Microbiome dynamics in breast cancer: Mechanisms, therapeutic impacts and research gaps

Breast cancer remains a leading cause of global mortality in women, while the microbiome emerges as a key modulator of carcinogenesis. Growing evidence highlights the gut and breast microbiomes' influence on breast cancer development, progression, and treatment response. This study examines microbiome-driven mechanisms in breast carcinogenesis and therapeutic outcomes, identifying critical research gaps. This narrative review systematically synthesized one hundred and two (102) peer-reviewed articles from PubMed, Scopus, and Web of Science using a structured search with specific keywords and inclusion criteria to explore the intricate relationship between the microbiome and breast cancer. This review reveals that microbiomes impact breast cancer risk through estrogen metabolism, DNA damage, and immune modulation. Systemic therapies, such as chemotherapy, alter microbial composition from Firmicutes-to-Bacteroidetes shifts, affecting efficacy and side effects. Specific bacterial species may predict treatment response, while dysbiosis links to inflammation and cognitive decline. However, research disparities exist, with limited studies in sub-Saharan Africa, particularly Nigeria, hindering global insights. The microbiome's multifaceted role through hormonal regulation, immune interactions, and therapy modulation, underscores its potential in personalized oncology. Future studies should prioritize longitudinal, geographically diverse cohorts to clarify microbiome-related disparities. Mechanistic research and microbiome-targeted interventions could enhance prevention, diagnosis, and treatment strategies, advancing precision medicine in breast cancer.