The RxPonder trial demonstrated that the benefit of chemotherapy for post-menopausal women with ER+ IBC depends on tumor biology, and thus the Oncotype Dx score rather than the identification of nodal metastases now largely dictates whether a patient receives chemotherapy.25 The potential benefit of adjuvant radiotherapy for women 70 years of age or older with ER+/HER2– IBC who have tumor-involved lymph nodes is of greater debate. This evidence concerns the gene ESR1 and inflammatory breast carcinoma.