Systemic therapy in resectable breast cancer

There is now convincing evidence that adjuvant systemic therapy for high-risk breast cancer can significantly reduce tumor mortality at 5 years. The overall treatment benefit for women with node-positive tumors may be considered moderate but clinically important. The most frequent choices of chemotherapy and hormonal therapy are discussed. In patients with node-negative receptor-negative tumors there is preliminary evidence of benefit from adjuvant combination chemotherapy. Primary (neoadjuvant) chemotherapy can allow conservative surgery in most tumors suitable for mastectomy, but this form of treatment remains, at present, experimental. Potential long-term toxicity from systemic adjuvant therapy should be continuously monitored.