To manage women with breast cancer, the panel concluded that treatment with a combination of chemotherapy drugs, particularly combinations that include anthracyclines and tamoxifen, provides the best chance for survival. This treatment approach is appropriate for most women with localized breast cancer. Women whose tumors have estrogen receptors should receive hormone therapy, and women who have undergone mastectomies and who are at a high risk for recurrence of cancer should receive radiotherapy. The selection of systemic adjuvant therapy is based on prognostic and predictive factors. Prognostic factors are measurements available at diagnosis or at the time of surgery that are associated with recurrence rate, death rate or other clinical outcome when adjuvant therapy is not provided.
Predictive factors are measures associated with the response to a specific therapy.
Few new prognostic or predictive factors have been validated in the past 10 years. Patient characteristics must be taken into account when planning therapy. According to the panel, accepted prognostic and predictive factors include age, tumor size, axillary node status, histologic tumor type, standardized pathologic grade and hormone-receptor status. The age and race of the patient may be used to make generalizations about appropriate care, but adjuvant therapy must always be tailored to the individual woman, her disease and her needs. The median age of a woman diagnosed with breast cancer is 60 to 65 years.