1994 Roussel Lecture: a biologic basis for changes in breast cancer management

Cancer treatment in the past has been based on contemporary biologic understanding of the disease process. For most of this century cancer was viewed as an anatomic problem, and the treatment was surgical, with radical and extended radical operations viewed as appropriate. With improved understanding of the true biologic nature of cancer, the extent of surgery has been modified, and clinical trials have confirmed the suitability of breast-conserving surgery. At the same time, adjuvant chemotherapies have extended disease-free survival and survival for many categories of patient. Unfortunately, these gains have been of limited clinical dimensions. More recently, the genetic model of cancer has led to attempts at cancer prevention. In the biologic sense we have entered an era in which surgery is the adjuvant therapy, and systemic treatments have increased breast cancer cure rates. We must now move from a strategy that tries to kill cancer cells to one that seeks to control their growth, which may, if successful provide an approach for true cancer prevention.