Early breast cancer is the most frequently diagnosed cancer among women worldwide. Different subtypes have been identified, and with them, new treatment strategies have emerged. In order to elaborate a personalised treatment, clinicians need reliable pathological and molecular disease subtyping, refined assessments of the risk of relapse, and predictive markers to estimate treatment benefit. Combining these elements allows for de-escalation in some patients and, on the contrary, identifies those who should receive more intensive therapy and serve as candidates for escalation strategies in standard practice or clinical trials. This article reviews the de-escalation and escalation strategies currently available and will explore future treatment perspectives in early breast cancer.

(BELG J MED ONCOL 2022;16(3):102–13)