Do you routinely send Oncotype Dx on ER positive tumors with node positive disease?

I believe that the intrinsic biology of the tumor is more important than the lymph node status in determining prognosis and potential chemotherapy benefit. Given this, I do use molecular assays for node positive disease with caution. Based on a 2010 Lancet Oncology paper in which tissue blocks from SWOG 8814 were analyzed using Oncotype Dx, there was no benefit to CAF/tam over tam alone in node positive breast cancer with a low RS. With intermediate RS there appeared to be no benefit, but the da...

There's no such thing as routinely ordering genomic assays - it is just bad clinical practice. Ask two questions before you consider ordering any genomic assays for breast cancer.

1. Will this patient tolerate chemotherapy - If answer is NO, do not order genomic tests.

2. Has the patient stated very clearly that they do not want chemotherapy - if answer is YES, do not order genomic tests.