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Early stage breast cancer adjuvant chemotherapy
Dr. Carlos Garbino


Adjuvant Chemotherapy for early stage breast cancer has substantive difficulties for a worldwide applicability due to important inequalities, in different countries and within the same country.
Governmental politics that provide economic support for health care systems should be implemented to solve these disparities that influence breast cancer care.
Important arguments for chemotherapy inclusion in the adjuvant setting are: Histologic Grade 3 tumors; Ki 67 higher than 14 %; Low Hormone Receptor status, less than 50 %; Positive HER 2 NEU status; Triple Negative status.
Microarrays technology is a new an important determination to be performed in patients with negative lymph nodes in an endocrine responsive tumor, in those countries whose economic facilities determine the availability of this procedure. In this setting, approved genetic testing such as ONCOTYPE DX, may be used to select chemotherapy in that subset of patients, if not already indicated due to HER 2 positivity or any other determinant factor, in an endocrine responsive cohort in order to determine the use of chemotherapy in addition to endocrine treatment.
Mammaprint is not yet recommended due to lack of predictive value.
According to the different mayor subtypes of breast cancer that had been identified, the following adjuvant chemotherapy treatment recommendations could be presented. (Annals of Oncology 22; 17136, 2011).

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