This RRCR-conference-volume marks "number six" in a 20-year evolution of international conferences on the adjuvant therapy of primary breast cancer. Starting in 1978, a handful of some 80 en thusiastic breast cancer surgeons and oncologists, met in a se cluded mountain resort near st. Gallen in Eastern Switzerland, to exchange their early data of some pioneer trials on adjuvant sys temic therapy of early breast cancer, and to correlate their future research efforts to overcome the frustrating prognostic stagna tion of this dominant neoplastic disease in Western females dur ing the past decades. Repeated every 3-4 years, these St. Gallen International Conferences on Adjuvant Therapy of Primary Breast Cancer have continuously grown in numbers of partici pants and in normative, therapeutic influence by being published in major oncology journals [1-3], the last (6th) conference hav ing taken place from February 25-28, 1998 with more than 1800 attendees from over 50 countries worldwide. What is the fascination of adjuvant therapy in primary (early) breast cancer, and what has changed,during the last 3 years since March 1995, to justify another international gathering of this size, and of the world's leading experts in the field? There is no question, that providing even more effective care and designing appropriate recommendations for the multitudes of patients with so-called early breast cancer or at high risk of developing the disease, remain highly important public health goals.

I. Epidemiology and Its Lessons

Diet and Mammary Gland Carcinogenesis
Prevention of Breast Cancer: Focus on Chemoprevention
Estrogen/Hormone Replacement Therapy and the Etiology of Breast Cancer
II. Genetics of Breast Cancer
Experimental Pathology and Breast Cancer Genetics: New Technologies
Update on Breast Cancer Susceptibility Genes
III. Biology of Breast Cancer: Diagnostic and Prognostic Implications
IGF-I Physiology and Breast Cancer
Determination of Clinical Utility of Tumor Markers: A Tumor Marker Utility Grading System
How Can Prognostic and Predictive Factors in Breast Cancer Be Used in a Practical Way Today?
Strategies for the Development of Vaccines to Treat Breast Cancer
IV. In Situ Breast Cancer
Hypothesis and Practice: Are There Several Types of Treatment for Ductal Carcinoma In Situ of the Breast?
Ductal Carcinoma In Situ of the Breast: Histological Classification and Genetic Alterations
Trials of Treatment for Non-invasive Breast Cancer
Summary
V. Controversies About the Axilla
The Axilla: To Clear or Not to Clear? That Is the Question!
Axillary Clearance in Operable Breast Cancer: Still a Necessity?
Sentinel Lymphadenectomy: A Safe Answer to Less Axillary Surgery?
Endoscopic Surgery to the Axilla: A Substitute for Conventional Axillary Clearance?
VI. Integrated Therapy: Changing Surgical Procedures for Breast Cancer
Surgical Considerations in Preoperative Chemotherapy of Breast Cancer
Integration of Plastic Surgery in the Course of Breast-Conserving Surgery for Cancer to Improve Cosmetic Result and Radicality of Tumor Excision
Summary
VII. Integrated Therapy: Primary Adjuvant Systemic Therapy
Is Primary Chemotherapy Useful for All Patients with Primary Invasive Breast Cancer?
The Primary Use of Endocrine Therapies
VIII. Integrated Therapy: Radiation Therapy/Endocrine Treatment
Why and How to Combine Chemotherapy and Radiation Therapy in Breast Cancer Patients
Novel Approaches Using Radiation Therapies
Molecular Biology of the Estrogen Receptor Aids in the Understanding of Tamoxifen Resistance and Breast Cancer Prevention with Raloxifene
Aromatase Inhibitors and Their Use in the Adjuvant Setting
GnRH Analogues and Ovarian Ablation: Their Integration in the Adjuvant Strategy
Summary
IX. Adjuvant Systemic Treatments: Cytotoxic Strategies
Putting the Taxanes to Work: Unanswered Questions
Putting Taxanes to Work in Operable Breast Cancer: A Search for Selective Indications from Empirical Studies
Continuous Infusional Chemotherapy for Early Breast Cancer: The Royal Marsden Hospital Experience
Tailored Chemotherapy to Equal Toxicity: Is It Possible?
Anti-angiogenesis Therapy and Strategies for Integrating It with Adjuvant Therapy
X. Adjuvant Systemic Treatments: Cytotoxics and Their Dosage
New Developments in High-Dose Chemotherapy for Breast Cancer
Summary
XI. Integrated Treatments: Quality of Life
Quality of Life Assessment in the Adjuvant Setting: Is It Relevant?
Quality of Life Assessment in the International Breast Cancer Study Group: Past, Present, and Future
Impact of Different Adjuvant Therapy Strategies on Quality of Life in Breast Cancer Survivors
Summary
XII. Clinical Research Around the World: Review of Cooperative Group Trials
North American Adjuvant Breast Cancer Trials
International Breast Cancer Study Group Trials
Nordic Trials of Adjuvant Therapy in Primary Breast Cancer
The EORTC-Breast Cancer Cooperative Group Clinical Research Programme in Early Breast Cancer
Italian Breast Cancer Adjuvant Chemo-hormone Therapy Cooperative Group Trials
Current Trials of the German Adjuvant Breast Cancer Group (GABG)
XIII. International Consensus Conference on Primary Treatment of the Breast: Update 1998
International Consensus Panel on the Treatment of Primary Breast Cancer V: Update 1998.