Dr. Albain on Staging and Biology in Breast Cancer

Kathy S. Albain, MD, medical oncologist, Loyola University Chicago, professor, Stritch School of Medicine, director, Breast Clinical Research Program, Thoracic Oncology Research Program, Cardinal Bernardin Cancer Center, discusses staging versus biology in breast cancer.

Physicians are often presented with patients who have high-stage disease signified by many positive nodes, larger tumor, or aggressive biologic features. In this situation, the decision is straightforward: A physician has to decide whether to give systemic chemotherapy or other, more intensive types of adjuvant therapy for curative intent.

Physicians are also presented with discordant clinical situations from time to time. In certain situations, a patient's stage of disease, tumor volume or disease burden may be high but the biology of the cancer may appear to be favorable or indolent. An equally discordant situation arises when a patient's small tumors have aggressive or unfavorable biology. In both of these situations, a physician is faced with questions regarding what should drive the treatment decision.