Current thinking on the management of primary carcinoma of the breast.

The most important advance in the management of early breast cancer over the last 20 years, has been the conceptual revolution whereby the mechanistic/anatomical view of the disease has been replaced by a more complex biological model. As a result of this paradigm shift, the role of local therapy has been redefined and a steady momentum towards a more conservative approach has been initiated. Furthermore, the trials of adjuvant systemic therapy, although not producing the anticipated major breakthrough, have at least demonstrated that the natural history of the disease can be influenced in a favourable direction. Future progress depends on a continuing involvement of all surgeons in multicentre trials and resistance to the establishment of a new therapeutic dogma.