Would you recommend observation in an elderly patient with an ER positive, early stage breast cancer who has a high risk Oncotype Dx score?   

I would not favor observation in high oncotype Dx as is it is a risk factor for high local relapse (based on NSABP where it showed higher risk relapse even after lumpectomy and RT, although risk was higher in younger vs. older).Even in PRIME 2 high grade was associated with higher risk of relapse wi...

I discuss with patients; its unclear what percentage of patients in the observation trials (CALGB 9343, PRIME II) were high oncotype and whether they were the failures that were observed. I review that we don't have great data using Oncotype to drive RT decisions but that it can be considered.