Although breast cancer presents as localized disease and is treated with local modalities, i.e. surgery and radiotherapy, patients die with metastatic disease.
For patients with positive nodes, the recurrence rates are well known. It is this group of patients who should receive more aggressive treatment. Chemotherapeutic regimens are available that cause responses in patients with advanced disease in the range of 20% to 6570, with about 15% complete responses The current paper deals with the application of several chemotherapeutic regimens at the time of surgery in those patients at high risk. The preliminary results indicate a significant decrease in the recurrence rates. Additional studies combining chemotherapy and hormonal procedures are mentioned. Concn 36:633-637, 1975. REAST CANCER WILL CAUSE AN ESTIMATED B 35,000 deaths this year in the United
States. Moreover, 1 of 15 women will be victims of this disease in their lifetime, and 90,000 new cases will occur this year.' Yet, when one examines the extent of disease at initial presentation and the type of therapy applied to the patients, 90% of patients present with localized or regional disease. Moreover, the type of treatment applied is most often local modalities of surgery and radiotherapy. Examining data from the End Results Section of the National Cancer Institute, one sees a relative lack of change in the overall statistics for the various disease stages over the last 30 years.' To change these statistics, we must begin to segregate those patients with truly localized disease, defined as a 90% or more probability of survival at 10 years, from those who will die of their disease despite apparent localized disease at the onset.
In the current paper I will attempt to develop the rationale for a combined modality approach where one utilizes systemic treatments with chemotherapy, endocrine therapy, and immunotherapy at the time when local therapy is