Olubukola Ayodele, Breast Cancer Lead at University Hospitals of Leicester NHS Trust, shared a post on LinkedIn:
“Breast cancer continues to remind me why oncology is fascinating.
We often describe breast cancer as a single disease, but in reality, it is anything but. It is heterogeneous, made up of multiple subtypes that can coexist within the same patient. Yet, in clinical practice, our treatments are usually directed at the dominant subtype identified at diagnosis.
And often, that works. We see good responses. Disease control. Even remission. But cancer is not static, it is constantly evolving over time.
When disease recurs or becomes active again, it may not be driven by the same biology we initially treated. The dominant clone we targeted may have been effectively suppressed or eradicated, allowing another subtype, previously less prominent, to emerge and take the lead.
This is why reassessing receptor status at recurrence is not just good practice, it is essential.
A repeat biopsy can fundamentally change management. Hormone receptor status, HER2 expression, even emerging molecular features can shift. And with that shift comes an opportunity to refine treatment, sometimes in a completely different direction.
It is a reminder that cancer care is not a one-time decision, but an ongoing process of listening to the biology of the disease as it evolves.
For clinicians, it reinforces the importance of staying curious and not making assumptions based on historical data alone. I have seen management plans completely transformed by a repeat biopsy.
Same patient. Same diagnosis. Different biology. Different strategy.
So when a patient asks, ‘Do we really need to do this test again?’
My answer is simple:
We are not treating the cancer you had then. We are treating the cancer you have now.
Breast cancer will keep teaching us this lesson, if we are willing to listen. Stay curious. And never assume the biology hasn’t changed.
- If you’re a clinician, how often has a repeat receptor test changed your management?
- If you’re a patient or advocate, did you know breast cancer can change subtype over time?”
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