[Operable breast cancer without axillary node involvement: current therapeutic concepts]

Although the majority of women with node-negative breast cancer will be disease-free at 10 years, 25 to 30 percent will have a recurrence and die from their disease. Therapeutic concepts for these patients are changing rapidly as a result of recently published randomized clinical trials showing a small but significant disease-free survival advantage at 4 years when adjuvant chemo- or hormonal therapy is given following surgery. This paper reviews these important trials as well as the literature pertaining to potentially new prognostic factors capable of selecting from the entire population of node-negative patients those who are truly at risk of relapsing and who are most likely to benefit from adjuvant therapy. Issues such as treatment toxicity and future directions for clinical research are also briefly discussed.