Breast cancer staging and the "alert": an educational dilemma

The reports of adjuvant chemotherapy of node-negative breast cancer have provoked controversy and confusion. Introduced by an "Alert" from the National Cancer Institute, the study was erroneously interpreted by the press, patients, and physicians to include all patients with Stage I breast cancer. In fact, the study excluded small cancers for which the receptor assay could not be done, excluded women over 70 years of age, and combined Stage I and II cancers. The analysis did not utilize the established staging system taught to students and physicians and sponsored in part by the NCI. This, and the willingness of physicians to follow such messages without review of the original data, is of concern to educators.