Adjuvant Therapy for Breast Cancer: Current Controversies and Future Prospects

Carcinoma of the breast remains the most common cancer in women in the United States. It is exceeded only by lung cancer as a cause of cancer death in women. In 1980, the National Institutes of Health (Bethesda, MD) held a consensus develop-ment conference that addressed the efficacy of adjuvant chemo-therapy in breast cancer (1). In 1985, another conference was held that addressed the survival benefit associated both with adjuvant chemotherapy and with adjuvant hormonal therapy for women with primary breast cancer (2). In 1990, at the time of the last consensus development conference (3), breast cancer ap-peared to be increasing modestly nationally, partly because of increased detection of early breast cancer by the growing use of screening mammography. The mortality rate in 1990 appeared to be absolutely flat. The consensus conference held 10 years ago concluded that breast conservation therapy was appropriate fo