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Oligometastatic Breast — SCE Medical Oncology MCQ

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HardBreast CancerOligometastatic BreastSCE Medical Oncology

A 58-year-old has de-novo ER-positive, HER2-negative breast cancer with one biopsy-proven bone metastasis. She is asymptomatic and fit. Which statement best reflects a UK MDT approach to this oligometastatic presentation?

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Correct answer: D — Prioritise effective systemic therapy and discuss selective local ablation at MDT

A fit patient with de-novo ER-positive metastatic breast cancer should start effective systemic therapy, with selective consolidative local treatment considered at a specialist MDT. Prioritise endocrine monotherapy and discuss deferred local ablation after progression: initial systemic therapy should reflect modern combination standards and local treatment can be discussed selectively. Prioritise breast surgery and discuss postoperative systemic therapy after recovery: up-front resection has not shown a routine survival advantage in de-novo stage-IV disease. Prioritise stereotactic bone radiotherapy and discuss endocrine therapy after ablation: local ablation should not displace prompt effective systemic treatment. Prioritise dual-site radical treatment and discuss surveillance after completion: oligometastatic presentation does not make cure sufficiently certain to omit systemic therapy.

Reference: NICE NG81 advanced breast cancer: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng81/chapter/Recommendations