The 1998 St. Gallen's Consensus Conference: an Assessment

Extract

A decrease in breast cancer mortality in the United States was reported for the first time in 1994 ( 1 ). This decrease has been attributed, in part, to better adjuvant therapies that have become standard after carefully conducted, randomized, controlled trials have established a clear benefit. In reality, however, physicians and patients must also make treatment decisions in situations where optimal trial data are lacking. Appropriately, leaders in the field have met at regular intervals to provide a consensus as to how new information can be incorporated into practice. The results of the 6th International Consensus Panel on the Treatment of Primary Breast Cancer are presented in this issue of the Journal ( 2 ). There are several noteworthy differences between the recommendations from this conference as compared with those from the 1995 consensus panel that reflect both our expanding knowledge base and our changing societal attitudes toward cancer and cancer treatment. Some of these changes stem from the growing confidence that adjuvant chemotherapy can improve survival in most cases of breast cancer, even though these differences may be small in absolute terms.