Ovarian ablation as adjuvant therapy for breast cancer.

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Abstract
Ovarian ablation was the first form of systemic treatment for breast cancer. Its efficacy as a palliative treatment for young women with metastatic breast cancer was initially described by Beatson (1) in 1896. Its use as a form of adjuvant therapy was suggested shortly thereafter, and the first randomized trials of ovarian ablation in the adjuvant setting began in 1948. Although many of these early trials were small and methodologically flawed by modern standards, their combined analysis through the Early Breast Cancer Trialists' Collaborative Group (EBCTG) has unequivocally established that ovarian ablation as a single intervention reduces recurrence and increases survival for women under the age of 50 years (2). Indeed, the magnitude of the benefit is similar to that seen with adjuvant chemotherapy or tamoxifen by indirect comparison (3, 4). Thus, the possibility that the benefit conferred by adjuvant chemotherapy is in part because of its ability to induce ovarian failure has been raised.