2025 São Paulo Breast Symposium Guidelines: luminal breast cancer and axillary surgery
DOI:
https://doi.org/10.29289/259453942025030%20Palavras-chave:
breast neoplasms, luminal breast cancer, estrogen receptors, endocrine therapy, axillary surgery, neoadjuvant therapyResumo
Introduction: This study aims to disseminate evidence-based expert consensus statements derived from the 2025 International Symposium on Breast Diseases of Inland São Paulo (SIMIP), addressing four critical areas in breast cancer management: (1) initial treatment strategies for luminal breast cancer with imaging-positive (iN1) and clinically positive axilla (cN1); (2) therapeutic approaches for estrogen receptor–low (ER-low) breast cancer; (3) optimal duration of adjuvant endocrine therapy (ET) in luminal tumors; and (4) criteria for omitting axillary surgery in early breast cancer. Methods: The 2025 São Paulo Breast Diseases Symposium was a two-day event held in São Paulo, Brazil, involving 110 panelists, including 99 mastologists (90%) and 11 professionals from related fields (pathology, breast imaging, radiotherapy, and clinical oncology). Panelists were selected based on recognized expertise, defined by at least 10 years of clinical experience or significant academic contribution. Four priority thematic axes were identified through a pre-symposium survey of Brazilian and South American specialists. Each topic was introduced by a 10-minute evidence-based lecture followed by a 50-minute technical debate. Anonymous electronic voting was conducted via a secure online platform during hybrid sessions, with consensus defined as agreement by ≥75% of participants. Results: For patients with imaging-positive axilla (iN1), 52% of panelists preferred upfront surgery, without reaching consensus. In clinically positive axilla (cN1), treatment choice between upfront surgery and neoadjuvant chemotherapy varied according to age and menopausal status, supported by 57% of voters, also without consensus. A consensus of 84% was achieved to manage ER-low breast cancer similarly to triple-negative disease, using chemotherapy combined with endocrine therapy. Regarding endocrine therapy duration, consensus was reached for 7–10 years in high-risk Luminal B tumors (97%) and for 5 years in low-risk Luminal A tumors (95%). Omission of axillary surgery was supported by 85% of panelists in patients with tumors ≤2 cm, clinically node-negative disease (cT1N0), hormone receptor-positive/HER2-negative tumors, and negative axillary ultrasound findings. Conclusions: These expert consensus statements support personalized, multidisciplinary strategies to optimize oncologic outcomes while minimizing morbidity. Consensus favors extended endocrine therapy for high-risk luminal disease, shorter therapy for low-risk tumors, combined chemotherapy and endocrine therapy for ER-low disease, and omission of axillary surgery in carefully selected early breast cancer cases. Management of iN1 and cN1 disease should remain individualized based on clinical and biological factors, particularly in Brazil, where late-stage presentation remains frequent.
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Copyright (c) 2026 Eduardo Carvalho Pessoa, Fabio Bagnoli, Marcelo Madeira, Joaquim Teodoro Araujo Neto, Giuliano Mendes Tosello, Fabricio Brenelli, Beatriz Baaklini Geronymo, Daniel de Araujo Buttros, Felipe Zerwes, Marcelo Antonini, Daniel Luiz Gimenes, Silvio Eduardo Bromberg, Augusto Tufi Hassan
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
