As of 1985, we continue to investigate better methods of treatment in an attempt to “break the cure barrier” in metastatic breast cancer. While clinical researchers probe new and more aggressive avenues of treatment in controlled clinical trials, the goal of the community practitioner in metastatic disease should be palliation, using the least toxic therapies available. In primary breast cancer, exciting new leads using adjuvant cytotoxic chemotherapy or tamoxifen, either alone or in combination, hold promise for improved cure rates in the decade to come. The community practitioner should avoid extrapolation from any of the ongoing adjuvant trials to the clinic since these trials are still in their early phases of follow-up (<10 years). If it could be accomplished, greater participation by community medical, surgical, and radiation oncologists in current adjuvant clinical trials could result in more rapid solutions to our most pressing questions regarding systemic therapies of breast cancer.
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