Adjuvant ovarian ablation versus CMF chemotherapy in premenopausal women with pathological Stage II breast carcinoma : the Scottish trial. Scottish Cancer Trials Breast Group and ICRF Breast Unit, Guy's Hospital, London

Breast cancer is both a common (27.6% of female cancers, 2831 cases in NSW in 1991) and fatal (18.8% of female deaths from cancer, 900 deaths in NSW in 1991) condition(49). The disease is frequently the subject of papers. Unfortunately many are retrospective analyses that at best indicate promising therapies. Randomised trials in breast cancer are increasing in number. Only 2-3% of women with breast cancer are included on randomised trials and some commentators have suggested increased recruitment would more quickly resolve and optimise management issues, especially since such trials require at least 10 years follow-up to provide solid data on toxicity, survival and effect(65). Within the setting of operable breast cancer (i.e., Stage I and II) randomised trials have addressed the usefulness of post-lumpectomy radiotherapy(39), chemotherapy(56,57,58), and hormone therapy(59). The Scottish Cancer Trials Breast Group (SCTBG), like the NSABP and other joint groups, have embarked on a series of trials that stratify patients on the basis of known prognostic factors. The introduction describes the institution of two trials in 1980 involving post-operative patients. The first trial examined the effect of tamoxifen in non-premenopausal women and reported an improved survival(59). The second trial, which is described in this report, collected the premenopausal, node-positive group in an attempt to quantify the effects of chemotherapy (CMF) and ovarian ablation (OA) in a randomised trial. Although the possible confounder of chemotherapy-induced ovarian ablation was recognised at trial inception, no controlling attempts were made.