St. Gallen International Breast Cancer Conferences & Consensus

Breast cancer is an important health problem both in developed and developing countries.

Particularly in countries with traditionally low incidence a sharp increase in numbers of new cases can be observed. At the same time, both clinical and translational research of the disease have given us a deeper inside of the biology leading to more tailored treatment and resulting in an unprecedented development of new drugs. Further, recent developments in MedTech led to new, more sophisticated treatment modalities.

However, all these positive developments need to be put in perspective of current standards.

In particular, new drugs need to be integrated into standard regimens. Pivotal trials in early breast cancer aim not only to improve survival in early breast cancer but serve also the purpose of drug registration with regulators. By treating an increasing number of patients with more and more drugs to increase survival rates, the majority of patients will inevitably be overtreated—even more than in the past—resulting in both medical and financial toxicity. Careful evaluation is needed to tailor treatments in order to avoid a pyrrhic victory in the battle against breast cancer.

The St. Gallen International Breast Cancer Conferences abandoned the previous focus on “minimal recommendations” about two decades ago. It was Aron Goldhirsch who moved scientific controversies in the management of early breast cancer where specific evidence for a given patient situation is not available or when results of studies are available but these results lack a common interpretation and/or extrapolation, in the center of our activities. This resulted in a more medical, patient-centred approach to producing a medical tool, rather than in the development of new guidelines, a public health tool. A more and more tailored treatment approach based on the risk of recurrence and the magnitude of effect in risk reduction of recurrence and death has been adopted. This process over the last 2 decades was accompanied by an increasing fragmentation of biological and therapeutic breast cancer subtypes and an increasing number of treatment options resulting in a more complex situation for physicians to counsel individual patients in the shared decision-making process. The St. Gallen recommendations should help the physician by serving as a basis for discussion with the patient, particularly when guidelines do not cover the individual patient’s situation.

The conference and the consensus statement follows the overarching theme of treatment de-escalation for many patients and of treatment escalation for well-defined patient populations acknowledging the fact that the above-mentioned developments usually led to a substantial overtreatment to the majority of patients. On the other side, an increasing problem is the lack of availability and of fair access to diagnostics and state of the art therapy for many patients. New attempts should be made and new approaches are needed.

The conference organizers have made considerable efforts to increase diversity among speakers including female representation and extended the panel from 40 to nearly 80 experts. International exchange of opinions of the participating experts, both in the conference faculty and among the conference participants, and the common proliferation of the consensus, adapted to local needs and resources, will help that better, more tailored treatments will ultimately arrive at our patients.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Breast Cancer Research. The article did not undergo external peer review.

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