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45

NCCN Guidelines for Patients

®

Breast Cancer - Early-Stage

(STAGES I AND II)

, Version 1.2016

There is more than one subtype of breast cancer.

Receiving chemotherapy is partly based on the

subtype. Chemotherapy is less often used to treat

rare subtypes that are not likely to spread beyond the

breast.

Tubular and mucinous breast cancers are rare

subtypes of invasive ductal carcinoma. Tubular breast

cancer is so named because the cancer cells look

like tubes. Mucinous (or colloid) breast cancer is so

named because there’s a lot of mucus around the

cancer cells. The chances are low that either subtype

will spread outside the breast. Thus, chemotherapy is

often not used.

Other subtypes of breast cancer have higher chances

of spreading outside the breast. However, the

chances for spreading are still low for most of these

subtypes. Higher-risk subtypes include most forms of

invasive ductal carcinoma as well as invasive lobular,

metaplastic, and mixed carcinomas. Metaplastic

carcinoma is breast cancer that changed from one

cell type to another. Mixed carcinoma is breast cancer

that has more than one cell type. Chemotherapy for

these subtypes is discussed next.

Chart 4.1

shows when chemotherapy is advised for

HER2-negative, hormone receptor–negative breast

cancer. These cancers are called “triple-negative.”

Chemotherapy is also based on tumor size.

Chemotherapy isn’t usually given if a breast tumor is

0.5 cm or smaller and hasn’t spread. This is because

the results of local treatment alone are often very

good. In contrast, chemotherapy is advised if a breast

tumor is 1.0 cm or larger. For all other tumors, your

doctor may want you to have chemotherapy to lower

the chances of the cancer returning.

Chart 4.2

shows when chemotherapy is advised for

HER2-negative, hormone receptor–positive breast

cancers. Chemotherapy is also based on tumor size.

Chemotherapy isn’t usually given if a breast tumor is

0.5 cm or smaller and hasn’t spread. This is because

the results of local treatment alone are often very good.

The 21-gene RT-PCR test looks at the activity of

21 genes to assess how likely it is that the cancer

would return after local treatment. It is used to

advise chemotherapy for breast cancers that are

0.51 cm and larger with no or little cancer growth in

the axillary lymph nodes. Test scores range from 0

to 100. Chemotherapy should be considered if the

test isn’t done. A score below 18 means you can

safely skip chemotherapy. A score of 18 to 30 means

chemotherapy may be helpful. Scores of 31 and

higher suggest that chemotherapy would help stop

the return of breast cancer.

Chemotherapy is advised if at least one lymph node

tumor is larger than 2 mm. However, some research

supports the use of 21-gene RT-PCR to advise

chemotherapy for women with cancer in 1 to 3 axillary

lymph nodes. More research is still needed.

4

Chemotherapy and HER2 inhibitors Treatment options: HER-2 negative cancer