Other approaches to determine whether patients have a high probability of metastases (and therefore no need for axillary dissection) have been the measurements of several circulating substances (e.g., polyamines, nucleosides, CEA and HCG). None of these are by themselves useful. There is a high percentage positive in those patients with metastatic disease (with up to 97% positive for either HCG, CEA, or guanosine (nucleoside). What we need is a correlation or a parameter of what the tumor cell number is, who to treat, and how long. Today's therapy is larger empiric. The ultimate goal is to individualize therapy. Figure 1 summarizes a planned treatment for a woman with a breast cancer in 1974.
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