Adjuvant systemic therapy for breast cancer. Issues for primary care physicians

Chemotherapy, hormone therapy, or both are used for adjuvant management in patients with breast cancer. Early systemic therapy can delay and possibly prevent the progression of micrometastatic disease. Positive axillary nodes constitute the major risk factor for later systemic disease, and most oncologists believe that all women with positive nodes should have adjuvant therapy. In patients with negative nodes, tumor size is apparently the most important factor. The prognosis is excellent when the lesion is smaller than 1 cm, and adjuvant therapy can probably be avoided. However, therapy is generally advisable when the tumor is larger than 2 cm. Although intense scheduled follow-up is beneficial for some patients, it is costly and does not always result in a survival advantage. Asymptomatic patients may do well with considerably less routine testing.