Thrombopoiesis meets tumorigenesis: unlocking the diagnostic and prognostic potential of platelet indices in breast cancer– a narrative review

Breast cancer, as the most frequently diagnosed malignancy in women, continues to challenge clinicians due to its heterogeneity and variable clinical outcomes. As traditional diagnostic and prognostic markers often fall short in fully capturing disease dynamics, there is growing interest in the role of hematological biomarkers, particularly platelet indices, as accessible and cost-effective tools in cancer management. Recent evidence suggests that thrombopoiesis is not merely a bystander process but actively contributes to tumorigenesis through complex interactions with cancer cells and the tumor microenvironment. Platelets influence breast cancer progression by promoting angiogenesis, shielding circulating tumor cells from immune clearance, and facilitating metastasis. These tumor-promoting functions are reflected in measurable changes in platelet indices, such as platelet count, mean platelet volume, platelet distribution width, and plateletcrit. Abnormal values of these indices have been associated with advanced tumor stage, lymph node involvement, and reduced survival, highlighting their potential as biomarkers for disease monitoring and prognostication. Nevertheless, with further validation and integration into multimodal diagnostic frameworks, platelet-based biomarkers may enhance precision in breast cancer risk stratification and treatment planning. This review underscores the need for continued investigation into the interplay between thrombopoiesis and tumorigenesis and the translational potential of platelet indices in breast cancer care.