ABSTRACT
Breast cancer is the second most common type of cancer among women in the United States with more than 200,000 women diagnosed with invasive disease and with approximately 40,000 dying annually from the disease (1). As a result of early detection efforts, nearly half of these women present with lymph node negative hormone receptor positive disease. Current treatment for early-stage breast cancer (ESBC) with adjuvant hormonal therapy and/or chemotherapy is based on clinical and pathological criteria including the presence and number of involved lymph nodes, tumor size and grade, hormone receptor status, and the presence of HER2/neu overexpression among others. Treatment decisions may also take into consideration patient age or menopausal status due to the anticipated lower risk of cancer recurrence, and the potential for smaller benefit and greater toxicity with aggressive systemic chemotherapy in older women. These considerations form the basis for clinical practice guidelines for the management of patients with ESBC (2,3). Current guidelines recommend adjuvant systemic chemotherapy and endocrine therapy for most women with lymph node negative, hormone receptor positive, ESBC. Unfortunately, such systemic chemotherapy is associated with considerable cost, proximal morbidity, as well as increasing evidence for serious delayed toxicities including neurocognitive dysfunction and secondary malignancies.
