1994 ROUSSEL-LECTURE - A BIOLOGIC BASIS FOR CHANGES IN BREAST-CANCER MANAGEMENT

Cancer treatment in the past has been based on contemporary biologic u nderstanding of the disease process. For most of this century cancer w as viewed as an anatomic problem, and the treatment was surgical, with radical and extended radical operations viewed as appropriate. With i mproved understanding of the true biologic nature of cancer, the exten t of surgery has been modified, and clinical trials have confirmed the suitability of breast-conserving surgery. At the same time, adjuvant chemotherapies have extended disease-free survival and survival for ma ny categories of patient. Unfortunately, these gains have been of limi ted clinical dimensions. More recently, the genetic model of cancer ha s led to attempts at cancer prevention. In the biologic sense we have entered an era in which surgery is the adjuvant therapy, and systemic treatments have increased breast cancer cure rates. We must now move f rom a strategy that tries to kill cancer cells to one that seeks to co ntrol their growth, which may, if successful provide an approach for t rue cancer prevention.