Clinical Guidelines from the 2025 International Symposium on Breast Diseases of Inland São Paulo: management of breast cancer in special situations
DOI:
https://doi.org/10.29289/2594539420250027%20Keywords:
breast cancer, inflammatory carcinoma, sentinel lymph node biopsy, axillary lymph node dissection, luminal tumors, vaginal estrogen therapy, neoadjuvant chemotherapyAbstract
Introduction: The 2025 International Symposium on Breast Diseases of Inland São Paulo addressed clinically relevant controversies in the management of breast cancer in special situations, including inflammatory carcinoma, axillary micrometastases after neoadjuvant chemotherapy, early luminal tumors in elderly women, and the use of vaginal estrogen therapy after breast cancer treatment. Methods: Four priority topics were presented in evidence-based lectures, followed by expert panel discussions and anonymous electronic voting. Consensus was predefined as agreement of at least 75% among panelists. Results: No consensus was reached regarding the use of sentinel lymph node biopsy in inflammatory carcinoma, although 73% of panelists voted against its performance. Likewise, no consensus was achieved on omitting axillary lymph node dissection in patients with axillary micrometastases after neoadjuvant chemotherapy, despite 61% considering this approach feasible. In elderly women with early luminal tumors, the most frequently selected option was to maintain standard treatment (29%), with no consensus supporting treatment de-escalation. In contrast, consensus was reached regarding the safety of vaginal estrogen therapy after breast cancer treatment, with 88% of panelists supporting its use in appropriately selected patients. Conclusions: These guidelines summarize expert-based recommendations for the management of breast cancer in challenging clinical scenarios and reinforce the importance of individualized, multidisciplinary decision-making. Sentinel lymph node biopsy was generally not supported in inflammatory carcinoma, and vaginal estrogen therapy was considered safe in selected breast cancer survivors. Greater caution remains warranted regarding treatment de-escalation in elderly women with early luminal tumors and omission of axillary lymph node dissection in the setting of residual micrometastatic nodal disease after neoadjuvant chemotherapy.
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Copyright (c) 2026 Eduardo Carvalho Pessoa, Fabio Bagnoli, Marcelo Madeira, Joaquim Teodoro Araujo Neto, Giuliano Tosello, Fabricio Brenelli, Beatriz Baaklini Geronymo, Daniel de Araujo Buttros, Lincon Jo Mori, Francisco Pimentel Cavalcante, Carlos Henrique dos Anjos, Fabiana Baroni Alves Makdissi, Augusto Tufi Hassan
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