Objective: Many different options for adjuvant chemotherapy are recommended in guidelines for the treatment of breast cancer. Therapeutic strategies vary among physicians. The major goals for this project were to gain a better understanding of how biomarkers are integrated into practice and how physicians select adjuvant chemotherapy.
Methods: We assembled a questionnaire with 23 example scenarios of breast cancer cases, including 6 items relevant to postoperative adjuvant therapy. During October-November 2012, the questionnaire was submitted to 131 physicians engaged in breast cancer treatment in Kanagawa Prefecture, Japan.
Results: Forty-eight physicians responded to the questionnaire, 46 of whom provided valid responses. Their responses revealed a notable lack of consensus regarding therapeutic choices. We analyzed 6 scenarios relevant to postoperative adjuvant therapy. In general, the selection of postoperative adjuvant therapy appeared to be based on hormone sensitivity, human epidermal growth factor receptor 2 (HER2) expression, lymph node metastasis, tumor size, histological/nuclear grade, vascular/lymphatic system invasion, Ki67 level, Oncotype DX score, and the patient's age.
Conclusion: Given the varied therapeutic choices that we observed, clinical research is needed to provide appropriate, unified therapeutic strategies.