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buy cialis generic In fact, given that proliferation is a continuum in ER positive cancers and that proliferation is a strong determinant of outcome in this group of tumors, the allocation of ER positive breast cancer patients into good or poor prognosis by using other microarray based methods for example, MammaPrint and genomic grade index or into low, intermediate, or high histological grade should be considered arbitrary to some extent see Multigene prognostic signatures section