Article type
Year
Abstract
At the same time as what became known as the "first" randomised trial was published in the British Medical Journal, one of the earliest randomised trials of a treatment for cancer was underway in Manchester, UK. This was a trial of ovarian irradiation for women with breast cancer. Now, 50 years later, it is included in the first of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overviews to be prepared as a Cochrane Review. This paper describes this continuing journey along a hierarchy of evidence in health care.
The first case report of hormone suppression as a treatment for breast cancer was published in 1896. It was soon followed by several case series and non-randomised comparisons and, between 1948 and 1988, more than a dozen randomised trials took place involving 3500 women. However, none of these trials was large enough to show reliably whether women treated with ovarian ablation were more likely to survive longer than not treated in this way. A systematic review was required and the first steps towards this were taken with the formation of the EBCTCG in 1983. This brought together trialists from around the world in an attempt to combine individual patient data from trials of tamoxifen and chemotherapy. Data were also collected from some ovarian ablation trials and a preliminary meta-analysis was published in 1990. The EBCTCG then expanded to include any aspect of the treatment of operable breast cancer and the systematic review of ovarian ablation began. The resulting analyses were discussed by the EBCTCG in 1990 and published just over a year later. The third cycle began in 1994 and early results were discussed by the EBCTCG in 1995. Ovarian ablation was the first of a series of papers to come from this cycle: published in the Lancet the following year. This review has now been reproduced as a Cochrane Review and appeared on issue 2,1998 of The Cochrane Library. However, the journey towards best evidence continues. The fourth cycle starts in 1999. Further follow-up will be available for the 3500 women currently in the review and data from an additional 5000 women in more recent trials, will be available.
The first case report of hormone suppression as a treatment for breast cancer was published in 1896. It was soon followed by several case series and non-randomised comparisons and, between 1948 and 1988, more than a dozen randomised trials took place involving 3500 women. However, none of these trials was large enough to show reliably whether women treated with ovarian ablation were more likely to survive longer than not treated in this way. A systematic review was required and the first steps towards this were taken with the formation of the EBCTCG in 1983. This brought together trialists from around the world in an attempt to combine individual patient data from trials of tamoxifen and chemotherapy. Data were also collected from some ovarian ablation trials and a preliminary meta-analysis was published in 1990. The EBCTCG then expanded to include any aspect of the treatment of operable breast cancer and the systematic review of ovarian ablation began. The resulting analyses were discussed by the EBCTCG in 1990 and published just over a year later. The third cycle began in 1994 and early results were discussed by the EBCTCG in 1995. Ovarian ablation was the first of a series of papers to come from this cycle: published in the Lancet the following year. This review has now been reproduced as a Cochrane Review and appeared on issue 2,1998 of The Cochrane Library. However, the journey towards best evidence continues. The fourth cycle starts in 1999. Further follow-up will be available for the 3500 women currently in the review and data from an additional 5000 women in more recent trials, will be available.