© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 2, 80-82,
January 17, 2001
© 2001 Oxford University Press
EDITORIAL |
Adjuvant Therapy for All Patients With Breast Cancer?
Affiliation of authors: Breast Cancer Program, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC.
Correspondence to present address: Marc E. Lippman, M.D., Department of Internal Medicine, University of Michigan Health System, 3101 Taubman Health Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109–0368 (e-mail: Lippmanm@umich.edu).
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.
The question is probably not whether chemotherapy works at all in
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