Should adjuvant chemotherapy be withheld from any patient with operable breast cancer?

We examined the clinical course of operable breast cancer and looked at what effect tumour size had on the probability of death from the disease. We analysed data from 1936 patients who were classified as having international stage I and II disease: decision theory was used to show a technique for determining the best strategy for adjuvant chemotherapy in the overall management of breast cancer.To evaluate this approach further, studies need to be designed to yield numerical values for the total morbidity of treatment on a scale from 0 to 100-the concept of utility loss-where 100 represents the maximum utility loss in patients in the early stages of disease. Such studies would contribute more to determining the best overall management of such patients than the current proliferation of clinical trials that are designed to evaluate either different combinations of adjuvant drugs or the effect of known combinations in selected subgroups of patients.