Early Molecular Intervention in HR Positive Breast Cancer: Rationale and ctDNA Integration

This segment outlines the biologic basis for early intervention when ESR1 mutations emerge and practical approaches to integrating ctDNA surveillance into routine care. Biologically, ESR1 alterations are a defined mechanism of acquired resistance to aromatase inhibitor therapy and signal evolving endocrine escape. The panel frames early intervention with a SERD such as camizestrant as a strategy to target that molecular driver before overt radiographic progression, with the goal of prolonging disease control and preserving quality of life. Clinically, speakers emphasize transparent shared decision making that explains molecular versus clinical progression, acknowledges remaining uncertainties about long term outcomes, and weighs potential QoL benefits. For operationalizing ctDNA every three months, practical recommendations include incorporating specialized blood draws into existing lab visits, selecting validated assays with acceptable turnaround, building nursing workflows for result tracking, and confirming payer coverage to avoid financial toxicity. Close communication with patients and documentation of rationale support appropriate adoption.