Controversies in Breast Cancer

BACKGROUND: A large number of controversies about the management of breast cancer produce uncertainties for patients and physicians alike. In addition, questions are constantly raised about the true value of new approaches or treatments. METHODS: The authors have conducted a critical review of the literature on several of these issues, and they present a balanced view that can be useful for clinical decision making. RESULTS: Although new staging systems for ductal carcinoma in situ have been proposed, a consensus has not yet been reached regarding the criteria to allow tumor excision alone. The extent of benefit of the main adjuvant therapies is becoming better established, and improvement in outcomes may accrue from dose-intensive treatments and autologous stem cell or hematopoietic growth factor support. CONCLUSIONS: Progress in breast cancer management continues to evolve. Several new approaches either reduce morbidity or improve outcomes.