Clinical Report: ctDNA Test Guides Breast Care in Elderly

Overview

A prospective study suggests that ctDNA testing can help identify older women with estrogen receptor-positive breast cancer who may avoid surgery and rely solely on endocrine therapy. The findings indicate that ctDNA status correlates with imaging results and can serve as a predictive tool for tumor progression.

Background

Breast cancer is the most commonly diagnosed cancer among women in the U.S., making effective management crucial, especially in older populations. Current guidelines often favor surgery, but many elderly patients may benefit from less invasive approaches. The integration of ctDNA testing could refine treatment decisions and enhance patient outcomes in this demographic.

Data Highlights

No numerical data available in the source material.

Key Findings

• ctDNA status closely tracked with imaging results in elderly patients.
• Persistent ctDNA after 6 months of therapy was linked to tumor progression.
• No patients with negative ctDNA at baseline experienced disease progression.
• Pretreatment ctDNA positivity was associated with increased progression risk, independent of clinical factors.
• ctDNA testing allows for decentralized monitoring through routine blood draws.
• Exploratory analyses revealed immune-related features in ctDNA-positive tumors.

Clinical Implications

The findings support the potential of ctDNA testing as a minimally invasive biomarker that can inform treatment strategies for older women with breast cancer. Clinicians may consider ctDNA status when deciding on the necessity of surgical interventions versus endocrine therapy alone.

Conclusion

This study underscores the promise of ctDNA testing in personalizing breast cancer management for elderly patients. Further validation in larger trials is needed to establish its role in clinical practice.

References

1. The ASCO Post, 2026 -- ctDNA Positivity After Neoadjuvant T-DM1 May Predict HER2-Positive Breast Cancer Recurrence
2. Conexiant, 2026 -- ACP Updates Breast Cancer Screening Guidance
3. The ASCO Post — ctDNA Positivity After Neoadjuvant T-DM1 May Predict HER2-Positive Breast Cancer Recurrence
4. the asco post — Breast Cancer: Ultrasensitive ctDNA Assay Findings and Outcomes After Neoadjuvant Therapy
5. EUSOMA and SIOG Older Patient Management Guidelines
6. Longitudinal ctDNA Surveillance for Older Women With ER+ Breast Cancer Who Omit Surgery
7. Revisiting primary endocrine therapy versus surgery in older women with breast cancer: meta-analysis | BJS | Oxford Academic