Review of gene-expression profiling and its clinical use in breast cancer.
Despite advances in the treatment of early-stage breast cancer, physicians still lack the ability to accurately predict which individual patients will relapse and would benefit from adjuvant chemotherapy. Traditional clinicopathologic factors are important in helping to determine risk of relapse, but do not fully account for the biologic complexity of breast cancer. Gene-expression profiling has provided us with insight into the heterogeneity of breast cancer and led to the development of prognostic and predictive molecular gene signature models designed to aid in clinical decision-making. However, it remains to be determined how much refinement in prognosis genomic models provide over standard clinicopathologic features and whether these refinements translate into improvements in clinical practice. On-going large prospective multi-center clinical trials will provide us with information regarding the clinical utility of two of these assays, but for now, implementation of these models into widespread clinical practice remains limited.