%0 Journal Article
%T Classical versus new prognostic factors for adjuvant treatment selection based on line software to estimate risk and benefit
%A PM Ravdin
%J Breast Cancer Research
%D 2005
%I BioMed Central
%R 10.1186/bcr1224
%X To address this problem the decision tool Adjuvant! (Fig. 1) was created [1,2]. It uses data from national databases and other sources to make estimates of a patient's baseline prognoses. It uses data from the Overview, and individual clinical trials to make estimates of treatment efficacy. It uses national data about age-specific competing mortality to make estimates of competing mortality. Although the program provides these estimates, it has the flexibility to allow the user to modify the estimates as they think appropriate. Over 200 pages of help files allow the user to review the data on which the program is based, and the methods used by the program and the assumptions which it makes. That for the most part these estimates are reasonable is supported by a validation of Adjuvant!'s estimates in a large independent database [3]. Specific sheets describing the toxicity and safety issues of different adjuvant treatment options are included.The presentation will discuss the strengths and limitations of this approach. The major strength is that this tool allows the doctor and patient to review in a quantitative sense the benefits and risk of different options. The limitations are that for many therapies we have limited knowledge about their long-term efficacy (and Adjuvant! makes specific assumptions to deal with this), and undoubtedly we will learn more about how some tumors' characters may affect their sensitivity to therapy. How new prognostic factors and genomic information may be included will be discussed.
%U http://breast-cancer-research.com/content/7/S1/S20