Routine brain imaging for asymptomatic HER2-positive patients is debated, with no current consensus; Given the severe clinical implications of brain metastases, further research is needed to determine the cost-effectiveness and clinical utility of routine imaging for high-risk patients to improve outcomes and inform targeted screening protocols.<h4>Methods</h4>This retrospective, monocentric study at the General Hospital of Vienna (AKH Wien) examined female HER2-positive breast cancer patients at first diagnosis to assess brain metastasis from January 2019 to February 2024. The gene discussed is ERBB2; the disease is breast cancer.