Adjuvant chemotherapy in the node-negative breast cancer patient

For node-negative patients with tumors 2 cm or greater, the advantage of adjuvant therapy seems to outweigh any associated morbidity. For women less than 50, polychemotherapy (CMF, CA, CAF) is the standard of care. For women older than 50 who are hormone receptor positive, tamoxifen provides the major benefit. For estrogen receptor-positive women less than 50, adding tamoxifen and for estrogen receptor-positive women older than 50, adding chemotherapy may provide smaller incremental benefit. For hormone receptor-negative women over 50 years, there is a lesser but real benefit from polychemotherapy and a small benefit from tamoxifen (perhaps because of false receptor-negative results.) For tumors 1 cm or less in size (or tubular, papillary < 2 cm), the prognosis is so favorable that outside a clinical trial, adjuvant therapy is not recommended. For patients with node-negative tumors 1 to 2 cm in size, other prognostic factors, size (1.1 versus 1.9 cm), possibility of tamoxifen benefit, and age (45 versus 80 years) all influence the physician's recommendation to the patient.