{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:52:21Z","timestamp":1784170341142,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"Introduction<\/jats:title>In the Asia-Pacific region, there is increasing contention on the practical challenges involved in managing human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (eBC). This modified Delphi consensus explores gaps in genetic counselling (GC) and genetic testing (GT), and clinical risk assessment for HER2<\/jats:italic>-negative eBC.<\/jats:p><\/jats:sec>Methods<\/jats:title>An expert panel of 16 Asia-Pacific medical oncologists, geneticists, and breast cancer surgeons arrived at 33 statements. The level of statement consensus was considered high at \u226575%. A survey of 134 healthcare practitioners (HCPs) (breast cancer surgeons, geneticists, oncologists, molecular biologists\/pathologists) explored the real-world practices in this region.<\/jats:p><\/jats:sec>Results<\/jats:title>A consensus was reached for 88% of the statements (29\/33) and aligned with international guidelines. Experts reached 100% consensus on offering pretest GC, obtaining consent before GT, considering first diagnosis of breast cancer (BC) as ideal time for GT, offering reflex testing for patients with likely\/pathogenic germline BRCA<\/jats:italic> variant, and considering patients with germline BRCA<\/jats:italic> mutant early triple-negative breast cancer (TNBC) patients who do not achieve pathological complete response after neoadjuvant treatment to be at high risk of recurrence. Over 90% of experts supported germline GT for BRCA<\/jats:italic> for TNBC patients irrespective of age at diagnosis or family history and prioritised tumour size and nodal status as prognostic factors for cancer recurrence. Experts reached 80%-90% consensus for using genetic risk assessment tools in low\/under-resourced healthcare systems and considering patients with likely\/pathogenic variants in BRCA<\/jats:italic> for risk reduction surgery. Significant gaps existed between real-world practices and recommendations, particularly in offering pretest GC to patients with suspected hereditary BC and to blood relatives of patients with BRCA<\/jats:italic> germline pathogenic variant BC, ideal time for GT, considering GT for early TNBC patients irrespective of age, offering post-test GC for positive results, utilising risk assessment tools, and streamlining GC through non-geneticist HCPs.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>GT and pretest GC should be mainstreamed at the first diagnosis of BC. Risk assessment for disease recurrence should be performed at diagnosis and post-surgery for HER2<\/jats:italic>-negative eBC patients. These recommendations would help standardise GC and improve GT access for clinical decisions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1507836","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:21:19Z","timestamp":1750656079000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Part I: consensus statements and expert recommendations for HER2-negative early breast cancer in the Asia-Pacific region: diagnosis and risk assessment"],"prefix":"10.3389","volume":"15","author":[{"given":"Soo Chin","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Hee","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian F.","family":"Singer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Balma\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca Alexandra","family":"Dent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique Kiak-Mien","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia Ayu","family":"Mulansari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mastura Md","family":"Yusof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances Victoria F.","family":"Que","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Shen","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Napa","family":"Parinyanitikul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cam Phuong","family":"Pham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Aishah","family":"Taib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun-Young","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoland","family":"Antill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Jeong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14174218","article-title":"Breast cancer in Asia: incidence, mortality, early detection, mammography programs, and risk-based screening initiatives","volume":"14","author":"Lim","year":"2022","journal-title":"Cancers"},{"key":"B2","unstructured":"Breast"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2147\/BCTT.S366530","article-title":"A scoping review on the status of female breast cancer in asia with a special focus on Nepal","volume":"14","author":"Dhakal","year":"2022","journal-title":"Breast Cancer Targets Ther"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djv107","article-title":"Female breast cancer incidence among asian and western populations: more similar than expected","volume":"107","author":"Sung","year":"2015","journal-title":"JNCI J Natl Cancer Inst"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2020.21.4.867","article-title":"A review of the epidemiology of breast cancer in asia: focus on risk factors","volume":"21","author":"Youn","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-7563.2009.01242.x","article-title":"Risk factors for breast cancer in East Asian women relative to women in the West","volume":"5","author":"Perry","year":"2009","journal-title":"Asia Pac J Clin Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.01.008","article-title":"Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with early breast cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS","volume":"31","author":"Park","year":"2020","journal-title":"Ann Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2021.22.10.3081","article-title":"Factors affecting delayed presentation and diagnosis of breast cancer in asian developing countries women: A systematic review","volume":"22","author":"Sobri","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2005936","article-title":"A population-based study of genes previously implicated in breast cancer","volume":"384","author":"Hu","year":"2021","journal-title":"N Engl J Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/03000605211070757","article-title":"BRCA1 \/ BRCA2 mutation spectrum analysis in South Asia: a systematic review","volume":"50","author":"Kharel","year":"2022","journal-title":"J Int Med Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1913948","article-title":"Breast cancer risk genes \u2014 Association analysis in more than 113,000 women","volume":"384","author":"Dorling","year":"2021","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1159\/000441714","article-title":"Current status of the management of hereditary breast and ovarian cancer in asia: first report by the asian BRCA consortium","volume":"19","author":"Nakamura","year":"2016","journal-title":"Public Health Genomics"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s11523-021-00796-4","article-title":"An overview