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This article comments on preoperative chemotherapy for the treatment of breast cancer. Preoperative therapy has been shown to increase survival and control of the cancer in breast cancer but not in all forms of it. There are 3 subsets of patients for whom preoperative therapy is beneficial, including patients with inoperable breast cancer and those who are poor candidates for breast conservation because of the size of the tumor.

A response by the author to a letter to the editor about his article "Health Care in the Age of Genetic Medicine," from the December 12, 2007 issue is presented.

The article presents a medical report concerning estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. The article suggests the much progress has been made in the treatment of early stage breast cancer, and that in patients with hormone-sensitive tumors, tamoxifen reduces the risk of recurrence and death by more than 30%. Additionally, treatment with aromatase inhibitors further reduces the risk of recurrence in post-menopausal women with estrogen-receptor positive tumors.

Context Adjuvant chemotherapy improves survival for patients with local-regional breast cancer, but healthy older patients at high risk of recurrence are frequently not offered adjuvant chemotherapy, and the benefit of adjuvant chemotherapy in older patients is uncertain. Objective To compare the benefits and toxic effects of adjuvant chemotherapy among breast cancer patients in age groups of 50 years or younger, 51 to 64 years, and 65 years or older. Design and Setting Retrospective review of data from 4 randomized trials that accrued patients from academic and community medical centers between 1975 and 1999. Median follow-up for all patients was 9.6 years. All trials randomized patients to different regimens, doses, schedules, and durations of chemotherapy and all had a treatment arm with doses or schedules that were regarded to be "high" and potentially more toxic. Patients A total of 6487 women with lymph node--positive breast cancer; 542 (8%) patients were 65 years or older and 159 (2%) were 70 years or older. Main Outcome Measure Comparison of disease-free survival, overall survival, and treatment-related mortality among different age groups. Results Multivariate analysis showed that smaller tumor size, fewer positive lymph nodes, more chemotherapy, and tamoxifen use were all significantly (P<.001) related to longer disease-free and overall survival. There was no association between age and disease-free survival. Overall survival was significantly (P<.001) worse for patients aged 65 or older because of death from causes other than breast cancer. Thirty-three deaths (0.5% of all patients) were attributed to treatment, and older women had higher treatment-related mortality. Older women and younger women derived similar reductions in breast cancer mortality and recurrence from regimens containing more chemotherapy. Conclusion Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health. [ABSTRACT FROM AUTHOR]