Do you use Oncotype to predict chemo benefit on all localized HR+ patients per TAILORx criteria or do you use your judgement and skip it in T1b-c grade 1 or grade 2 tumors?  

Oncotype is not always needed, for example in grade 1, small tumors as suggested. As a reminder, still, most ER positive tumors are endocrine sensitive and only a minority will be higher risk, endocrine resistant tumors.  The biggest contribution for Oncotype has been to spare the many patient...

I discourage sending Oncotype in T1bN0 and small, low grade T1c (<1.5 cm) cancers, based largely on results from MINDACT (which used Mammaprint, not Oncotype), unless the patient expresses a strong preference for receipt of chemotherapy if the Oncotype returns high despite a very small potential ...

There are a few more important variables that need to be mentioned here. First, tumor histology, ductal/NST, versus lobular, versus mixed, or micropapillary. Second, the definition of ER positivity. Patients are defined as HR+ if their tumors show 1%-100% ER IHC staining. However, there is limited d...