Validity of the clinical alert on breast cancer

In May 1988, the National Cancer Institute issued a clinical alert calling for the routine use of systemic adjuvant therapy for all node-negative breast cancers. Subsequent review of the data that the National Cancer Institute used as a basis for its endorsement revealed several limitations, including failure to consider cost-benefit ratios and failure to exclude late toxicities. The authors conclude that the issuance of the release was premature and that it does not attempt to balance the slight lengthening of disease-free survival against the overall population costs. It is suggested that physicians individually assess the potential merits of such a treatment regimen in each of their patients with node-negative breast cancer.