1. Chemotherapy is used in women at risk for metastatic disease. Cytotoxic agents used include methotrexate, fluorouracil, cyclophosphamide (Cytoxan, Neosar), doxorubicin, mitoxantrone (Novantrone), and paclitaxel (Taxol). In the management of stage 0 disease, chemotherapy is not used initially.

2. Stage I and stage II disease are treated with chemotherapy based on the relative risk of systemic recurrence. This risk is often based on the woman's age, axillary lymph node involvement, tumor size, hormone receptor status, histologic tumor grade, and cellular aggressiveness. Systemic chemotherapy is recommended for women with stage I disease who have node-negative cancers and a tumor size greater than 1 cm in diameter.

3. Women with stage IIA breast cancer are treated with adjuvant chemotherapy with or without tamoxifen. Some women with positive lymph nodes are placed on chemotherapy, including doxorubicin, fluorouracil, and methotrexate.

4. In women with stage III breast cancer, similar agents are selected. Doxorubicin is particularly useful in treating inflammatory breast cancer. In women with stage IIIB cancer, chemotherapy is usually administered before primary surgery or radiation therapy. High-dose chemotherapy plus stem-cell transplantation does not improve survival rates. In women with stage IV disease, chemotherapy is useful in treating metastatic breast cancer.

References: See page 184.

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