AJCC Staging Criteria

The New Cancer Staging Paradigm

In January of 2018, cancer staging will enter a new era. For the first time, the American Joint Committee on Cancer (AJCC) will include genomic diagnostics as part of the standard pathology workup for early breast cancer patients (T1-2, N0, M0) in the 8th edition of the cancer staging manual. The only test recognized with Level 1 evidence is Oncotype DX.

Inclusion of Oncotype DX

After an extensive evidence review, the AJCC has decided to include the Oncotype DX Breast Recurrence Score test in the Prognostic Staging tables to stage node-negative breast cancer patients. The Level 1 evidence supporting this decision includes prospective outcomes on over 63,000 breast cancer patients.1-5


A Surgeon’s Perspective on the Evolution of Breast Cancer Staging

Anthony Lucci, M.D., Professor of Breast Surgical Oncology at MD Anderson Cancer Center puts the 8th Edition AJCC Staging Manual into historical context.

Restaging Early Breast Cancer

AJCC RestagingThe inclusion of genomic test results into staging protocols will enable some patients to be downstaged versus traditional TNM staging criteria alone. For a patient who has an Oncotype DX Breast Recurrence Score of less than 11, a cancer that would previously have been classified as Stages IB-IIIA will be effectively downstaged as Stage IA. To be eligible for restaging with Oncotype DX, the patient’s cancer must be T1-2 (<5 cm), node-negative, metastasis-negative, and must also be ER-positive and HER2-negative.

Implementing the New Criteria

AJCC CalendarPublished in late 2017, the 8th Edition AJCC Staging Manual will officially go into effect on January 1, 2018. However, clinicians are free to use the scientific content of the 8th Edition immediately.

Prognostic Stage Groups

The new prognostic stage groups are based on the addition of biologic and genomic factors to the anatomic factors that have traditionally been used in cancer staging.

Prognostic Stage Group

1 Genomic Test, 2 Points of Clarity

As the only genomic test recognized by the AJCC for Level 1 evidence, the Oncotype DX Breast Recurrence Score uniquely provides two points of clinical clarity. By ordering a single test, clinicians not only gain additional prognostic information useful for staging the patient, but also gain insight on the likely benefit of adjuvant chemotherapy.

AJCC One Test Two Clarity

1. Sparano et al. N Engl J Med. 2015.
2. Roberts et al. Breast Cancer Res Treat. 2017.
3. Shak et al. ESMO 2016.
4. Stemmer et al. npj Breast Cancer. 2017.
5. Nitz et al. Breast Cancer Res Treat. 2017.

a. DOI: 10.1007/s10549-017-4358-6
b. DOI: 10.1038/s41523-017-0034-6

Get the Breast Chapter Update

As of 11/9/17, AJCC updated its 8th Edition Cancer Staging Manual chapter on breast cancer. This update includes an additional year's worth of data from the National Cancer Database (NCDB).

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Prospective Outcomes:
WSG Plan Ba

Recently released 5-year data from the West German Study Group on disease-free survival in N+ and high-risk N0 breast cancer patients.

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Clinical Validation:

Clalit Health Services' registry analysis complements findings from TAILORx, SEER, and WSG.

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