Systemic therapy as the initial step in the management of operable breast cancer

Evidence is presented to suggest that treatment of primary breast cancer may be more advantageous if begun initially with chemotherapy, to attack the systemic component of this disease which is ultimately responsible for all deaths. It is also suggested that the current widely practiced reverse policy of surgery followed by adjuvant chemotherapy is probably counterproductive and that the deeply entrenched use of Handley-Halsted tenets largely prevents acceptance of the newer evidence and adoption of change.