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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A woman previously treated for ER-positive, HER2-negative breast cancer develops biopsy-accessible liver metastases after a 6-year disease-free interval. Treatment would differ substantially if the recurrence had lost hormone receptors or acquired HER2 amplification. What is the NICE-aligned pathological step before selecting systemic therapy?

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Correct answer: E — Reassess hormone-receptor and HER2 status on recurrent tissue because discordance would change management

CG81 advises considering reassessment of hormone-receptor and HER2 status at recurrence when a change would alter management, exactly as in this case. The original phenotype cannot safely be assumed to remain unchanged. PD-L1 may be relevant in selected triple-negative disease but does not replace HR/HER2 reassessment; early-breast tumour profiling tests are not used to choose metastatic treatment, and tumour markers cannot define receptor phenotype.

Reference: NICE CG81 advanced breast cancer: diagnosis and assessment (Updated June 2026): https://www.nice.org.uk/guidance/cg81/chapter/Diagnosis-and-assessment