[Breast carcinoma--adjuvant chemo- and hormone therapy]

Abstract

Many cases of early breast cancer appear to be restricted to the breast and perhaps the axillary lymph nodes, but may relapse if given local treatment only. This fact points to the presence of occult micrometastases present at diagnosis. Fisher was among the first to pinpoint this problem, and to establish the concept of adjuvant systemic treatment in early operable breast cancer. The pioneering work of Fisher, Bonadonna and others has now largely been confirmed in many prospective trials. Adjuvant systemic treatment works in terms of improving disease-free and overall survival of women with breast cancer. Postmenopausal women benefit from tamoxifen supplemented by chemotherapy given according to specific risk profiles. Chemotherapy is the treatment basis in premenopausal women, but hormonal manipulation (either tamoxifen or derivatives thereof, or cessation of ovarian function) may perhaps also offer benefit. Dose intensity of chemotherapy has been shown to be important in breast cancer. Thus, high dose chemotherapy protocols with reinfusion of peripheral blood haematopoietic stem cells are being evaluated in prospective trials. It seems important to await the mature results of these trials before this potentially very effective but extremely toxic and expensive treatment is being offered on a routine basis. Examined under the stringent criteria of evidence-based medicine, the literature on adjuvant systemic treatment of breast cancer has certainly stood the test of time. It would, however, seem prudent not to abandon the tradition of clinical studies, and to continue to accrue women with this frequent disorder in clinical trials. Sadly, this possibility is rather neglected by many clinicians working outside large university and other hospital centers, and these colleagues would be kindly invited to participate actively in trials offered by collaborative groups such as the IBCSG.