Treatment of breast cancer: its progress and its limits

Conservative surgical treatment has replaced mastectomy in the treatment of many breast cancers in the first clinical stages. This treatment introduces the risk of local recurrences which should always be prevented by radiotherapy. A better local control after conservative treatment or mastectomy might increase the cure rate. However, this is still open to controversy. In the case of more locally advanced tumors, a neoadjuvant chemotherapy decreases the risks of local recurrences but does not improve survival. The benefit of medical adjuvant treatment presented up to 10 and 15 years in the meta-analysis are reserved. The nature of the benefit, short delay in additional survival or cure of some patients is discussed. The effects of chemotherapy are most likely partly secondary to an action on the ovaries since the results are much more apparent in premenopausal patients. Comparative trials with new chemical or biological agents are still necessary. Up to now the benefit brought by the mammographic screening seems to be more important than the therapeutic progress itself.