like CRISPR-based gene editing, predictive modeling using AI, and radiogenomics could bridge the gap of tumor heterogeneity.^[5] The continuation of research and advancements in immunotherapy, targeted therapies, data analytics, and new technologies for molecular testing is essential to harness the full potential of Pr-M. It can become the cornerstone of this new era of personalized treatments using epigenetics, personalized drug treatments, radio-genomics, liquid biopsies, and various other emerging areas. An integrated approach to enhance patient awareness, exchange of vital information, and coordinated efforts among researchers, regulatory bodies, clinicians, and healthcare providers will ultimately improve the overall quality of treatment for patients with breast cancer.

Ekta Dhamija

Editor-in-Chief, IJBI