Validation of minimal risk of recurrence classification by the Breast Cancer Index in early stage breast cancer

The Breast Cancer Index (BCI) was previously shown to identify ~20% of postmenopausal patients with early stage, hormone receptor positive (HR+), node negative (N0) breast cancer with minimal (<5%) risk of 10-year distant recurrence (DR) even without receiving adjuvant endocrine therapy (ET). This prospective-retrospective study further validated the BCI minimal risk classification in postmenopausal patients with early-stage, HR + HER2- N0 breast cancer from the Netherlands Cancer Registry (NCR) and the Tamoxifen and Exemestane Adjuvant Multinational (TEAM, NCT00279448, NCT00032136) randomized trial who received 5 years of primary adjuvant ET. BCI classified approximately 15% of patients as minimal risk. In the NCR cohort (n = 1264 out of 15,053 HR+ patients in the registry), risks of DR in the minimal, low, intermediate, and high groups were 4.8%, 3.3%, 8.0%, and 12.4%, respectively (P < 0.001). In the TEAM cohort (n = 978 out of 3544 in the BCI study), DR risks were 3.8%, 8.3%, 12.6% and 22.7% (P < 0.001). In multivariate analyses, BCI risk scores provided independent information over standard prognostic factors (P < 0.001). This study confirmed the ability of the adjusted BCI model to identify postmenopausal women with HR + HER2- N0 breast cancer who are at minimal risk of DR and may consider de-escalating adjuvant ET.