Progress in breast cancer management

Nearly 50 years have passed since the first demonstration that adjuvant multiagent chemotherapy could reduce the risk of breast cancer recurrence.1 More than 2 million individuals globally are diagnosed with breast cancer every year, causing over 600 000 yearly deaths.2 The demonstration of the benefit of adjuvant chemotherapy reshaped the paradigm of treatment for operable breast cancer in a durable way; even today, most patients diagnosed with breast cancer receive some form of (neo)adjuvant systemic treatment to improve long-term outcomes.3 Although the overall paradigm of systemic treatment has remained, much has changed in 50 years. Clinicians now better understand, diagnose, and surgically and medically treat breast cancer, all features that are reflected in improved long-term outcomes. To provide a historical benchmark, only a humbling 26% of the patients in the pivotal chemotherapy study by Bonadonna and colleagues4 were free from recurrence after 20 years of follow-up.4 Reassuringly, more recent analyses have shown a much more favourable picture, with progressively reduced recurrence rates.