New molecular classifications of breast cancer

Traditionally, pathologic determinations of tumor size, lymph node status, endocrine receptor status, and human epidermal growth factor receptor 2 (HER2) status have driven prognostic predictions and adjuvant therapy recommendations for patients with early stage breast cancer. However, these prognostic and predictive factors are relatively crude measures, resulting in many patients being overtreated or undertreated. As a result of gene expression assays, there is growing recognition that breast cancer is a molecularly heterogeneous disease. Evidence from gene expression microarrays suggests the presence of multiple molecular subtypes of breast cancer. The recent commercial availability of gene expression profiling techniques that predict risk of disease recurrence as well as potential chemotherapy benefit have shown promise in refining clinical decision making. These techniques will be reviewed in this article.