Adjuvant Therapy for All Patients With Breast Cancer?

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Abstract
In this issue of the Journal, Fisher et al. (1) from the National Surgical Adjuvant Breast and Bowel Project (NSABP) provide a retrospective analysis of the prognosis and treatment of patients with tumors 1 cm or less and negative axillary lymph nodes. They address a critical question about adjuvant therapy decision making: whether or not these therapies should be applied to patients with tumors smaller than 1 cm. They examine a series of contributory randomized trials conducted by the NSABP over the past quarter century and conclude, “chemotherapy and/or tamoxifen should be considered for the treatment of women with ER [estrogen receptor]-negative or ER-positive tumors of 1 cm or less and negative axillary lymph nodes.” This finding is a paradigm-shifting conclusion, especially in regard to chemotherapy, and we believe that this conclusion needs to be examined carefully.