Table 1.
Summary of the English language, interactive, web-based clinical decision tools available to support breast cancer treatment in clinical practice.
| Tool | Purpose | Population | Intervention | Characteristics | Outcome | Target User/s | Validation | Date of Last Update |
|---|---|---|---|---|---|---|---|---|
| Neoadjuvant Therapy | ||||||||
| Breast Cancer Nomogram to Predict Positive SLNs, after Neoadjuvant Chemotherapy [34,35] | The probability of finding positive SLNs in clinically node-negative breast cancer patients who have been treated with neoadjuvant chemotherapy | Women diagnosed with invasive breast cancer from 27 to 87 years who have undergone (preoperative) neoadjuvant chemotherapy | Neoadjuvant chemotherapy | Age, histologic type, nuclear grade, preoperative tumor size, percent decrease in tumor size, location of tumor in the breast (multifocal or multicentric), lymphovascular invasion, ER/PR/HER2 | Probability of positive SLNs | Physicians | Unknown/Not Externally Validated | Unknown |
| Breast Cancer Nomogram to Predict Positive SLNs, without Neoadjuvant Chemotherapy [36,37] | The probability of finding positive SLNs in breast cancer patients who have not undergone neoadjuvant chemotherapy | Women diagnosed with invasive breast cancer from 22 to 99 years who have not undergone (preoperative) neoadjuvant chemotherapy | Neoadjuvant chemotherapy | Age, location of tumor in the breast (upper inner quadrant & multifocal or multicentric), histologic type, preoperative tumor size, lymphovascular invasion, ER/PR/HER2 | Probability of positive SLNs | Physicians | Unknown/Not Externally Validated | Unknown |
| Breast Cancer Nomogram to Predict Additional Positive Non-SLN, without Neoadjuvant Chemotherapy [38,39] | The probability of finding additional positive non-SLNs in breast cancer patients found to have disease on SLN biopsy and have not undergone neoadjuvant chemotherapy | Women diagnosed with invasive breast cancer with disease on SLN biopsy who have not undergone neoadjuvant chemotherapy | Neoadjuvant chemotherapy | Histologic type, tumor size on surgical pathology, # of lymph nodes removed, # of positive SLNs with cancer, size of largest focus of metastasis in the SLN, extranodal extension in positive lymph nodes, lymphovascular invasion | Probability of positive non-SLNs | Physicians | External | Unknown |
| Breast Cancer Non-SLN Nomogram Calculator, with Neoadjuvant Chemotherapy [40,41] | The probability of finding additional positive non-SLNs in breast cancer patients found to have disease on SLN biopsy and have completed neoadjuvant chemotherapy | Women diagnosed with invasive breast cancer on SLN biopsy after neoadjuvant chemotherapy with primary tumor size <14 cm | Neoadjuvant chemotherapy | Lymphovascular invasion, detection method of SLN, multicentric primary tumor, nodal disease prior to neoadjuvant chemotherapy, pathologic tumor size | Probability of positive non-SLNs | Physicians | External [41] | Unknown |
| Response to Neoadjuvant Chemotherapy [42] | The probability of having no invasive cancer left in the breast and lymph nodes after completion of neoadjuvant chemotherapy | Women diagnosed invasive breast cancer | Anthracycline-based chemotherapy/Paclitaxel/FAC | Age, tumor size, initial diameter, histologic type, histologic grade, ER status, multicentricity | 1. Probability of achieving pathologic complete response 2. Probability of residual invasive tumor less than 3 cm 3. Probability of breast conserving surgery |
Physicians and patients | Unknown | Unknown |
| Residual Cancer Burden Calculator [43] |
The probability of residual cancer burden after neoadjuvant treatment | Women diagnosed with invasive breast cancer | Neoadjuvant treatment | Histologic assessment of primary tumor bed area, overall cancer cellularity, histologic estimate of the % of cancer that is in situ, # of positive metastatic lymph nodes, diameter of largest nodal metastasis | 1. Residual cancer burden 2. Residual cancer burden class |
Physicians and patients | Unknown | Unknown |
| Chemotherapy Response Calculator [44] | 5–10-year disease-free survival after receiving 3–4 courses of preoperative anthracycline based chemotherapy. | Women diagnosed with DCIS or invasive breast cancer who have undergone 3–4 courses of preoperative anthracycline based chemotherapy. | Preoperative anthracycline chemotherapy | Histologic type, histologic grade, ER status, tumor size, number of axillary metastatic nodes | 5/10-year disease-free probability | Physicians and patients | Unknown | Unknown |
