Breast cancer--a medical disease?

The treatment of breast cancer has changed significantly over the last 20 years. It is now believed that breast cancer usually spreads early and that removal of neither lymph nodes nor the breast prolongs survival, although these procedures do improve local control of the disease. Involvement of lymph nodes is prognostically important as a reflection of the body's defenses against spreading cancer cells. Systemic adjuvant therapy with tamoxifen improves survival in estrogen receptor (ER)-positive women and chemotherapy does so in ER-positive or negative women. This article gives an overview of the evolution in the treatment of breast cancer over the past 20 years, and describes the Breast Cancer Prevention Trial (BCPT) and several trials of adjuvant therapy which are now being conducted by the National Surgical Adjuvant Breast Project (NSABP).