Table 3.

Systemic treatment recommendations for subtypes

‘Subtype’	Type of therapy	Notes on therapy
‘Luminal A’	Endocrine therapy alone	Few require cytotoxics (e.g. high nodal status or other indicator of risk: see text).
‘Luminal B (HER2 negative)’	Endocrine ± cytotoxic therapy	Inclusion and type of cytotoxics may depend on level of endocrine receptor expression, perceived risk and patient preference.
‘Luminal B (HER2 positive)’	Cytotoxics + anti-HER2 + endocrine therapy	No data are available to support the omission of cytotoxics in this group.
‘HER2 positive (non luminal)’	Cytotoxics + anti-HER2	Patients at very low risk (e.g. pT1a and node negative) may be observed without systemic adjuvant treatment.
‘Triple negative (ductal)’	Cytotoxics
‘Special histological types’*
A. Endocrine responsive	Endocrine therapy
B. Endocrine nonresponsive	Cytotoxics	Medullary and adenoid cystic carcinomas may not require any adjuvant cytotoxics (if node negative).

^*Special histological types: Endocrine responsive (cribriform, tubular, and mucinous); Endocrine nonresponsive (apocrine, medullary, adenoid cystic and metaplastic).