Adjuvant systemic management of early stage carcinoma of the breast

In the last three decades, there has been a gradual, though significant cha nge in the treatment of early stage breast cancer. For almost a century, ph ysicians advocated an "anatomical view" of the dissemination of this diseas e, which justified a more radical and mutilating treatment strategy [1,2]. Finally in the mid-1970s, results from large randomized trials began to sho w that either mastectomy [3] or lumpectomy with radiation therapy [4] were appropriate treatment for women with early stage disease. These results sug gested that breast cancer can actually be a systemic disease ("biological v iew") even in early stages. This hypothesis was confirmed when large random ized clinical trials demonstrated the effectiveness of adjuvant systemic th erapy in controlling micrometastatic disease in women with node-positive [5 ] and node negative [6-8] disease. As we approach the end of this century, most patients with early stage dise ase will be offered some form of adjuvant systemic therapy, before or after local treatment with surgery, with or without local radiation therapy. The re has been a lot of interest on the proper sequence of the therapeutic mod alities, in particular with the recent publication of larger randomized tri als of primary systemic therapy [9-11]. This specific topic is discussed el sewhere in this issue by Singletary. (C) 2000 Elsevier Science Ltd. All rig hts reserved.