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This RRCR-conference-volume marks "number six" in a 20-year
evolution of international conferences on the adjuvant therapy of
primary breast cancer. Starting in 1978, a handful of some 80 en
thusiastic breast cancer surgeons and oncologists, met in a se
cluded mountain resort near st. Gallen in Eastern Switzerland, to
exchange their early data of some pioneer trials on adjuvant sys
temic therapy of early breast cancer, and to correlate their future
research efforts to overcome the frustrating prognostic stagna tion
of this dominant neoplastic disease in Western females dur ing the
past decades. Repeated every 3-4 years, these St. Gallen
International Conferences on Adjuvant Therapy of Primary Breast
Cancer have continuously grown in numbers of partici pants and in
normative, therapeutic influence by being published in major
oncology journals 1-3], the last (6th) conference hav ing taken
place from February 25-28, 1998 with more than 1800 attendees from
over 50 countries worldwide. What is the fascination of adjuvant
therapy in primary (early) breast cancer, and what has changed,
during the last 3 years since March 1995, to justify another
international gathering of this size, and of the world's leading
experts in the field? There is no question, that providing even
more effective care and designing appropriate recommendations for
the multitudes of patients with so-called early breast cancer or at
high risk of developing the disease, remain highly important public
health goals."
Key questions involved in the treatment of disseminated breast
cancer are discussed in this well-presented overview. It is the
result of an initiative taken by the Swiss Group for Clinical
Cancer Research to reveal the most recent developments in
experimental and clinical research. The topics discussed include:
the comparison of in vitro cultures of epithelial cells with breast
cancer cells, the effect of steroids and their antagonists, the
involvement of suppressor genes in tumour progression, the
modulation of transforming growth factors by estrogen, and
prognostic factors such as cERB-2 and EGF-R in breast cancer.
We often hear physicians, health care professionals, poli ticians,
and patient advocates that "nothing has happened in the treatment
of breast cancer," since patients with breast cancer, the most
frequent neoplastic condition in women in industrialized countries,
are continuing to suffer relapse and succumb to this dreadful
disease This negativistic attitude does not seem to be justified,
but, why is the transmission of clinical trial results into general
practice, and with it progress, such a slow process? After many
decades of frustrating stagnation of long-term survival
expectations, in all stages of early, oper/lble breast cancer
treated only by surgery and locoregional radio therapy, adjuvant
systemic therapy (chemo- as well as endocrine treatments) clearly
showed to significantly benefit in terms of disease-free and
overall survival. This evolution has been extensively expounded on
by the Worldwide Oxford Overview and the Expert Consensus Panel at
the fourth International Conference 'on Adjuvant Therapy of Primary
Breast Cancer in St. Gallen (Early Breast Cancer Trialists'
Collaborative Group 1992; Glick et al. 1992). What has happened
since then? During the past 3-5 years, several new concepts and
treatment strategies have emerged and have been studied in various
major breast cancer groups and treatment centers worldwide. Some of
these can already be considered to assist in the primary treatment
of operable breast cancer today, while others are . still
undergoing clini, cal trials for better definition of their
practical usefulness."
Advances in breast cancer research, achieved through the progress
of knowledge and development of new therapies, have been translated
into improved quality of care for breast cancer patients. Clinical
investigations and clinical trials have made the largest
contribution to the body of knowledge that finds its way to the
patient. Never before during the past decades of management of
breast cancer has there been such a fruitful intellectual
cross-fertilization of ideas among individuals involved in the
generation of hypotheses, basic research, development of drugs and
treatments, conduct of clinical trials, and statistical evaluation
- the results of all of which are now translated into progress in
clinical care. Even issues such as the quality of life of breast
cancer patients, once the domain for few, are now being openly
addressed by trials and discussed in a much broader forum. The IVth
International Conference on the Adjuvant Therapy of Primary Breast
Cancer, also known as the st. Gallen Conference, was again attended
by more than 800 scientists and clinicians interested in this broad
spectrum of breast cancer research and the interactions between
such diverse fields of interest and specialties as cancer
pathology, molecular biology, and psychosocial oncology. This
volume collects findings and conclusions presented at the
conference.
The ultimate "consumer" of the data presented at conferences on the
primary treatment of operable breast cancer is the patient, and
when, as in this disease, the benefits of therapy are relatively
mod est, the availability and interpretation of the data from
trials be comes an issue of primary importance. The effects of
present treat ment are in fact such that more patients relapse
despite therapy than are estimated to benefit from it. It is,
therefore, extremely dif ficult for the physician to recommend
unequivocally one particular adjuvant treatment modality for the
vast population of women with breast cancer. The interpretation of
results from clinical research-oriented pro grams is constantly
applied, however, in the treatment of breast cancer patients
outside of clinical trials. From presented or publish ed data, many
physicians extrapolate indications for the use of a given treatment
regimen for their patients, perceiving it as the "best available
therapy. " It is essential that the "best available therapy" be
selected individually for each patient. However, considering the
modest effect of treatment upon outcome, it is imperative that
those who provide the data - those who are involved in both pa
tient care and clinical research - make it known that the best cur
rent treatment for the population of breast cancer patients is
avail able within the framework of clinical trials. In this way not
only present-day patients but also future ones will derive the
greatest benefit.
The European School of Oncology came into existence to respond to a
need for informa tion, education and training in the field of the
diagnosis and treatment of cancer. There are two main reasons why
such an initiative was. considered necessary. Firstly, the teaching
of oncology requires a rigorously multidisciplinary approach which
is difficult for the Univer sities to put into practice since their
system is mainly disciplinary orientated. Secondly, the rate of
technological development that impinges on the diagnosis and
treatment of cancer has been so rapid that it is not an easy task
for medical faculties to adapt their curricula flexibly. With its
residential courses for organ pathologies and the seminars on new
techniques (laser, monoclonal antibodies, imaging techniques etc.)
or on the principal therapeutic controversies (conservative or
mutilating surgery, primary or adjuvant chemotherapy, radiotherapy
alone or integrated), it is the ambition of the European School of
Oncology to fill a cultural and scientific gap and, thereby, create
a bridge between the University and Industry and between these two
and daily medical practice. One of the more recent initiatives of
ESO has been the institution of permanent study groups, also called
task forces, where a limited number of leading experts are invited
to meet once a year with the aim of defining the state of the art
and possibly reaching a consensus on future developments in
specific fields of oncology.
This book provides the reader with up-to-date information on
important advances in the understanding of breast cancer and
innovative approaches to its management. Current and emerging
perspectives on genetics, biology, and prevention are first
discussed in depth, and individual sections are then devoted to
pathology, imaging, oncological surgery, plastic and reconstructive
surgery, medical oncology, and radiotherapy. In each case the focus
is on the most recent progress and/or state of the art therapies
and techniques. Further topics to receive detailed consideration
include particular conditions requiring multidisciplinary
approaches, the investigation of new drugs and immunological
agents, lifestyle and psychological aspects, and biostatistics and
informatics. The book will be an excellent reference for
practitioners, interns and residents in medical oncology, oncologic
surgery, radiotherapy, pathology, and human genetics, researchers,
and advanced medical students.
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