The functional and therapeutic potential of epitranscriptomics in breast cancer

Breast cancer (BCa) is one of the most commonly diagnosed malignancies worldwide and is clinically heterogenous. BCa is classified into distinct histopathological and molecular subtypes that inform diagnosis, treatment, and prognosis. Although therapeutic advances, particularly targeted therapies, have improved outcomes, metastatic BCa remains an unmet clinical need. In addition, treatment options remain limited especially for triple negative BCa (TNBC). There is an urgent need to develop novel approaches that can prevent, delay, or reverse disease progression in these patients. The roles of genetic and epigenetic alterations in BCa are well established. Emerging evidence highlights the dysregulation of epitranscriptomic mechanisms involving covalent RNA modifications as a contributing factor in BCa pathogenesis. Notably, recent evidence supports functional crosstalk between epigenetic and epitranscriptomic processes with potential clinical and therapeutic relevance. This review explores key epitranscriptomic RNA modifications, m⁶A, m⁶A_m, m⁵C, m⁷G, and m¹A in the context of BCa. The functional consequences of the epitranscriptomic regulators ("writers," "erasers", and "readers") are discussed alongside the accumulating evidence of their contribution to cancer development and progression. This review considers how RNA modifications and their regulators might serve as biomarkers or therapeutic targets and offers new directions for translational research and clinical intervention in BCa.