The Evolution of Primary Multimodality Treatment in Resectable Breast Cancer

In the late 1970s, clinical trials by the National Surgical Adjuvant Breast Project (NSABP) and the Instituto Nazionale Tumori in Milan showed that postoperative chemotherapy significantly improved disease-free intervals in premenopausal women with Stage II breast cancer, with the Milan trial also reporting an increase in survival from 74% to 90%. Postmenopausal women in the Milan study who received 75% of their calculated drug dose also had prolonged disease-free intervals. These findings, along with the identification of the estrogen receptor as a prognostic factor, have led to further studies suggesting that national breast cancer mortality could be reduced within five years. The document also discusses the potential benefits of adjuvant therapy in postmenopausal patients and the importance of estrogen receptor status in guiding treatment. It concludes that multimodal primary treatment is beneficial for premenopausal patients with axillary lymph node involvement and that postmenopausal women also benefit from such treatment, with ongoing clinical trials being crucial for therapy improvement.