Breast cancer is the leading cause of death among solid
tumours in women, and its incidence is increasing in the
West. Adjuvant chemotherapy and hormonal treatment
improve survival but have potentially serious side effects,
and are costly. Because adjuvant treatment should be given
to high risk patients only, and traditional prognostic factors
(lymph node status, tumour size) are insufficiently accurate,
better predictors of high risk and treatment response are
needed. Invasive breast cancer metastasises
haematogenously very early on, so many breast cancer
prognosticators are directly or indirectly related to
proliferation. Although studies evaluating the role of
individual proliferation regulating genes have greatly
increased our knowledge of this complex process, the
functional end result—cells dividing—has remained the
most important prognostic factor. This article reviews the
prognostic value of different proliferation assays in invasive
breast cancer, and concludes that increased proliferation
correlates strongly with poor prognosis, irrespective of the
methodology used. Mitosis counting provides the most
reproducible and independent prognostic value, and
Ki67/MIB1 labelling and cyclin A index are promising
alternatives that need methodological fine tuning
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