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.