Implications of adjuvant hormonal and cytotoxic chemotherapy.

The implications of medical adjuvant treatments of primary breast cancer are best appreciated from an analysis of the available data on rates of local recurrence and survival after mastectomy. Breast cancer may be considered as a systemic disease from the time of clinical presentation in most cases and its cure rate has been estimated at 18% for all cases and 30% for stages I and II combined. Advancing age seems attended by an increasing rate of dying from breast cancer. Local recurrences appear to obey the same mechanisms that govern the occurrence of distant metastases. Their appearance after mastectomy has an average or median delay of one to two years. These data are important factors that condition the indication and planning of reconstructive surgery. They form the background on which adjuvant treatments will exert their influence. Prophylactic castration is of little or no value in altering survival after mastectomy. In contrast, intensive long-term combination chemotherapy of the CMF type seems to increase the relapse-free survival and overall survival, and to decrease the rate of local recurrence specifically in premenopausal patients. It is little or not effective after the menopause. Intensive research is needed to develop better modalities of systemic adjuvant treatment in order to improve the curability of breast cancer.