How would you counsel a patient with HR+, HER2- breast cancer with an OncotypeDx ROR score of 0 who is refusing endocrine therapy?

This is often a challenging case to discuss with patients. Although we know that this patient's likelihood of distant recurrence is very low if she takes 5 years of adjuvant endocrine therapy, we don't actually know what her risk of recurrence is with no systemic therapy. Presumably, those with very low Oncotype recurrence scores are those that are the most endocrine sensitive, and may actually derive more benefit than those patients with higher scores. Many women tolerate both tamoxifen and aromatase inhibitors quite well, especially those women who have not had prior chemotherapy. Also, the majority of symptoms that occur with endocrine therapy are reversible, so any negative effects are likely to be short-lived. I generally recommend tha...

An occasional scenario in a busy breast practice. From personal experience, I have seen a few with a score of zero and in that case, it is important to correlate with pathologic findings, how the cancer was discovered, and then balance treatment options against low risk of recurrence. These would be expected to be grade 1 tumors found on screening mammogram, and although carry minimal risk, endocrine therapy would still be advised. One patient, I recall, had lobular cancer, very difficult to see her tumor on the mammogram, and unexpectedly had a high number of lymph nodes involved after surgery. This would be consistent with a very indolent disease biology and a long time to disease detection often with minimal changes on imaging.

Correlatin...