title: Risk estimations and treatment decisions in early stage breast cancer: agreement among oncologists and the impact of the 70-gene signature.
abstract: BACKGROUND
  Clinical decision-making in patients with early stage breast cancer requires adequate risk estimation by medical oncologists. This survey evaluates the agreement among oncologists on risk estimations and adjuvant systemic treatment (AST) decisions and the impact of adding the 70-gene signature to known clinico-pathological factors.
  
  
  METHODS
  Twelve medical oncologists assessed 37 breast cancer cases (cT1-3N0M0) and estimated their risk of recurrence (high or low) and gave a recommendation for AST. Cases were presented in two written questionnaires sent 4 weeks apart. Only the second questionnaire included the 70-gene signature result.
  
  
  RESULTS
  The level of agreement among oncologists in risk estimation (κ=0.57) and AST recommendation (κ=0.57) was 'moderate' in the first questionnaire. Adding the 70-gene signature result significantly increased the agreement in risk estimation to 'substantial' (κ=0.61), while agreement in AST recommendations remained 'moderate' (κ=0.56). Overall, the proportion of high risk was reduced with 7.4% (range: 6.9-22.9%; p<0.001) and the proportion of chemotherapy that was recommended was reduced with 12.2% (range: 5.4-29.5%; p<0.001).
  
  
  CONCLUSIONS
  Oncologists' risk estimations and AST recommendations vary greatly. Even though the number of participating oncologists is low, our results underline the need for a better standardisation tool in clinical decision-making, in which integration of the 70-gene signature may be helpful in certain subgroups to provide patients with individualised, but standardised treatment.
authors: Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors: C A
authors: CA
authors: Drukker
authors: Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors: H C
authors: HC
authors: van den Hout
authors: Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors: G S
authors: GS
authors: Sonke
authors: Department of Medical Oncology, Hospital René Huguenin, Institut Curie, 35 Rue Dailly, 92210 Saint-Cloud, France.
authors: E
authors: E
authors: Brain
authors: Department of Medical Oncology, Institut Bergonié Comprehensive Cancer Center, Univ. Bordeaux, INSERM U916, 229 Cours de l'Argonne, 33000 Bordeaux, France.
authors: H
authors: H
authors: Bonnefoi
authors: Breast Cancer Unit, Champalimaud Cancer Center, Avenida Brasília, 1400-038 Lisbon, Portugal.
authors: F
authors: F
authors: Cardoso
authors: Department of Medicine, European Institute of Oncology, Via Ripamonti 435, Milan, Italy.
authors: A
authors: A
authors: Goldhirsch
authors: Department of Obstetrics and Gynecology, Breast Center, University of Munich, Klinikum Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
authors: N
authors: N
authors: Harbeck
authors: Department of Internal Medicine, Isala Klinieken, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors: A H
authors: AH
authors: Honkoop
authors: Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands.
authors: R H T
authors: RH
authors: Koornstra
authors: Department of Medical Oncology, Academic Medical Center, Meibergdreef 9, 1105 AZ University of Amsterdam, The Netherlands.
authors: H W M
authors: HW
authors: van Laarhoven
authors: Department of Internal Medicine, HAGA Hospital, Leyweg 275, 2545 CH Den Haag, The Netherlands.
authors: J E A
authors: JE
authors: Portielje
authors: Division of Gynecologic Oncology, National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors: A
authors: A
authors: Schneeweiss
authors: Department of Internal Medicine, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
authors: C H
authors: CH
authors: Smorenburg
authors: Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors: J
authors: J
authors: Stouthard
authors: Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: s.linn@nki.nl.
authors: S C
authors: SC
authors: Linn
authors: Division of Molecular Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors: M K
authors: MK
authors: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003657:Decision Making; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D020869:Gene Expression Profiling; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: 70-gene signature; Adjuvant systemic therapy; Breast cancer; Clinical decision-making; Risk estimation