In cases in which Oncotype DX test is not available, how do you decide which patients with HR+ and Her2- breast cancer are candidates for adjuvant chemotherapy?

If OncotypeDx is not available for an ER+ Her2- primary breast cancer:

In general, there are two main components to the 21 gene assay: proliferative thrust and estrogenic signaling. Thus tumors that have strong staining for ER tend to be driven by estrogenic signaling. This is especially true if th...