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Every year, many Canadians are receiving adjuvant chemotherapy for breast cancer that may not be required. Like many therapies given to large unselected populations, it is evident that some individuals benefit a great deal, some less, and some not at all. There is increasing evidence that the recently developed 21-gene assay test1,2,3 can identify breast cancer patients considered for adjuvant chemotherapy who will not benefit from this treatment.

In the US, the 21-gene assay test was approved by the US Food and Drug Administration (FDA) in 2005. Since 2007, this test has become routine for node-negative breast cancer patients whose tumours test positive for hormone receptors and who are candidates for adjuvant chemotherapy.4,5 The cost-benefit analyses in the US project substantial quality of life and cost benefits due to avoided chemotherapy.

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