| Radiation Therapy | ||||||||
| Breast Cancer Nomogram to Predict Benefit of Radiation for Older Patients who have undergone Breast Conserving Surgery [45,46] | 5- and 10-year risk of mastectomy with and without any radiation therapy for older women with breast cancer after breast conserving surgery | Women diagnosed with breast cancer from 66 to 79 years who have undergone breast conserving surgery | 1. Breast conserving surgery with any radiation therapy 2. Breast conserving surgery without any radiation therapy |
Age, race, tumor size, ER status, pathological nodal status | 5/10-year risk of mastectomy | Physicians and patients | Internal | Unknown |
| IBTR! Version 2.0 [47] | 10-year ipsilateral breast tumor recurrence risk with and without the addition of whole breast radiation therapy | Women diagnosed with invasive, non-metastatic breast cancer who have undergone breast conserving surgery and axillary evaluation. | 1. Whole breast radiation therapy 2. No radiation therapy |
Age, tumor size, tumor grade, margin status, lymphovascular invasion, chemotherapy, tamoxifen/aromatase inhibitor | 10-year risk of ipsilateral breast tumor recurrence | Physicians | External (Only one arm has been validated) | June 2018 |
| Surgery/Adjuvant Treatment | ||||||||
| BTxChoice [48](Limited availability (Currently only accessible through PI) | Predicted probability of 21-gene score, 10-year risk of distant recurrence, breast cancer specific mortality, and lifeyears gained with and without chemotherapy | Women diagnosed with node-negative, invasive, hormone receptor-positive, HER2-negative breast cancer |
1. Endocrine therapy alone 2. Endocrine + Chemotherapy |
Age, comorbidities, tumor size, histologic tumor grade, ER/PR status, with and without 21-gene recurrence score | 1. 10-year risk of distant recurrence 2. Breast cancer specific mortality 3. Life-years gained with and without chemotherapy |
Physicians and patients | External [48] | May 2021 |
| RSClin [30] (Limited availability: Accessible through OncotypeIQ®/Exact Sciences website) | 10-year risk of distant recurrence with and without chemotherapy | Women diagnosed with node-negative, hormone receptor-positive, HER2-negative breast cancer |
1. Endocrine therapy alone 2. Endocrine + Chemotherapy |
Age, tumor size, histologic tumor grade, ER/PR status, 21-gene recurrence score | 10-year risk of distant recurrence with and without chemotherapy | Physicians and patients | External [30] | December 2020 |
| Age Gap Decision Tool: Primary Endocrine Therapy with and without Surgery [49] | 2- and 5-year risk of breast cancer specific mortality, other-cause mortality, and all-cause mortality with endocrine therapy+/-surgery | Women from 70 to 99 years diagnosed with primary operable invasive breast cancer, tumor size (T1–4), nodes 0–2, no distant metastasis | 1. Primary endocrine therapy alone 2. Surgery + Primary endocrine therapy |
Age, tumor grade, tumor size, nodal status, individual comorbidities, frailty (Activities of Daily Living) | 1. 2/5-year risk of overall mortality 2. 2/5-year risk of breast cancer related mortality 3. 2/5-year risk of other-cause mortality |
Physicians and patients | External [50] | August 2019 |
| Age Gap Decision Tool: Surgery with and without chemotherapy [50] | 2- and 5-year risk of breast cancer specific mortality, other-cause mortality, and all-cause mortality with surgery+/-chemotherapy | Women from 70 to 99 years diagnosed with primary operable invasive breast cancer, tumor size (T1–4), nodes 0–2, no distant metastasis | 1. Surgery only 2. Surgery + Chemotherapy |
Age, tumor grade, tumor size, nodal status, ER status, HER2 status, individual comorbidities, frailty (Activities of Daily Living) | 1. 2/5-year risk of overall mortality 2. 2/5-year risk of breast cancer related mortality 3. 2/5-year risk of other-cause mortality |
Physicians and patients | Unknown | August 2019 |
| INFLUENCE [51,52] | The 1–5-year risk of locoregional recurrence in early breast cancer patients treated with radiotherapy, chemotherapy, or hormone therapy | Women from 18 to 100 years diagnosed with invasive, non-metastatic breast cancer who have undergone surgery | Hormone therapy/Chemotherapy/Radiotherapy | Age, tumor size, nodal involvement, differentiation, ER status, PR status, multifocality | 1 to 5-year risk of locoregional recurrence | Physicians and patients | External [52] | May 2021 |
