Progress from clinical trials on breast cancer

The current management of carcinoma of the breast is very different than it was a relatively few years ago. The improvements in care have been introduced into practice as a result of clinical trials. From the nonrandomized but controlled clinical trial of radical mastectomy by William S. Halsted demonstrating that locoregional control could be dramatically improved, trials have become considerably more sophisticated in both design and analysis. Randomized clinical trials of breast conservation therapy were begun in Milan by Dr. Veronesi. Trials by the National Surgical Adjuvant Breast and Bowel Program headed by Dr. Bernard Fisher have, with other trials, defined the benefits and techniques of this less morbid treatment approach. Improvements in survival have also emerged from randomized clinical trials of adjuvant systemic therapy. Although these improvements are significant, they do not eliminate the risk of death from breast cancer. Much remains to be answered in the clinical management of breast cancer. Clinical trials will assess new developments and introduce improvements to clinical practice. Funding for research in breast cancer must support basic investigation into the biology of the disease process, new approaches to control disease, and clinical trials to test therapeutic principles and techniques.