title: Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations.
abstract: An American Society of Clinical Oncology (ASCO) panel considered the Cancer Care Ontario (CCO) recommendations on the role of patient and disease factors in selecting adjuvant therapy for women with early-stage breast cancer for endorsement.
  
  
  
  ASCO staff reviewed the CCO guideline for methodologic rigor, and an ASCO panel of content experts reviewed the content of the recommendations.
  
  
  
  For making decisions regarding adjuvant therapy, nodal status, tumor size, estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, tumor grade, and lymphovascular invasion are relevant; Oncotype DX score and Adjuvant! Online may be used as risk stratification tools; and age, menopausal status, and medical comorbidities should be considered. Chemotherapy should be considered for patients with positive lymph nodes, ER-negative disease, HER2-positive disease, Adjuvant! Online mortality greater than 10%, grade 3 lymph node-negative tumors (T > 5 mm), triple-negative (ER-negative, PgR-negative, HER2-negative) tumors, lymphovascular invasion positivity, or estimated distant relapse risk of greater than 15% at 10 years based on Oncotype DX recurrence score (RS). Chemotherapy may not be beneficial or required for small node-negative tumors (T < 5 mm) without high-risk features or for patients with HER2-negative, strongly ER-positive, and PgR-positive cancer with micrometastatic nodal disease, T less than 5 mm, or Oncotype DX RS with an estimated distant relapse risk of less than 15% at 10 years.
  
  
  
  The ASCO panel endorses the recommendations with minor suggested revisions and highlights three areas that warrant further consideration: tumor histology and adjuvant therapy recommendations, risk stratification tools and proposed Oncotype DX RS thresholds to guide decisions about chemotherapy, and patient factors in decision making.
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: N Lynn
authors.initials: NL
authors.lastname: Henry
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA. guidelines@asco.org.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Vandana G
authors.initials: VG
authors.lastname: Abramson
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Kimberly H
authors.initials: KH
authors.lastname: Allison
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Carey K
authors.initials: CK
authors.lastname: Anders
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Diana T
authors.initials: DT
authors.lastname: Chingos
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Openshaw
authors.affiliation: N. Lynn Henry, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Vandana G. Abramson, Vanderbilt-Ingram Cancer Center, Nashville, TN; Kimberly H. Allison, Stanford University Medical Center, Stanford; Diana T. Chingos, University of Southern California/Young Survival Coalition, Los Angeles; Arti Hurria, City of Hope, Duarte, CA; Carey K. Anders, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Thomas H. Openshaw, Eastern Maine Medical Center Cancer Care, Brewer, ME; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Ian E
authors.initials: IE
authors.lastname: Krop
mesh_terms: D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000473:pathology; D003657:Decision Making; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human