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Johannes Holtschmidt, MD, German Breast Group, Neu-Isenburg, Germany, examines the risks associated with understaging high-risk node-negative breast cancer patients receiving neoadjuvant treatment. Patients with micrometastatic residual disease, particularly those initially assessed as lower risk, tend to have a poor prognosis. These outcomes highlight the challenges of identifying node-positive cases and the need for systemic therapy options in the post-neoadjuvant setting, rather than relying solely on surgical or local regional approaches, to address recurrence risks and improve long-term outcomes. This interview took place at the 2024 San Antonio Breast Cancer Symposium (SABCS) congress in San Antonio, TX. These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.