Lancet
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Review Comparative Study
Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group.
In a worldwide collaboration, information was sought and centrally checked on mortality and recurrence for each woman in any randomised trial that began before 1985 of any aspect of systemic adjuvant therapy for early breast cancer. Checked data were available for 75,000 women (about 90% of those ever randomised), of whom 32% had died and another 10% had experienced recurrence. The parts now reviewed include 30,000 women in tamoxifen trials, 3000 in ovarian ablation trials, 11,000 in polychemotherapy trials, 15,000 in other chemotherapy comparisons, and 6000 in immunotherapy trials. ⋯ Indirect randomised comparisons do not reveal significant differences between different forms of polychemotherapy, or differences between different tamoxifen doses, but do show that long-term tamoxifen (eg, 2 years, or even 5 years) is significantly more effective than shorter tamoxifen regimens. In old age (70+) tamoxifen is of demonstrated efficacy, but chemotherapy has not been evaluated. Between ages 50 and 69 direct comparisons show that chemotherapy plus tamoxifen is better (1p less than 0.00001) than chemotherapy alone both for recurrence and for mortality, and better (1p less than 0.00001) than tamoxifen alone for recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)