Utilization of ctDNA in the Surveillance of Breast Cancer

Molecular Recurrence Before Clinical Recurrence: The Management Gap Revealed by ctDNA Surveillance in High-Risk Breast Cancer Abstract Introduction: National surveillance guidelines continue to recommend only clinical exams and annual tomography for patients with stage I-III breast cancer. This study adds to the growing literature supporting ctDNA surveillance in high-risk breast cancer can identify molecular recurrent disease months prior to standard surveillance guidelines. Methods: During a 3-year period, the charts of high-risk breast cancer patients undergoing ctDNA as part of their surveillance screening were reviewed. Patients were followed according to standard guidelines and underwent serial ctDNA blood draws to detect recurrent disease. Results: 132 high risk breast cancer patients underwent ctDNA testing. 113 (85%) patients had a non-detectable ctDNA value and remained disease free in follow up. Two patients (01.7%) with negative ctDNA developed recurrent cancer. Nineteen (19/132 14%) patients had detectable ctDNA during their surveillance follow-up. Of the Nineteen patients with detectable ctDNA, Sixteen (84%) went on to have recurrence. CtDNA was positive 5.3 months prior to disease recurrence being detected. Positive and negative results were further analyzed showing an 88.89% sensitivity and 97.37% specificity for ctDNA detecting early. Conclusion: CtDNA offers a more aggressive, highly sensitive, and specific way to follow patients in the surveillance setting. All patients with elevated ctDNA were followed until biopsy proven disease was encountered, after which adjuvant therapy was initiated. More research is needed to see if ctDNA detected recurrence and treatment affects overall survival in high-risk breast cancer.