Brain metastases are a major clinical concern in metastatic breast cancer, particularly in HER2-positive and triple-negative disease. Over time, approximately 25% to 50% of patients with these subtypes develop brain metastases, which can lead to neurological disability, cognitive impairment, reduced independence, and substantial deterioration in quality of life.

Despite this risk, routine brain imaging is not consistently recommended for patients without neurological symptoms.

An article published in The Breast argues that it may be time to reconsider this symptom-directed approach. Sarah Sammons, Nayan Lamba, and Nancy U. Lin outline a growing case for brain MRI screening in selected patients with metastatic breast cancer, while also acknowledging that survival benefit, optimal timing, cost-effectiveness, and potential harms remain uncertain.