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Prognostic and predictive factors in early, nonmetastatic breast cancer

Theodoros Foukakis, MD, PhD
Jonas Bergh, MD, PhD, FRCP (London UK)
Section Editor
Daniel F Hayes, MD
Deputy Editor
Sadhna R Vora, MD


The widespread application of adjuvant systemic therapy has reduced mortality from breast cancer in the Western world [1-4]. Unfortunately, many patients are not treated appropriately, with some overtreated (when they would have been cured solely with local therapy) and others undertreated (eg, not treated in the adjuvant setting or treated with drugs that are ultimately not active). It would be of great value to have reliable prognostic factors that could help select those patients most at risk for recurrence. In addition, clinically applicable predictive factors would aid in the personalization of adjuvant therapy by identifying which therapies would be most likely of benefit to patients and which patients would not benefit, potentially sparing them from the unnecessary exposure to potentially toxic and expensive therapies.

By definition, a prognostic factor is capable of providing information on clinical outcome at the time of diagnosis, independent of therapy. Such markers are usually indicators of growth, invasion, and metastatic potential [5,6]. By contrast, a predictive factor is capable of providing information on the likelihood of response to a given therapeutic modality. Such markers are either within the target of the treatment or serve as modulators or epiphenomena related to expression and/or function of the target. Although they can be separately classified, several factors in breast cancer are both prognostic and predictive (eg, the presence of overexpression of the human epidermal growth factor receptor 2 [HER2]).

This topic will review prognostic and predictive factors that are relevant for patients diagnosed with early, nonmetastatic breast cancer. An overview of the treatment of breast cancer and relevant factors for patients with metastatic breast cancer is discussed [7,8] separately.

(See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer".)

(See "Systemic treatment for metastatic breast cancer: General principles".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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