Status of adjuvant chemotherapy in patients with breast cancer

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Abstract
The clinical behavior of breast cancer in the human female is characterized by inconsistency. Without question, however, the clinical management of this disease in all stages has resulted in the improved quality and quantity of life. The histologic evidence of axillary lymph node involvement correlates well in a number of series with ultimate prognosis. The ability to characterize high-risk groups for recurrent disease set the stage for surgical adjuvant clinical trials in humans. As the chemotherapeutic management of advanced breast cancer patients improved as well, it seemed logical to attempt to treat patients with evidence of lymph node involvement with an adjuvant program in addition to surgical extirpation. The early results of a number of clinical trials in the surgical adjuvant setting has clearly shown that this concept was worth testing; a biologic effect has been observed with the most pronounced effect in younger women. Improved disease-free intervals occurred and ultimate survival seems to have been affected. The ultimate cure for the majority of females with operable but prognostically unfavorable breast cancer has not as yet been reached however. Thus, in an appropriately highly charged research atmosphere the "routine" management of this disease has as yet to be demonstrated.