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Systemic Adjuvant Therapy for Stage I Breast Cancer

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Breast Cancer, a Heterogeneous Disease Entity

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Abstract

Broad general statements about stage I breast cancer no longer reflect our current understanding of breast cancer biology and provide only limited information for treatment selection. Tumor size and lymph node status are strong and partially independent prognostic factors but do not capture many other important prognostic and therapeutic variables. Pathological markers such as histological grade; oestrogen receptor (ER) and human epidermal growth factor 2 receptor status; the presence of lymphovascular invasion; and clinical factors such as age and co-morbid illness are vital to estimate prognosis and predict response to adjuvant therapy. Clinically validated multivariable prediction models such as The Nottingham Prognostic Index and Adjuvant! online incorporate some of these variables and represent an important step towards providing individualized risk prediction. Commercially available multi-gene assays risk-stratify ER-positive breast cancer and appear to derive much of their prognostic value from robust quantification of proliferation status and provide complementary information to clinical variable-based prognostic models. In the coming years existing multivariable prediction models will be refined, new robust models will incorporate novel prognostic and predictive biomarkers allowing better risk stratification within all breast cancer subtypes and bring us closer to the ultimate goal of personalized medicine.

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Author information

Authors and Affiliations

  1. Department of Breast Medical Oncology, M.D Anderson Cancer Center, The University of Texas, 301439, 77230-1439, Houston, TX, USA

    Lajos Pusztai

  2. Department of Breast Medical Oncology, South East Cancer Center (SECC), Waterford Regional Hospital, Waterford, Ireland

    Catherine M. Kelly

Authors
  1. Lajos Pusztai
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  2. Catherine M. Kelly
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Correspondence to Lajos Pusztai .

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Editors and Affiliations

  1. , University of Szeged, Department of Oncotherapy, Korányi fasor 12, Szeged, 6720, Hungary

    Zsuzsanna Kahán

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Pusztai, L., Kelly, C.M. (2011). Systemic Adjuvant Therapy for Stage I Breast Cancer. In: Kahán, Z. (eds) Breast Cancer, a Heterogeneous Disease Entity. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0489-3_11

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