Physician treatment decisions for hormone receptor-positive, HER2-negative early breast cancer in young patients: a Latin American survey

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Background: The management of hormone receptor-positive (HR+), HER2-negative early breast cancer in young women presents unique challenges due to the absence of standardized guidelines and variability in clinical decision-making. In Latin America, these challenges are compounded by disparities in healthcare systems and limited access to genomic testing and supportive services. Objectives: To evaluate current attitudes, diagnostic strategies, and treatment practices among Latin American oncologists regarding the care of young women with HR+ early breast cancer. Design: A cross-sectional survey study targeting practicing oncologists across Latin America. Methods: A 30-item online questionnaire was distributed to 329 oncologists from 17 Latin American countries. The survey explored physician demographics, access to diagnostic tools, treatment preferences, and availability of support services, including genetic counseling and fertility preservation. Results: The findings revealed significant heterogeneity in clinical practices. Among patients with a Recurrence Score (RS) of 20–25, 53.8% of oncologists recommended adjuvant chemotherapy, while 23.4% considered additional clinicopathologic features. Fertility preservation counseling was inconsistently offered: 29.5% provided it routinely, whereas 12.5% never did. Ovarian function suppression (OFS) was universally recommended by 46.2% of respondents, with breast cancer specialists showing more nuanced use than non-specialists ( p = 0.019). Access to genetic counseling was limited, with 12.5% reporting no access. Temporary interruption of endocrine therapy to pursue pregnancy was supported by 41.0% of respondents, though approaches varied. Female oncologists were more likely to recommend extended endocrine therapy (73.2% vs 60.8%, p = 0.019) and to refer patients for sexual health support (19.3% vs 8.7%, p = 0.05). Conclusion: This study highlights considerable variability in the management of young women with HR+ early breast cancer across Latin America. Physician gender, specialty, and resource availability significantly influence treatment decisions. These findings underscore the urgent need for regionally tailored clinical guidelines and improved access to diagnostic and supportive care resources to ensure equitable and evidence-based care.

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