Would you perform an oncotype DX in a patient with a 0.5cm ER positive breast cancer with one lymph node positive for macrometastatic disease? 

We published data from SEER in May of last year (Massarweh, JCO May 2018) looking at BCSS and OS in 55 thousand women with 0-3 lymph node involvement at 5 years. In patients with low and intermediate RS (up to 30) there is very little difference between node negative and node positive patients in terms of BCSS. Patients do well regardless of nodal status if their score is not high.

Patients with high RS >30 have a high risk of death from breast cancer, regardless of nodal status, and despite the...

While I generally do not use gene profiling for node-positive breast cancer, I do think that the evidence points to diminished benefit from chemotherapy with lower gene profiling scores, with more evidence available from the 21-gene and 70-gene assays. However, at this point, the optimal cutpoints for decision-making remain unclear. For such cases, I ask patients to participate in the decision to best understand how comfortable they may feel with some uncertainty traded off against avoiding chem...