Let me share some more about this important subject.

Lymph node positive breast cancer that means the cancer has spread from breast itself to

the lymph nodes in the armpit area. Now, historically, this was really an important factor in determining

if patients needed chemotherapy or not. Historically, the size of the cancer, the grade of the cancer,

but particularly, if the cancer was involving lymph nodes that meant that you would automatically

get chemotherapy and in premenopausal women probably one of big benefits of chemotherapy

has been knocking out the ovaries at least temporarily, so the question then becomes

do all patients who are lymph node positive have to have chemotherapy and as I have said,

not exactly. This is particularly true in the estrogen receptor-positive patients who

may have anywhere from one to three positive lymph nodes. The Oncotype DX test has been

validated for lymph node positive estrogen receptor-positive patients with a maximum

of three positive lymph nodes. Now, all of us in the field have known for years that

chemotherapy may not work that well in estrogen-receptor positive patients, but we have given the chemotherapy

anyway. Now for patient who is triple negative or HER2-neu positive or things like that,

no question that chemotherapy is really important, but in the lymph node positive patients, the

estrogen-receptor positive patients, the Oncotype score, the recurrence score can help us in

start to differentiate who is going to benefit from adjuvant chemotherapy. With a low risk

Oncotype score, the validation studies that have been done showed no benefit of adjuvant

chemotherapy up to three positive lymph nodes being involved and in the high-risk patients,

those who have a high risk recurrence score, there is no question that chemotherapy is

needed and that the patients benefit from it. With the intermediate risk score in the

middle, then here other clinical factors will come into play determining the role of adjuvant

chemotherapy, so the bottom-line of all this says if you are lymph node positive, do not

automatically think that you need chemotherapy whether you are pre or postmenopausal, make

sure that an Oncotype test is done if you are estrogen receptor-positive. You may be

able to avoid unnecessary chemotherapy, in particular chemotherapy that may not actually

benefit you.

Michael Alvarado: Did you know that not every breast cancer patient needs chemotherapy?

In fact today, there is a way to identify whether or not you would benefit from that

chemotherapy based on the biology of your tumor. To learn more about the Oncotype DX

assay and how to discuss the results with your physician, just press this button.