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Eighth Edition Cancer Staging Manual of Breast Cancer by the American Joint Committee on Cancer: are the new changes to improve staging or a treatment decision tool?
  1. Cecily Quinn1,
  2. Emad A Rakha2
  1. 1 Department of Histopathology, St Vincent's University Hospital, University College, Dublin, Ireland
  2. 2 Department of Pathology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
  1. Correspondence to Dr Emad A Rakha, Department of Histopathology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; emadrakha{at}

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In a major departure from traditional anatomical staging, the eighth edition of the American Joint Committee on Cancer (AJCC) tumour, node, metastases (TNM) staging system has introduced a breast cancer Prognostic Stage that aims to incorporate and ultimately replace anatomical TNM staging for breast cancer.1 2 The newly developed Prognostic Stage combines anatomical TNM with tumour intrinsic biology, namely the Nottingham histological tumour grade1 and predictive biomarkers (oestrogen, progesterone and Her2 receptor expression), in addition to certain multigene assays in a subgroup of patients. The proposed Prognostic Stage aims to improve stratification of patients with respect to outcome.

We welcome the recognition of the well-validated power of grade as a prognostic tool.3 4 The role of hormone receptor and human epidermal growth factor receptor 2 (HER2) in predicting response to adjuvant systemic therapy is undisputed, and initial results from randomised clinical trials have produced level 1 evidence supporting the accuracy of certain multigene assays in identifying low-risk patients with breast …

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  • Handling editor Cheok Soon Lee.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.