Decision-making in early breast cancer: guidelines and decision tools

The meta-analysis of trials of adjuvant systemic therapy for early breast cancer provides robust information on the impact of both cytotoxic chemotherapy and tamoxifen on relapse-free and overall survival to 15 years from diagnosis. These data are described in terms of relative risk reduction and are not meant to be viewed as a prescription for therapy. To translate relative risk reductions into absolute benefits for the individual patient and then trade off the gains against the long-term and short-term side-effects and toxicities is a highly complex process for the clinician, and current guidelines are formatted in such a way that they fail to use current information in a way that allows a quantitative assessment of the benefits and risks of adjuvant therapy. This review article explores current guidelines and describes some aids that may be used to help inform women about their treatment options for early breast cancer.