Systemic adjuvant therapy can provide a survival benefit. However, chemotherapy in particular is associated with major side effects. For those women in whom it is unlikely that the disease has spread, there will be little advantage in systemic adjuvant therapy but the potential for considerable morbidity from the side effects. The number of nodes involved is an important selection factor for adjuvant systematic therapy, since the benefits of systemic therapy are expressed as a reduction in risk. The probability of lymph node involvement is related directly to the size of the primary tumours.
Larger tumours are more likely to have metastasised to axillary lymph nodes than smaller ones.
It is important to note that there is an increase in the proportion of women with breast cancer who may not benefit from systemic adjuvant therapy. Screen-detected cancers, which tend to be small and associated with an excellent prognosis, are becoming increasingly more common. Adjuvant systemic chemotherapy has little role in this group of patients. The views or opinions stated in external resources which are links on this home page do not necessarily reflect those of the National Breast Cancer Centre.