How do you approach discussion of adjuvant chemotherapy for a T1b (0.5 cm) hormone positive breast cancer with high risk features and an Oncotype Score of 31?

The best available data suggests that the relative benefit of chemotherapy predicted by gene profiling scores is seen across anatomic stages, but the absolute differences in smaller size node negative tumors will of course be smaller, even with a higher Oncotype Dx score. While precise estimates are difficult to provide in these cases, I would discuss with the patient that there is a small benefit to be achieved in terms of distant disease-free survival (DDFS) in the 10 year timeframe with the a...