Can Tumor Size Predict Who Benefits from Chemotherapy?

nurse in ERThe past two decades have seen a dramatic increase in the number of women diagnosed with T1a and T1b breast cancer. This rise in early-stage breast cancer is largely attributed to the increase in screening mammography that can detect cancer in its early stages, in some cases when the tumors are under 1cm and before the tumor has spread to the lymph nodes. In T1a breast cancer, the tumor size is less than or equal to 5 millimeters (mm); in T1b, the tumor size is greater than 5 mm, but less than or equal to 10 mm.

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T1a and T1b breast cancers without lymph node spread have excellent long-term outcomes, with more than 95% of women alive at 10 years. However, important clinical questions remain:  Are there subsets of patients—characterized by certain combinations of tumor size and hormone receptor subtype (HR+/-, HER2+/-)— who could enjoy the same strong survival rates while skipping chemotherapy altogether? And are there others—with different combinations of tumor size and subtype—for whom chemotherapy would significantly increase survival?

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