High-dose chemotherapy and autologous bone marrow support in the treatment of metastatic and primary breast cancer

Oncologists, especially British ones, are by nature a pessimistic lot. Nowhere is this pessimism as clearly evident as in the treatment of breast cancer. In 1988, the Early Breast Cancer Trialist & Cooperative group provided an overview analysis of adjuvant chemotherapy for primary breast cancer.’ At 5 years of follow-up, these investigators demonstrated a statistically improved, disease-free and overall survival supporting adjuvant chemotherapy for premenopausal women with involved lymph nodes and a trend toward improved, disease-free survival for post-menopausal women with node-positive disease (not statistically significant). Nonetheless, there were firm statements made that the use of adjuvaut therapy for postmenopausal women was ‘contraindicated’.* Now, 5 years later, continued analyses of many randomized trials has indicated a modest but consistent benefit for adjuvant chemotherapy in both preand postmenopausal women, which was not predicted by medical oncologists performing the trials.’ The same physicians, whose pessimism and conservatism was so evident just 3 years ago, now declared that ‘all patients under 70 years with early breast cancer, irrespective of their nodal or receptor status, should be told that their best survival chance lies with