[Systemic adjuvant therapy of breast cancer: myths and controversies]

The value of adjuvant systemic therapy in breast cancer patients is well established but remains essentially modest. Operable breast cancer patients with positive or negative axillary lymph nodes, will have a 20% decrease in their annual odds of death at 10 years with appropriate systemic therapy. Several questions are still open in the field of systemic adjuvant therapy. For patients with node negative disease, treatment recommendations were recently issued by a group of experts with the aim to percent over- and under-treatment. The optimal duration of tamoxifen adjuvant therapy is still debatable, as is its role in a prevention setting. In patients with 10 or more positive axillary nodes, the search for more effective therapies prompted investigators to compare standard dose chemotherapy to high dose chemotherapy. Also, the value of adding a taxoid in the adjuvant chemotherapy regimen, is tested by several research groups. Hopefully, some of these hypothesis will be translated into a greater benefit for each individual breast cancer patient.