Yet another risk score—will it really help decision making?

We—health professionals and the growing number of patients with early breast cancer (including ductal carcinoma in situ)—have known for many years that the chance of any benefit from adjuvant chemotherapy is vanishingly small.1 The harms, also known, were and are viewed as a badge of honour, an emblem of courage, for deciding to do “everything possible,” encouraged quite often by friends, family, and the media. Clinicians could be reassured that they had not neglected their patients by failing to offer every treatment or by suggesting that it might not be worth going through for such an uncertain chance of benefit.

Now we have the “breakthrough” of yet another expensive “measurement” (with quite a wide grey area) that can be used as “proof” that chemotherapy can be avoided by many. But it still leaves uncertainty, particularly in the now measured grey area. More waiting for test results and more anxiety; just as much uncertainty. Perhaps reality will show when the euphoria dies down. It will do little to change the culture of increasingly relying on tests and medical interventions or to alleviate fear and anxiety. How much will it really help decision making or avoidance of regret?