Clinical trials and primary breast cancer. The therapeutic implications

Determinants of Physicians’ Preferences for Alternative Treatments in Women with Early Breast Cancer

To learn about factors, that influence a physician's decision making, a mail survey was conducted asking physicians about their preferences for radical mastectomy vs. local excision plus irradiation, and for adjuvant chemotherapy vs. no adjuvant treatment for two hypothetical women with operable, clinical stage I breast cancer - one 35 years old and the other 60 years old. Two hundred and sixty-one physicians from varied specialties in Connecticut and Massachusetts returned the questionnaire. Approximately half of the respondents would accept either mastectomy or limited surgery plus radiation therapy for either patient. Adjuvant chemotherapy was recommended by 97% of respondents for the younger patient and by 66% for the older patient. Several factors appeared to be related to therapeutic preferences. An individual physician's attitude towards patient involvement in decision making was the most important predictor of surgical preference for both the patients, whereas the role of specialty (i.e., surgeons vs. other providers) was more important for the surgical management of the older patient. For the decision involving adjuvant chemotherapy, specialty, hospital size, and presence of radiotherapy equipment on site were important predictors. Factors other than survival (such as disease-free interval and cosmetic results) were viewed as important standards of effectiveness by some physicians.

Observations on Indian node-negative breast cancer patients: a multivariate analysis

The modern treatment of breast cancer has evolved over the past 100 years based on clinical observations. Therapeutic principles, from the choice of surgical procedure to the management of disseminated disease, have also changed. The axillary tumour burden, that is, the number of histologically positive nodes (N+) plays an important role as a prognostic factor. However, in histologically Negative nodes (N-), it is necessary to discriminate individuals at high risk despite negative nodes. This presentation analyses retrospectively the prognostic factors for long-term failures in N- patients. These prognostic factors need to be studied in detail, and controlled clinical trials should be carried out to detect high risk N- patients and consider them for adjuvant chemotherapy.