Disease related indicators for a proper choice of adjuvant treatments.

Adjuvant systemic therapy (AST) clearly reduces mortality from breast cancer. The decision to recommend AST is based on prognosis and prediction. Clinically useful prognostic factors have historically been principally anatomic, based on size of the tumor and the presence or absence axillary lymph node metastases. More recently, multi-parameter assays have become incorporated into prognostic calculations, principally in patients who are ER positive. None has been established to have clinical utility in patients who are ER negative.