Breast cancer.

Several issues of clinical importance were in the forefront of discussion during 1989. Heated debates continue regarding whether alcohol, oral contraceptives or hormonal replacement therapy modifies a patient's risk for developing breast cancer. It is quite apparent, and rightfully so, that a major impetus in the arena of research in breast cancer seems to be towards cure of the disease. The rationale for offering adjuvant systemic treatment to a larger group of primary breast cancer patients who have a potential for cure certainly seems justifiable. However, one still needs to individualize patients based on their prognosis and objectively weigh the potential benefits and risks of adjuvant therapy in a given clinical situation, especially in patients with less than 1 cm primary tumors and negative axillary nodes as they have been shown to have a 20-year recurrence-free survival of 86%. A better understanding of several molecular and genetic parameters has begun. Further developments in this area may lead to clinically appropriate means of preventing or treating this disease. Metastatic disease continues to remain an incurable entity. Efforts aimed at treating metastatic disease with more 'intensive dose chemotherapy' have not been demonstrated to be beneficial for affected patients.