of PARP inhibitors for the treatment of breast cancer","volume":"16","author":"Cortesi","year":"2021","journal-title":"Target Oncol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1200\/JGO.19.00381","article-title":"Genetic counseling, testing, and management of HBOC in India: an expert consensus document from Indian society of medical and pediatric oncology","volume":"6","author":"Malhotra","year":"2020","journal-title":"JCO Glob Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1579","article-title":"Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country","volume":"31","author":"Lee","year":"2022","journal-title":"J Genet Couns"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-018-04897-6","article-title":"Global disparities in breast cancer genetics testing, counselling and management","volume":"43","author":"Yip","year":"2019","journal-title":"World J Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/s41436-018-0090-9","article-title":"Ethical, social, and cultural issues related to clinical genetic testing and counseling in low- and middle-income countries: a systematic review","volume":"23","author":"Zhong","year":"2021","journal-title":"Genet Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07549-8","article-title":"Consensus guidelines on genetic` testing for hereditary breast cancer from the american society of breast surgeons","volume":"26","author":"Manahan","year":"2019","journal-title":"Ann Surg Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1742080","article-title":"Practical consensus recommendations for optimizing risk versus benefit of chemotherapy in patients with HR positive her2 negative early breast cancer in India","volume":"10","author":"Parikh","year":"2021","journal-title":"South Asian J Cancer"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"B22","unstructured":"Oxford Centre for Evidence-Based Medicine: Levels of Evidence\n \n \n \n 2009"},{"key":"B23","doi-asserted-by":"publisher","first-page":"47","DOI":"10.21037\/cco.2016.05.11","article-title":"Genetic testing for hereditary breast cancer in Asia\u2014moving forward","volume":"5","author":"Kwong","year":"2016","journal-title":"Chin Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1200\/JCO.23.02225","article-title":"Germline testing in patients with breast cancer: ASCO\u2013society of surgical oncology guideline","volume":"42","author":"Bedrosian","year":"2024","journal-title":"J Clin Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"77","DOI":"10.6004\/jnccn.2021.0001","article-title":"Genetic\/familial high-risk assessment: breast, ovarian, and pancreatic, version 2.2021, NCCN clinical practice guidelines in oncology","volume":"19","author":"Daly","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.03.284","article-title":"ESO\u2013ESMO 4th international consensus guidelines for breast cancer in young women (BCY4)","volume":"31","author":"Paluch-Shimon","year":"2020","journal-title":"Ann Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"10229","DOI":"10.1038\/s41598-019-46707-6","article-title":"Evaluating BRCA mutation risk predictive models in a Chinese cohort in Taiwan","volume":"9","author":"Hung","year":"2019","journal-title":"Sci Rep"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2105215","article-title":"Adjuvant olaparib for patients with BRCA1 - or BRCA2 -mutated breast cancer","volume":"384","author":"Tutt","year":"2021","journal-title":"N Engl J Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.09.159","article-title":"Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1\/2 and high-risk, early breast cancer","volume":"33","author":"Geyer","year":"2022","journal-title":"Ann Oncol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.ejca.2020.12.023","article-title":"Clinical practice guidelines for BRCA1 and BRCA2 genetic testing","volume":"146","author":"Pujol","year":"2021","journal-title":"Eur J Cancer"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1159\/000530584","article-title":"St. Gallen\/vienna 2023: optimization of treatment for patients with primary breast cancer - A brief summary of the consensus discussion","volume":"18","author":"Balic","year":"2023","journal-title":"Breast Care"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2016.00004","article-title":"Breast cancer genetic counseling: A surgeon\u2019s perspective","volume":"3","author":"Agnese","year":"2016","journal-title":"Front Surg"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ph14121270","article-title":"Expanding the use of PARP inhibitors as monotherapy and in combination in triple-negative breast cancer","volume":"14","author":"Yordanova","year":"2021","journal-title":"Pharmaceuticals"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4902","article-title":"The influence of Malay cultural beliefs on breast cancer screening and genetic testing: A focus group study","volume":"27","author":"Shaw","year":"2018","journal-title":"Psychooncology"},{"key":"B35","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1186\/s12885-024-12038-7","article-title":"Economic evaluation of germline genetic testing for breast cancer in low- and middle-income countries: a systematic review","volume":"24","author":"Goh","year":"2024","journal-title":"BMC Cancer"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.v29.6","article-title":"Use of telephone intake for family history taking at a cancer genetics service in Asia","volume":"29","author":"Chin","year":"2020","journal-title":"J Genet Couns"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1286","article-title":"Understanding patients' views and willingness toward the use of telehealth in a cancer genetics service in Asia","volume":"30","author":"Sim","year":"2021","journal-title":"J Genet Couns"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_238937","article-title":"Genetic counseling and testing in a community setting: quality, access, and efficiency","volume":"39","author":"Cohen","year":"2019","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.2217\/fon-2022-0310","article-title":"A real-world US study of recurrence risks using combined clinicopathological features in HR-positive, HER2-negative early breast cancer","volume":"18","author":"Sheffield","year":"2022","journal-title":"Future Oncol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14081898","article-title":"Definition of high-risk early hormone-positive HER2-negative breast cancer: A consensus review","volume":"14","author":"Garutti","year":"2022","journal-title":"Cancers"},{"key":"B41","unstructured":"Lynparza approved in Japan as adjuvant treatment for patients with BRCA-mutated HER2-negative high-risk early breast cancer\n \n \n \n 2022"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1507836\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T05:21:22Z","timestamp":1750656082000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1507836\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":41,"alternative-id":["10.3389\/fonc.2025.1507836"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1507836","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"article-number":"1507836"}}