NSABP B-04 trial 25 years later: lessons for oncologists

Abstract

This critical analysis of the article of B. Fisher et al. “Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation” (2002) was written for physicians interested in learning how evidence based oncology has challenged the Halstedian model of breast cancer progression and the radical loco-regional treatment as the way to stop this progression. The 25-year update of the NSABP B-04 study is unique in its design and the remarkable length of follow-up. Our detailed analysis of the article provides an example how oncologists learn about biology of the disease, test the hypothesis of the metastatic spread of the tumor, and what the bases of the modern principles of loco-regional treatment of breast cancer are. Also, the modern clinical recommendations are written using similar systematic analysis of the available literature. The presented analysis explains the logic behind using various end-points. This analysis illustrates how the study helps to dismantle the stereotype that super radical surgical treatment of breast cancer was effective and to promote research in less aggressive loco-regional treatments of other tumors. To our knowledge this type of analysis has never been published before in Russian oncology literature.

Keywords

• breast cancer
• mastectomy
• halsted
• fisher
• nsabp b-04