Management of primary breast cancer. What the past decade has taught us.

Early detection of breast cancer provides the best chance of cure. For women with stage O or clinical stage I disease, two surgical options are available, with equivalent long-term survival. An increasing number of these women are choosing lumpectomy with radiation therapy to the remaining breast tissue rather than modified radical mastectomy. Clinical stage II patients are treated with modified radical mastectomy. For premenopausal women with positive axillary lymph nodes, six months of adjuvant chemotherapy increases survival. Whether postmenopausal women with positive nodes benefit from chemotherapy is unclear. At present they are best treated in the context of a therapeutic trial. A subset of premenopausal women with stage I breast cancer have tumors that are estrogen receptor-negative and are at high risk of recurrence. These women may benefit from adjuvant chemotherapy and should be entered into a therapeutic trial.