Adjuvant chemotherapy in young breast cancer patients with endrocrine receptor (ER) disease

Background: Breast cancers in young women are typically aggressive, in part owing to the over representation of high grade triple negative tumours, but also because young age is an independent negative predictor of cancer-specific survival. Given the high risk of local and distant recurrence in young women with invasive breast cancer, most, if not all, young patients are candidates for chemotherapy. However, this can be different when considering endocrine receptor disease. In the case of young patients with low risk ER+ early breast cancer, the additional benefit of adjuvant chemotherapy remains undetermined. Here, the decision to administer chemotherapy is based on either an assessment of the composite risk of recurrence and likely benefits of treatment (based upon patient age, tumour lymph node status, size, grade, lymphovascular invasion), or the results of a gene expression profile. Given the toxicity associated with chemotherapy, the long-term follow-up and the aggressiveness of the disease, the decision to undergo adjuvant treatment is of vast importance.