I. Craig Henderson – författare

modalities. The single most important fact about breast cancer is the great variation in its natural history and its responsiveness to therapy from one patient to another. The clinician must integrate an assessment of the patient's likely course based on clinical and pathological staging and laboratory studies with objective evidence on the benefits of therapy. The primary aim of this book is to provide the clinician with the tools to do just that. Outcomes of clinical trials and details about commonly used drug regimens, drug dosage, and the expected side effects are summarized in generous tables and figures. Medical terminology has been defined and descriptions of the evolution in our thinking and understanding of the disease are often given to provide perspective in the interpretation of evidence from current studies for busy clinicians and trainees alike.

The results of randomized trials evaluating the use of early adjuvant systematic treatment for patients with respectable breast cancer provide a rebuttal to those who would argue that little progress has been made in the treatment of cancer. Few subjects have been so systematically studied in the history of medicine and it seems fair to conclude that the value of adjuvant systemic therapy in prolonging the lives of women with breast cancer is more firmly supported by empirical evidence than even the more conventional of primary treatments using various combinations of surgery and radiotherapy. This book reviews the rationale for, results of, special problems and future directions of adjuvant therapy of breast cancer. It also includes an appendix from the Early Breast Cancer Trialists' Collaborative Group (OXford) which lists all of the adjuvant trials which have been closed, as well as the active studies now ongoing.

The results of randomized trials evaluating the use of early or adjuvant systemic treatment for patients with resectable breast cancer provide an eloquent rebuttal to those who would argue that we have made no progress in the treatment of cancer. Many of the tumors that we have been most successful in curing with chemotherapy and other newer forms of treatment are relatively uncommon. In contrast, breast cancer continues to be the single most common malignancy among women in the western world, is increasingly a cause of death throughout Asia and Third-World countries, and remains one of the most substantial causes of cancer mortality world­ wide. The use of mammography as a means of early detection has been shown to reduce breast cancer mortality by 25-35% among those popu­ lations in which it is utilized. The use of adjuvant systemic treatment in appropriate patients provides a similar (and additional) reduction in breast cancer mortality. Few subjects have been so systematically studied in the history of medicine, and it seems fair to conclude that the value to adjuvant systemic therapy in prolonging the lives of women with breast cancer is more firmly supported by empirical evidence than even the more conventional or primary treatments using various combinations ofsurgery and radiotherapy.

X-ray mammography screening is the current mainstay for early breast cancer detection. It has been proven to detect breast cancer at an earlier stage and to reduce the number of women dying from the disease. However, it has a number of limitations. These current limitations in early breast cancer detection technology are driving a surge of new technological developments, from modifications of x-ray mammography such as computer programs that can indicate suspicious areas, to newer methods of detection such as magnetic resonance imaging (MRI) or biochemical tests on breast fluids. To explore the merits and drawbacks of these new breast cancer detection techniques, the Institute of Medicine of the National Academy of Sciences convened a committee of experts. During its year of operation, the committee examined the peer-reviewed literature, consulted with other experts in the field, and held two public workshops. In addition to identifying promising new technologies for early detection, the committee explored potential barriers that might prevent the development of new detection methods and their common usage.Such barriers could include lack of funding from agencies that support research and lack of investment in the commercial sector; complicated, inconsistent, or unpredictable federal regulations; inadequate insurance reimbursement; and limited access to or unacceptability of breast cancer detection technology for women and their doctors. Based on the findings of their study, the committee prepared a report entitled Mammography and Beyond: Developing Technology for Early Detection of Breast Cancer, which was published in the spring of 2001. This is a non-technical summary of that report.