Commentary on September 1985 NIH Consensus Development Conference on Adjuvant Chemotherapy for Breast Cancer

The conservative recommendations of the second (1985) NIH Consensus Development Conference on Adjuvant Chemotherapy for Breast Cancer may result in needless premature deaths. The failure to recommend chemotherapy for high-risk postmenopausal patients is contrary to current practice among American oncologists. A recent Chemotherapy Foundation survey of medical oncologists revealed that 75% employed adjuvant polychemotherapy for high-risk postmenopausal women. Valid statistical data supporting the survival benefit of tamoxifen are derived from both Stage I and Stage II postmenopausal patients. While recommending tamoxifen as treatment of choice for Stage II, the Consensus lost an opportunity to encourage increased survival in Stage I patients and also discouraged chemoprevention trials such as those now underway in England. The curative potential of chemotherapy for high-risk women regardless of age was ignored despite several large studies ongoing now for 8-19 years which indicate 10-27% increased disease-free survival. As many as 10,000-15,000 lives per year could be saved in the United States by more realistic recommendations and the application of early aggressive chemotherapy for high-risk patients and tamoxifen for Stage I postmenopausal patients.