Abstract
Breast cancer is the most common malignancy in women in the United States. Prognosis in early stage disease is excellent, but the results of treatment of advanced disease with conventional surgery, radiation, or chemohormonal therapy have been disappointing. Promising results, with regard to overall survival and disease-free survival, have been obtained in certain subgroups of advanced breast cancer patients given very high doses of chemotherapy. However, this dose-intensive approach is very controversial. Therapies designed to decrease the morbidity, particularly bone marrow suppression, associated with high-dose chemotherapy include bone marrow or peripheral blood stem cell transplantation and administration of broad-spectrum antibiotics and recombinant hematopoietic growth factors. Availability of these adjunctive therapies now allows for testing of the hypothesis that, for certain breast cancer patients, more may be better. Although these new therapies may increase the survival of women with advanced breast cancer, they are costly. This raises important issues regarding who should bear the expense for the development and delivery of these treatments. Certainly, large-scale testing of new therapies will strain limited federal research support. At the present time, several high-priority trials in high-risk breast cancer patients are being conducted with support from multiple sources. It is critical to develop an equitable formula for the distribution of costs of new treatments for patients with advanced breast cancer in our rapidly changing health care environment.
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