Skill Checkup: A Menopausal Woman With a Lump in Her Right Breast

Pavani Chalasani, MD, MPH


January 18, 2022

Because four positive lymph nodes were identified during surgery, the current standard of care is to recommend adjuvant chemotherapy for this patient. Some practitioners might also consider use of a gene expression profile or biomarker assay, although they are not validated in the setting of four or more positive lymph nodes.

Ki-67 is an indirect measure of cell proliferation. Although a high Ki-67 value is often considered a marker for poorer prognosis in early breast cancer, it cannot predict benefit of chemotherapy as a single measure. Recently, the International Ki67 in Breast Cancer Working Group concluded that "Ki67 has limited value for treatment decisions due to questionable analytical limitations." However, Ki-67 is included as part of the recurrence score, which can offer a broader evaluation of risks and benefits of adjuvant chemotherapy.

The androgen receptor has recently been studied as a potential marker of prognosis in some breast cancer subsets, as well as a potential therapeutic target. It has not, however, been identified as an indicator of adjuvant chemotherapy benefit.


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