Markers of increased risk for failure of adjuvant therapies

Mortality from breast cancer has been declining in the Western World since 1985. Arguably, widespread application of effective adjuvant systemic therapy has been a considerable contributing factor. Data from individual trials and the Oxford Overview Meta-analyses demonstrate that both endocrine and chemotherapy are associated with significant and substantive proportional reductions in annual hazard rates of relapse and death. These statistics raise the question: Should all patients be treated with all therapies in order to ensure an ongoing sharp decline in breast cancer mortality? The answer to this question depends on the perspectives of the patient, her caregiver, and her society towards the relative toxicities and benefits of therapy. If a patient is willing to accept toxicities for any benefit, then the answer is yes. However, if a woman is willing to forego some benefit to avoid the toxicities of therapy, then the clinician should carefully use well-validated prognostic and predictive factors to help the patient select her most acceptable treatment plan.