[Adjuvant chemotherapy in breast cancer--is omission an error?]

Adjuvant chemotherapy in women with breast cancer is currently regarded as standard procedure. An efficacy of 10-20% can only be viewed as modest, even if a statistically significant prolonging of disease-free interval and overall survival has been established. The value of this mode of therapy is questionable because 80-90% of patients are subjected to chemotherapy with no effect, i.e. they would either have remained well regardless, or they are primarily resistant. In both cases, they are prone to suffering significant side effects. The cost-benefit ratio also needs to be taken into consideration. It is therefore recommended that the therapeutic effect is depicted in absolute percentages and not in relative percentages and absolute numbers. Only rendering the results as absolute percentages allows a true comparison between the small number of patients who benefit and the vast majority who do not. Even if this mode of therapy is regularly implemented worldwide by doctors, requested by patients and understandably backed by industry, the central question remains: 'How great do the benefits of a particular therapy have to be, in order to justify its use? Who should set the limits?' For the time being it therefore does not appear to be a mistake not to subject the patients in question to chemotherapy, unless they are part of a study.