ABSI 2025 Consensus Guidelines on the Management of Breast Cancer in Low- and Middle-Income Countries

The Association of Breast Surgeons of India (ABSI) periodically publishes national consensus statements to adapt evidence-based breast cancer management to Indian realities. This 2025 update aimed to develop pragmatic, scenario-based guidance and assess concordance between expert recommendations and current clinical practice.

An expert panel formulated 40 single-best-answer questions spanning screening, diagnosis, surgery, axillary management, reconstruction, systemic therapy, radiotherapy, genetics, survivorship, and delivery of care. Responses were collected from panel experts (n = 24) and delegates (n = 159) at the ABSI Annual Meeting 2025 (Kolkata) using identical Google Forms. Concordance was defined a priori: almost 100% (same top choice, ≥ 90% in both groups), small discordance (same top, ≤ 10% difference), medium discordance (same top, 10-30% difference), significant discordance (> 30% difference or different top choice). Option distributions were compared using chi-square tests.

Of 40 questions, 10 showed almost complete concordance, 12 small discordance, 17 medium discordance, and 1 significant discordance. Highest agreement included the following: empowering community health officers for early detection, preference for breast-conserving surgery when feasible, SLNB for node-negative early breast cancer, and mandatory fertility/psycho-sexual counselling for young patients. Divergences were noted in HER2 therapy duration in low-risk disease, radiotherapy in DCIS, reconstruction choices, and axillary management in Z0011-eligible macro-metastasis.

Indian experts and practising surgeons show strong alignment on core surgical principles and supportive care priorities. Targeted guidance is needed for areas of practice variation to ensure uniform, evidence-informed care delivery in India.