Would a low genomic MammaPrint score deter you from offering adjuvant chemotherapy to a premenopausal woman with HR+ pT3N0 breast cancer?  

The MINDACT trial only included 11.6% T3 patients. And in MINDACT’s updated analysis, in women ≤50 years old with high clinical risk, there was about a 5% absolute difference in DMFS at 8 years, favoring chemotherapy even if they have low genomic risk. Of course, there is debate about wheth...

Our current guidelines indicate that premenopausal patients with LN-negative breast cancer and low risk by genomic expression profile need not receive chemotherapy. In this patient, I would discuss the available data and, if she agrees, proceed with endocrine therapy to include ovarian suppression, ...

I would do AI with ovarian suppression and a CDK4/6 inhibitor. However, I would consider chemo in this case if it's a luminal type B (high Ki-67) cancer, and after discussing with the patient.