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Originally published as JCO Early Release 10.1200/JCO.2002.02.026 on July 9 2002

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Journal of Clinical Oncology, Vol 20, Issue 17 (September), 2002: 3628-3636
© 2002 American Society for Clinical Oncology

Revision of the American Joint Committee on Cancer Staging System for Breast Cancer

By S. Eva Singletary, Craig Allred, Pandora Ashley, Lawrence W. Bassett, Donald Berry, Kirby I. Bland, Patrick I. Borgen, Gary Clark, Stephen B. Edge, Daniel F. Hayes, Lorie L. Hughes, Robert V.P. Hutter, Monica Morrow, David L. Page, Abram Recht, Richard L. Theriault, Ann Thor, Donald L. Weaver, H. Samuel Wieand, Frederick L. Greene

From the University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine, Houston, and Scott and White Memorial Hospital, Temple, TX; University of California Los Angeles–Jonsson Comprehensive Cancer Center, Los Angeles, CA; University of Alabama at Birmingham, Birmingham, AL; Memorial Sloan-Kettering Cancer Center, New York, and Roswell Park Cancer Institute, Buffalo, NY; University of Michigan, Ann Arbor, MI; WellStar Kennestone Hospital, Atlanta, GA; International Union Against Cancer representative, Livingston, NJ; Northwestern University, Chicago, IL; Vanderbilt University Medical Center, Nashville, TN; Beth Israel Deaconess Medical Center, Boston, MA; University of Oklahoma Health Science Center, Oklahoma City, OK; University of Vermont, Burlington, VT; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; and Carolinas Medical Center, Charlotte NC.

This article was published ahead of print at www.jco.org.Address reprint requests to S. Eva Singletary, MD, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 444, Houston, TX 77030-4095; email: esinglet{at}mdanderson.org

PURPOSE: To revise the American Joint Committee on Cancer staging system for breast carcinoma.

MATERIALS AND METHODS: A Breast Task Force submitted recommended changes and additions to the existing staging system that were (1) evidence-based and/or consistent with widespread clinical consensus about appropriate diagnostic and treatment standards and (2) useful for the uniform accrual of outcome information in national databases.

RESULTS: Major changes included the following: size-based discrimination between micrometastases and isolated tumor cells; identifiers to indicate usage of innovative technical approaches; classification of lymph node status by number of involved axillary lymph nodes; and new classifications for metastasis to the infraclavicular, internal mammary, and supraclavicular lymph nodes.

CONCLUSION: This revised staging system will be officially adopted for use in tumor registries in January 2003.


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N. Engl. J. Med., December 30, 2004; 351(27): 2817 - 2826.
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S.-J. Kim, S.-k. Kim, E. S. Lee, J. Ro, and S. h. Kang
Predictive value of [18F]FDG PET for pathological response of breast cancer to neo-adjuvant chemotherapy
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J. L. Pater
Treatment of locally advanced breast cancer
Can. Med. Assoc. J., August 3, 2004; 171(3): 220 - 221.
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H. J. Burstein, K. Polyak, J. S. Wong, S. C. Lester, and C. M. Kaelin
Ductal Carcinoma in Situ of the Breast
N. Engl. J. Med., April 1, 2004; 350(14): 1430 - 1441.
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G. V. Glinsky, T. Higashiyama, and A. B. Glinskii
Classification of Human Breast Cancer Using Gene Expression Profiling as a Component of the Survival Predictor Algorithm
Clin. Cancer Res., April 1, 2004; 10(7): 2272 - 2283.
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K. Pantel, V. Muller, M. Auer, N. Nusser, N. Harbeck, and S. Braun
Detection and Clinical Implications of Early Systemic Tumor Cell Dissemination in Breast Cancer
Clin. Cancer Res., December 15, 2003; 9(17): 6326 - 6334.
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I. A. Olivotto, P. T. Truong, and C. H. Speers
Staging Reclassification Affects Breast Cancer Survival
J. Clin. Oncol., December 1, 2003; 21(23): 4467 - 4468.
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S. H. Giordano
Update on Locally Advanced Breast Cancer
Oncologist, December 1, 2003; 8(6): 521 - 530.
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S. B. Edge, J. C. Niland, M. A. Bookman, R. L. Theriault, R. Ottesen, E. Lepisto, and J. C. Weeks
Emergence of Sentinel Node Biopsy in Breast Cancer as Standard-of-Care in Academic Comprehensive Cancer Centers
J Natl Cancer Inst, October 15, 2003; 95(20): 1514 - 1521.
[Abstract] [Full Text] [PDF]

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A. Goldhirsch, W. C. Wood, R. D. Gelber, A. S. Coates, B. Thurlimann, and H.-J. Senn
Meeting Highlights: Updated International Expert Consensus on the Primary Therapy of Early Breast Cancer
J. Clin. Oncol., September 1, 2003; 21(17): 3357 - 3365.
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W. A. Woodward, E. A. Strom, S. L. Tucker, M. D. McNeese, G. H. Perkins, N. R. Schechter, S. E. Singletary, R. L. Theriault, G. N. Hortobagyi, K. K. Hunt, et al.
Changes in the 2003 American Joint Committee on Cancer Staging for Breast Cancer Dramatically Affect Stage-Specific Survival
J. Clin. Oncol., September 1, 2003; 21(17): 3244 - 3248.
[Abstract] [Full Text] [PDF]

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M. Kaufmann, G. von Minckwitz, R. Smith, V. Valero, L. Gianni, W. Eiermann, A. Howell, S. D. Costa, P. Beuzeboc, M. Untch, et al.
International Expert Panel on the Use of Primary (Preoperative) Systemic Treatment of Operable Breast Cancer: Review and Recommendations
J. Clin. Oncol., July 1, 2003; 21(13): 2600 - 2608.
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S. B. Edge and D. G. Sheldon
Counterpoint: Sentinel Lymph Node Biopsy Is Not Indicated for Ductal Carcinoma In Situ
J Natl Compr Canc Netw, April 1, 2003; 1(2): 207 - 212.
[Abstract] [PDF]

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Y. Kang, L. D'Hondt, M. Andre, J.-L. Canon, D. Yee, I. Rabinowitz, I. Bedrosian, S. L. Tucker, and K. Keyomarsi
Cyclin E in Breast Cancer
N. Engl. J. Med., March 13, 2003; 348(11): 1063 - 1064.
[Full Text] [PDF]

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I. A. Olivotto, B. Chua, S. J. Allan, C. H. Speers, S. Chia, and J. Ragaz
Long-Term Survival of Patients With Supraclavicular Metastases at Diagnosis of Breast Cancer
J. Clin. Oncol., March 1, 2003; 21(5): 851 - 854.
[Abstract] [Full Text] [PDF]

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C. A. Bunnell and E. P. Winer
Lumping Versus Splitting: The Splitters Take This Round
J. Clin. Oncol., September 1, 2002; 20(17): 3576 - 3577.
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