When not to treat--chemotherapy for small (< or = 1 cm) breast cancers

The role of adjuvant chemotherapy in treatment of breast cancers < or = 1.0 cm is controversial. Careful consideration must be given to the patient's overall risk of recurrence and death given her tumor size and lymph node status. Studies indicate that overall survival for women with lymph node-negative breast cancers < or = 1.0 cm is 90-99%. Given the known relative benefit of adjuvant chemotherapy for breast cancer, the absolute benefit of chemotherapy in this setting is usually < or = 1%. The toxicities of adjuvant chemotherapy, including cognitive dysfunction, early menopause, cardiac dysfunction, and leukemia, are significant to patients. The decision to treat women who are already at a very low risk of recurrence with adjuvant chemotherapy must involve an honest and detailed discussion between the patient and her oncologist.