A new look at node-negative breast cancer

Node-negative breast cancer is a prevalent form of the disease worldwide, particularly in regions with rigorous screening and disease awareness efforts. Although there is a common biology between node-negative and node-positive breast tumors, it is still important to specifically address risk assessment and predictive factors in node-negative breast cancer. The relative risks and benefits are more pronounced in these patients, but there is no single prognostic factor available for deciding whether to administer chemotherapy and selecting the best adjuvant chemotherapy regimen. In the absence of universal predictive factors, the trend is to give chemotherapy to all patients to ensure the highest possibility for cure. Tumor grade is important in that it is predictive of risk over time, but lacks standardization. Adjuvant! Online, a web-based algorithm, is also used to guide treatment decisions. Recently, the urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1) biomarkers have been used to determine disease risk and, consequently, determine whether or not chemotherapy is needed. However, the assay requires a fresh-frozen tissue sample, which is not always feasible. The oncotype DX® genomic assay has also been used to help prognosis estimation and treatment decisions. It is currently under evaluation in conjunction with the uPA/PAI-1 assay in the Plan B trial. The question that remains in adjuvant chemotherapy today for patients with node-negative disease is proper patient selection. Node-negative breast cancer does not automatically suggest a good prognosis, or the preclusion of chemotherapy benefits, and additional biomarkers are needed to help identify patients who do benefit from chemotherapy.