While I occasionally order the BCI assay in my intermediate risk patients (large primary tumor with negative nodes or smaller tumor with limited nodal involvement), I find that I get this concerning result (increased risk of late recurrence but no apparent benefit from extended adjuvant therapy base...

I seldom send BCI. I agree that this requires a detailed patient/provider discussion about risks/benefits of continuing endocrine therapy. I would have had that discussion prior to sending the BCI, with the understanding that the results of the BCI would impact treatment decision-making. In this set...

I am confused. The BCI is prognostic and identifies patients with node-negative disease who, with 2 different extended hormonal therapy approaches, had very little benefit if any compared to toxicity. However extended hormone therapy has shown benefit at least in distant relapses and others; theref...

I would discuss the risks/benefits with the patient and make an informed decision. Most likely I would recommend Extended Therapy.

No, I would not recommend additional hormonal therapy. I believe that the BCI test validated in MA-17 and aTTOM does address basic biology of disease: if BCI shows less benefit w/ extended hormonal therapy, then continuing w/ Rx may only result in cumulative toxicities (which are certainly not trivi...

Yes.