[Therapeutic advances in breast neoplasms achieved through multimodal treatment]

The epidemiology of breast cancer and the frustrating stagnation of present primary care by local means such as surgery (with or without postoperative radiotherapy) are reviewed. The unsolved problem of early occult micrometastases in breast cancer--as in many other tumors--renders unlikely any real further progress towards higher curability in mammary carcinoma by "optimizing" or even "minimizing" local therapy alone. In contrast, higher remission rates and prolonged tumor control in metastatic breast cancer have been achieved during the last 10 years by advances in combination chemo- or chemo-hormono-therapy. Current controlled studies with adjuvant chemotherapy added to radical mastectomy show encouraging results, such as decreased over-all recurrence rates within 3--4 years and possibly also increased survival. Recent data of Swiss and foreign randomized adjuvant studies in primary breast cancer are reviewed and analyzed. Since mode of administration, duration and patient selection are not yet sufficiently clarified and standardized, routine use of "adjuvant chemotherapy" cannot be advocated on a large scale basis at the present time. There is, however, an urgent need for controlled patient trials with the inclusion of hormonal and possibly immunological "adjuvant regimens", to assure critical evaluation of clinical benefit and protect future patient cohorts from the possible long-term risks of additional primary cytotoxic therapy.