Tailoring treatment to cancer risk and patient preference: the 2025 St Gallen International Breast Cancer Consensus Statement on individualizing therapy for patients with early breast cancer

Background: Breast cancer is a global disease affecting millions of individuals. Ongoing advancements in multidisciplinary management of breast cancer patients warrant discussion and integration into standard treatment plans. Design: The St Gallen Breast Cancer Consensus conference is an international, biennial meeting where experts make treatment recommendations for state-of-the-art care of early stage breast cancer. Results: Important innovations in the 2025 St Gallen recommendations include updated guidance on genetic testing; endorsement of hypofractionated, and ultra-hypofractionated, radiation therapy schedules for larger numbers of patients; recommendation for platinum-based chemotherapy in triple-negative breast cancer, and use of biological risk markers to consider anthracyclines in other breast cancer subtypes; avoidance of sentinel lymph node surgery in many patients with low-risk, estrogen receptor (ER)-positive cancers; use of immunotherapy in triple-negative and certain ER low-positive tumors; guidance for re-irradiation and systemic therapy in the setting of local-regional recurrence; criteria to guide treatment of oligometastatic breast cancer; and important recommendations for improving survivorship by minimizing neuropathy symptoms and addressing sexual health concerns of breast cancer patients. Conclusions: International, multidisciplinary guidance for early breast cancer is evolving and offers patients better outcomes, improved treatment choices, and greater concern for patient preferences and survivorship needs.