Annually there are 186,000 cases of breast cancer. However, the reduction of the risk of recurrence can be changed with the use of adjuvant therapy. Unfortunately, identification of the patient who can benefit from adjuvant therapy is difficult prospectively. Because adjuvant therapy carries its own risks and complications, the use of adjuvant therapy must be evaluated within this context. The concept of adjuvant therapy in breast cancer treatment is the reduction of risk of recurrence in the patient who has no discernible disease post surgical resection of tumour.
Chemotherapy works better in younger patients.
For a patient who is not destined to have a recurrence adjuvant treatments offer her no benefit. Instead adjuvant therapy increases her risk for adverse events such as secondary malignancy, thromboembolism and cardiac complications. The adverse effects of chemotherapy include fever, neutropenia, secondary malignancies such as leukemia, heart failure from toxic effects on the myocardium and thromboembolism. Effects of tamoxifen include thromboembolism and endometrial carcinoma. Because breast cancer is prevalent, the decrease in risk of recurrence with the use of adjuvant therapy is seen across the population, but does not translate to great benefit for the individual patient.