The curability of breast cancer: present and future

The clinical course of breast cancer is more of a chronic nature, as compared to other, highly curable malignancies, such as testicular cancer, acute leukemia and Hodgkin's disease. Therefore, five-year and ten-year relapse-free survival is not equivalent to cure. Patients with operable breast cancer can be cured with combined modality therapies. The probability of cure is inversely proportional to initial stage. The hazard rate of relapse is highest during the first three to five years and decreases gradually thereafter. Survival curves for operable breast cancer start to parallel the survival of the general population 15 to 25 years after diagnosis. Between a quarter to a third of patients with locally advanced and/or inflammatory breast cancer are curable with combined modality strategies and a small fraction of highly selected patients with overt metastatic breast cancer have lengthy complete remissions after chemotherapy or combined modality therapy. In recent years proof of principle was obtained for chemoprevention with selective estrogen receptor modulators in several multicenter trials. Additional studies are ongoing to determine the optimal preventive intervention. (C) 2003 Elsevier Ltd. All rights reserved.