Cancer types · Common solid tumours
Breast Cancer
Breast cancer is not one disease. It is described by its hormone-receptor (ER and PR) and HER2 status, together with grade and stage, and these features shape how the disease is understood and which questions are discussed.
Molecular questions become more prominent in advanced or recurrent disease, when receptor status may be reassessed and tumour or plasma profiling may be considered. Family history and age at diagnosis can also raise hereditary questions that matter to relatives.
Clinical and molecular questions that often arise
- What is the receptor subtype, and has it been reassessed if the disease has recurred or spread?
- For advanced disease, does a molecular report show alterations with evidence in this subtype, and how strong is that evidence?
- Do personal or family history and age at diagnosis suggest a hereditary assessment?
- Are there clinical trials linked to the subtype and molecular findings, and what would need verifying?
Information that may be part of an individual assessment
- Histopathology with tumour type and grade.
- ER, PR and HER2 testing, including how low levels of HER2 are reported by the testing laboratory.
- Imaging such as mammography, ultrasound, MRI and staging scans, as clinically appropriate.
- Gene-expression assays in selected early-stage settings.
- Germline (inherited) testing where indicated by guidelines and history.
Which investigations are appropriate is decided by the treating team for each person.
Molecular profiling and biomarker interpretation
Depending on the setting, molecular and biomarker questions in breast cancer may involve:
- ER and PR status
- HER2 status, including low-expression categories as defined by the assay
- PIK3CA, AKT1 and PTEN alterations in selected advanced settings
- ESR1 mutations, often assessed in plasma in advanced hormone-receptor-positive disease
- Germline BRCA1, BRCA2 and PALB2
- PD-L1 in selected triple-negative settings
Biomarkers, panels and available tests vary by subtype, disease setting, assay and guideline version. A detected alteration is not automatically actionable.
How KPCIRC pathways may apply
POAS
POAS may help where an existing tissue or liquid-biopsy report lists several alterations and the clinician wants each one read against breast-cancer subtype, disease setting and evidence strength, with trial and access questions organised separately.
Molecular Tumour Board
An MTB discussion may be useful when receptor status has changed, when reports conflict, or when molecular findings raise questions that benefit from oncology, pathology and genetics perspectives together.
Second opinion and progression review
A second opinion may be considered when the subtype, stage or proposed plan needs clarification. Progression review may help organise the timeline when new imaging, markers or symptoms raise questions about the current approach.
Hereditary risk and screening
Some breast cancers are associated with inherited variants in genes such as BRCA1, BRCA2 and PALB2. Cancer risk assessment and genetic counselling can help decide whether testing is appropriate and what a result could mean for relatives. Screening plans for relatives depend on age, history and the confirmed scope of the Cancer Screen pathway.
How to access the relevant pathway
Patients and families
- Talk to your treating oncologist about whether an additional review may help.
- Request a consultation and tell us which question you want answered.
- Share records only when asked, through the secure route.
Referring doctors
- Define the clinical question and the pathway: POAS, MTB, second opinion or progression review.
- Start a case enquiry without patient identifiers.
- Scope, fees and timing are confirmed before any review proceeds.
Questions and limitations
Should every person with breast cancer have genetic testing?
Testing decisions depend on age at diagnosis, subtype, personal and family history and current guidance. A risk assessment or genetic counselling discussion can help clarify whether testing is appropriate.
Does a PIK3CA or ESR1 finding mean a specific treatment will work?
No. A finding may be associated with evidence for a treatment in a particular setting, but suitability depends on the full clinical picture and the treating oncologist’s judgement.
Does this page apply to my situation?
This page is educational. It explains common questions but cannot account for individual circumstances. Your treating clinician is best placed to interpret your reports and plan your care.
Educational content reviewed against the KPCIRC service scope. It is not a diagnosis, a treatment recommendation or a statement that a specialist or service is available for this cancer type.