[Adjuvant chemo- and hormone therapy of breast cancer]

During the past few years "consensus statements" on the adjuvant treatment of patients with breast cancer have been issued periodically (the last one in the spring of 1992). Many physicians have interpreted such a tabellary synopsis as a "push-button" treatment, which is, of course, beside the point, since the text of the original publications for several subgroups of patients defines this treatment as "optional". In fact, physicians cannot decide by themselves, which treatment a patient should have. All patients must be shown both sides of the medal, i.e. a small chance to live longer and the risk of side effects, and finally each individual patient has to decide for herself on the basis of "informed consent". In case of widespread acceptance, as mentioned by some authors, that nearly all patients should be treated in some adjuvant manner, a large group which does not need any adjuvant treatment at all, will remain undefined. This group comprises at least 50% of all women ever treated for primary breast cancer. All physicians should consider it to be an urgent responsibility to define this group. This can be achieved only by means of studies, which include untreated or placebo-treated controls.