Curveball.

Think you’ve got the breast cancer basics down? Think again. The AJCC eighth edition for breast cancer staging is here. And it’s no joke. It goes way beyond standard anatomical considerations by incorporating biological factors such as tumor grade, receptor status, and even gene expression prognostic panels to create almost 200 unique combinations. So the obvious first question is: Do we really have to use this? According to a staging validation study published last week in Jama Onc, yes. Across two large, independent, prospectively obtained cohorts of stage I-III breast cancer patients receiving upfront definitive surgery, the new system restaged over half of all patients and predicted disease-free survival significantly better than previous anatomic staging. The good news? You don’t have to risk carpal tunnel making a stack of 200 8th ed. flashcards. Creators of the new staging note it is intentionally open to fluidity given the continuous bombardment of new data. For instance, it currently includes Oncotype DX as the only applicable gene expression profile, while the subsequent MINDACT and PROMIS trials have already made solo genomic testing so last month. Online staging calculators will need to update staging algorithms regularly, and, luckily, there’s already an app for that.