[RobinP]

To Unregistered who asked-"Is this saying that if you have a low mitotic index (say 1) and high her2 score (say 6.5) that her2 is not a strong indicator and that mitotic activity is a better indicator of disease free survival"



Answer- I think the article is merely suggesting that if you have a high proliferation correlated with a high percentage of her2, than your prognosis is worse than if the proliferation index was low. That's not to say that high her2 and low proliferation index is insignificant though, and it's not to say that her2 is less of a prognostic marker than a mitotic index.



Other comments I have concerning the initial posted article is that 500 study participants was a small study. Additionally, I did not favor the method of her2 testing with IHC. I would have rather seen FISH testing, as Lani suggested. However, one thing is clear; proliferation index is a strong prognostic predictor, especially associated with her2.



Hopefully, we will see more and larger studies for very early stage her2+, node negative bc that will predict prognosis for this group clearly. We all have a pretty good idea that larger her2+ breast cancers, with and without nodal involvement are not favorable things to have. But what about node negative small invasive her2+bc such as T1 lesions; what is exactly the prognostic significance of this subset?