| Breastconservation.com [53,54] | The preoperative risk of positive margins after breast-conserving surgery (Only for training and educational purposes) | Women diagnosed with invasive, T1-2, Nodes 0–2, non-metastatic breast cancer considering breast conserving surgery | Breast conserving surgery | Preoperative MRI availability, microcalcifications, preoperative N-stage/T-stage, remaining % of fibro glandular tissue on mammography, palpability of tumor, suspicion of multifocality, ER status, presence of DCIS in biopsy, histological type, histological grade | Risk of positive surgical margins following breast conserving surgery | Physicians | External [53,55] | October 2019 |
| PREDICT [56] | The 5-, 10- or 15-year overall, breast cancer-specific, and other-cause survival after endocrine therapy/chemotherapy trastuzumab/bisphosphonates/surgery | Women diagnosed with invasive, non-metastatic breast cancer from 25 to 85 years. Results may be less accurate for women over 80 years old | Combinations of Surgery/Endocrine therapy/Bisphosphonates/Chemotherapy/Trastuzumab | Age, menopausal stage, ER status, HER2 status, Ki-67 status, size of largest invasive tumor (before neoadjuvant treatment), tumor grade, primary breast cancer detection type, # of positive nodes, micrometastases status | 5/10/15-year overall, breast cancer-specific, and other-cause survival | Physicians and patients | External [56] | March 2020 |
| CancerMath: Therapy calculator [57] | The 15-year breast cancer-specific survival and life expectancy for hormonal therapy+/-chemotherapy | Women diagnosed with hormone receptor-positive DCIS or invasive breast cancer | Hormone therapy/Chemotherapy | Age, tumor size, # of positive nodes, nodal detail (optional), ER status, PR status, HER2 status, histological type, grade | 1. 15-year breast cancer death rate 2. Life expectancy with and without therapy |
Physicians | External [58,59] | April 2009 |
| CancerMath: Nipple involvement calculator [57] | The risk of cancer in the nipple for assistance in deciding on nipple-sparing mastectomy | Women diagnosed with early-stage breast cancer | Nipple-sparing mastectomy | Tumor size, tumor distance | Probability of nipple involvement | Physicians | External [60] | April 2009 |
| Nottingham Prognostic Index [6,61] | The 5-year overall survival which allows physicians to select those patients with an excellent prognosis after surgery alone, in whom adjuvant therapies are inappropriate | Women diagnosed with invasive early-stage node negative breast cancer who have received surgery only and are inappropriate to receive adjuvant therapies | Surgery | Tumor size, lymph node stage, histological grade | 1. 1 to 5-year overall survival 2. Annual percentage overall mortality rate |
Physicians | External [6] | June 2017 |
| Adverse Effects | ||||||||
| BRA Score [62] | A woman's 30-day and/or 1-year risk for surgical or medical complications following mastectomy with immediate breast reconstruction | Women diagnosed with breast cancer who have undergone mastectomy with immediate tissue expander or autologous reconstruction | 1. Tissue expander (30-day, 1 year) 2. TRAM flap (30 day) 3. Latissimus flap (30-day) 4. Microvascular reconstruction (30-day) 5. Single-stage implant (1-year) |
Height, weight, age, comorbidities, medication history, procedures history, American Society of Anesthesiologists physical status, radiation therapy, smoking status | 1. Overall surgical complications (surgical site infection, seroma, dehiscence, flap loss, explanation) 2. Risk of reoperation 3. 30-day surgical complications |
Physicians and patients | Internal [62] | Unknown |
| Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer [63,64] | The absolute and cumulative risk of radiation related ischemic heart disease and death by age 80 years (Designed for training and educational purposes only) | Women diagnosed with invasive, non-metastatic breast cancer from 40 to 80 years who have undergone radiation therapy | Radiation therapy | Age, mean radiation dose, laterality of breast cancer, history of ischemic heart disease, history of other circulatory disease, history of diabetes, history of COPD, current smoker, BMI, analgesic medication, hormone replacement therapy | 1.Cumulative/absolute risk of ischemic heart disease after radiation by age 80 2. Cumulative/absolute risk of death by ischemic heart disease after radiation by age 80 |
Physicians | Unknown | November 2018 |
CMF, Cyclophosphamide Methotrexate Fluorouracil; FAC, Fluorouracil, Adriamycin, and Cyclophosphamide; SLN, sentinel-lymph node; UIQ, upper inner quadrant.