There is clear evidence of long-term benefits
The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) 2000 overview of adjuvant systemic treatment trials for early breast cancer has demonstrated clear evidence of substantial and significant reductions in both recurrence and mortality, with follow-up now to 15 years.1 This is the fourth EBCTCG overview of adjuvant systemic therapies, conducted at 5-year intervals since 1985.2-6 The EBCTCG 2000 analysis, based on individual patient data from 145 000 women diagnosed with early breast cancer, involved 194 trials started by 1995 in which chemotherapy and hormonal therapy were evaluated alone and in combination for their effects on recurrence, breast cancer mortality and total mortality. This overview, with data from more trials than the earlier overviews, more patients and more years of follow-up, provided new and long-term information on adjuvant chemotherapy in women aged 50–69 years, tamoxifen duration, combined modality therapy, and cause-specific mortality (Box).
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- 3. Early Breast Cancer Trialists’ Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy: 133 randomised trials involving 31 000 recurrences and 24 000 deaths among 75 000 women. Lancet 1992; 339: 1-15, 71-85.
- 4. Early Breast Cancer Trialists’ Collaborative Group. Ovarian ablation in early breast cancer: overview of the randomised trials. Lancet 1996; 348: 1189-1196.
- 5. Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998; 351: 1451-1467.
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- 8. Cuzick J, Powles T, Veronesi U, Forbes JF, et al. Overview of the main outcomes in breast cancer prevention trials. Lancet 2003; 361: 296-300.
- 9. Perez EA. TAC — a new standard in adjuvant therapy for breast cancer? N Engl J Med 2005; 352: 2346-2348.
- 10. Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor–positive breast cancer: status report 2004. J Clin Oncol 2005; 23: 619-629.
- 11. Howell A. Adjuvant aromatase inhibitors for breast cancer. Lancet 2005; 366: 431-433.
- 12. Tuma RS. Trastuzumab trials steal show at ASCO meeting. J Natl Cancer Inst 2005; 97: 870-871.
Professor John Forbes and Professor Jack Cuzick are Early Breast Cancer Trialists’ Collaborative Group collaborators.