Clinical Guidelines from the 2025 International Symposium on Breast Diseases of Inland São Paulo: GLP-1 Inhibitors, Risk-Reducing Surgery in BRCA Carriers, Liquid Biopsy, and DCIS Treatment De-escalation
DOI:
https://doi.org/10.29289/2594539420250028Palavras-chave:
breast neoplasms, glucagon-like peptide 1, prophylactic surgical procedures, liquid biopsy, carcinoma, intraductal, noninfiltratingResumo
Introduction: The 2025 International Symposium on Breast Diseases of Inland São Paulo convened to establish consensus on emerging topics in oncology. This study aims to disseminate the clinical guidelines voted on regarding four aspects of breast cancer management: the impact of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) on risk reduction; risk-reducing surgery in breast cancer gene (BRCA) mutation carriers; use of liquid biopsy (circulating tumor DNA [ctDNA]) in metastatic cases; and management of low-grade ductal carcinoma in situ (DCIS). Methods: Four priority topics were presented in evidence-based lectures, followed by technical discussions and anonymous electronic voting by 100 panelists. Consensus was defined as an agreement of ≥75%. Results: No consensus was reached on GLP-1RAs for breast cancer risk reduction (50% in favor, 43% citing inconclusive evidence, 7% against). Risk-reducing surgery in BRCA mutation carriers achieved consensus (92% in favor) as beneficial for survival. Liquid biopsy was recommended for monitoring metastatic cases (74% in favor, just below the consensus threshold). Standard treatment for low-grade DCIS was preferred (84% in favor) over active surveillance (16%). Conclusions: The guidelines highlight the absence of conclusive evidence for GLP-1RAs in breast cancer prevention, the survival benefit of risk-reducing surgery in BRCA carriers, the utility of liquid biopsy in metastatic cases, and the preference for standard treatment in low-grade DCIS to prevent progression. Further studies are needed to address unresolved issues.
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Copyright (c) 2026 Eduardo Carvalho Pessoa, Fabio Bagnoli, Marcelo Madeira, Joaquim Teodoro Araujo Neto, Giuliano Tosello, Fabricio Brenelli Brenelli, Beatriz Baaklini Geronymo, Daniel de Araujo Buttros, Cesar Cabello, Ana Luisa de Castro Baccarin, Paulo Tenorio, Pedro Moraes, Augusto Tufi Hassan
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
