Neoadjuvant Chemotherapy Underused in Breast Cancer

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Neoadjuvant chemotherapy remains underused in triple negative and HER2-positive breast cancer, possibly because women are more likely to have their first oncology consult with a surgeon rather than a medical oncologist. 

Why This Matters

  • Guidelines recommend neoadjuvant chemotherapy for most triple negative and HER2-positive breast cancers.

  • Guidelines also recommend women consult with a medical oncologist before surgery.

  • Most women in the study were seen first by a surgeon and had surgery first.

  • The findings suggest that efforts to increase medical oncology consults before surgery could increase the use of neoadjuvant chemotherapy among eligible women.

Study Design

  • The team linked administrative datasets to review 12,881 women diagnosed with stage I-III triple negative (n = 5476) or HER2-positve (n = 7405) breast cancer from 2012-2019 in Ontario, Canada.

Key Results

  • Only 22.9% of women (n = 2952) had neoadjuvant chemotherapy as their first treatment. Among patients who had surgery first, 8.4% were seen by a medical oncologist before surgery.

  • Given that more than 60% of the women had tumors ≥ 2 cm and 40% had node-positive disease, a substantially higher percentage would be expected to receive neoadjuvant chemotherapy if guidelines were followed.  

  • Approximately 98% of women had their first consultation with a surgeon; 95% of these patients went on to up-front surgery with no medical consult.

  • On multivariable analysis, increasing tumor size and node-positive disease were associated with increased odds of receiving neoadjuvant chemotherapy.

  • Women treated at a Regional Cancer Centre were more likely to have their first consultation with a medical oncologist.


  • It’s not known if the low rates of medical oncology consultations were because surgeons did not refer women to medical oncologists or if medical oncologists declined the referrals.

  • It’s also not clear if receptor status — and hence eligibility for neoadjuvant chemotherapy — was known prior to surgery.

  • Datasets were limited to patients who had surgery. Women who had neoadjuvant chemotherapy but then declined surgery due to metastases or other reasons were not included.


  • The study was funded by the Ontario Ministry of Health and others.

  • Investigator disclosures were not reported.

This is a summary of a preprint research study, “Neoadjuvant chemotherapy for triple negative and Her2+ve breast cancer: striving for the standard of care,” led by Amanda Roberts of Sunnybrook Health Sciences Centre, Toronto, Canada, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].

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