For anyone who has sat across from a doctor and heard the words “you will need chemotherapy,” the impact is immediate. The treatment that follows surgery can bring severe side effects, including hair loss, nausea, fatigue, fertility issues and, in some cases, longer-term cognitive effects. While it remains lifesaving for many, chemotherapy can be physically and emotionally taxing.
Now, new research is helping refine who needs it. Scientists have developed a genomic test that can help identify which breast cancer patients are unlikely to benefit from chemotherapy and may safely avoid it. The findings come from the OPTIMA trial, led by researchers including University College London, which followed more than 4,000 women with early breast cancer across several countries, including the UK, Sweden, Norway, Australia, New Zealand and Thailand.
The trial used a test called Prosigna, which analyses the activity of 50 genes in tumour tissue to estimate the risk of cancer recurrence. Patients classified as low risk were treated with hormone therapy alone, without chemotherapy. After five years of follow-up, survival outcomes were broadly similar between groups: around 93-94% of low-risk patients who skipped chemotherapy remained alive and disease-free, compared with a very similar rate among those who received chemotherapy.
Researchers concluded that, for a substantial group of patients with low-risk disease, chemotherapy offered little additional benefit in terms of survival outcomes, while still exposing them to its side effects. The findings have been described by investigators as “practice-changing,” reflecting a broader shift towards personalised cancer treatment based on tumour biology rather than a one-size-fits-all approach.
The implications are particularly significant in countries like Bangladesh. According to national cancer data, breast cancer is among the most common cancers affecting women and contributes to a large proportion of cancer-related deaths. Access to advanced diagnostic tools remains limited, meaning many patients still receive chemotherapy without detailed risk stratification.
A test like Prosigna could, in principle, help reduce overtreatment by identifying patients who are unlikely to benefit from chemotherapy and could be managed with less intensive therapy.
The results were presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, one of the world’s leading cancer conferences, underscoring the level of global interest in the findings.
However, researchers stress that this approach is not yet universal. Evidence is strongest for certain groups of early breast cancer patients, and further studies are ongoing, particularly in younger patients and men.
The direction of travel, however, is clear: cancer treatment is becoming increasingly personalised. For patients, that could mean fewer unnecessary side effects without compromising outcomes. For doctors, it represents a shift towards more precise, biology-driven decision-making. For many, it offers something that has long been in short supply in cancer care: greater certainty.
