I don't get this

Great link! Here's what I learned:

Take Tamoxifen AFTER chemo has finished for the best results (if you do it sequentially, you get a further 16% less chance of recurrence - that's huge!)

ER/PR+ women may have a gene that tells whether they would benefit from chemo or not

There's more I'm forgetting, I have to go back and read it again.

not my board, but (I think) it really depends on oncotype, even with more than 4 nodes. The one (kinda small) study of oncotype in node positive shows a "less than zero" chemo benefit for low RS, a small benefit for intermediate, and a large benefit for high RS.

This is of course assuming ER+, I believe tripple neg is much more responsive to chemo. But yes, I think some women should not be getting chemo if they have a low RS.

Even some 4's with a high ER do well w/o chemo!

I don't think the article says anything about HOW positive the hormones are making any difference...otherwise why would they have to do this special gene assay? Why couldn't they just base chemo on the % of ER/PR+?

I've read in many places that chemo only increases your protection by a certain %, but it's usually been 10-15%. If you're at a high risk already, then any percentage helps.

This is Kathy Albain's report on an analysis they did of a subgroup of the SWOG8814.  This was a study of postmenopausal women with positive nodes.  In the original study there were 1477 women.  They took two groups out of the study to look at.  One group was the Tamox Only group and the other was the group that got Chemo(CAF) then Tamox.  They eliminated from their subgroup analysis the 234 women who got Tamox and Chemo together and also eliminated the women who did not have good tumor samples that Oncotype DX could measure.  That left 367 women out of the original 1477, or about 25% of the study.  They then got RS scores for those women and put them in their Low, Int., High RS groups and treatment groups (6 groups) and looked at their Breast Cancer Specific Survival.  In the abstract it says, "For the exploratory analysis of BCSS, only deaths due to breast cancer were counted as events, censoring deaths due to other causes (such as late cardiovascular events) as well as patients alive at the last follow-up visit.

Below is the data that is presented on the poster, these are the actual numbers, not the 10 year estimates.  The fraction is # who died/# studied.  The poster says that there is an Interaction for BCSS by RS,  p=0.021.  

Low RS     Tamox.  4/55 (BCSS 92.7%)   Tamox + Chemo. 10/91 (BCSS 89.0%)         Difference  - 3.7%

Int RS Tamox.  11/46 (BCSS 76.1%)         Tamox + Chemo  10/57  (BCSS 82.5%)         Difference  6.4%

High RS Tamox.  20/47 (BCSS  57.4%)   Tamox + Chemo  18/71  (BCSS  74.6%)         Difference  17.2%

They were able to test 148 women on Tamox. and 219 women who had both Chemo and Tamox.  These are not very many women, so you can't get a lot of information from this,  but overall the BCSS for Tamox users was 76.4% and for Chemo+Tamox users was 82.6%.  

If you would like to see the statistics and read the abstract of this study you can do so. 

Step 1:  Google  this

sabcs 2009

Step 2:  Click on 

Enduring Materials (it's in the very first thing listed)

Step 3:  Click on the link under Abstracts2View

Abstracts from the 32nd Annual SABCS Dec. 10-13, 2009

Step 4:  Click on the box under Option 1 and Submit

Step 5:  In the Search For box at the  top type the researcher's name (Albain) and hit return

Step 6:  Click on the first Study to read the abstract or click on the orange P (in a circle) to see the poster of the study.

When looking at the poster I can make it bigger or smaller on my computer by holding down SHIFT and OPEN APPLE and tapping the + symbol or the - symbol.  (I use a Mac).