An expert consensus meeting took place in January 2005, making a fundamental change in the algorithm for selecting adjuvant systemic therapies for women with early breast cancer. Rather than the earlier approach, commencing with risk assessment, the experts indicated that, after operation and pathological evaluation of the disease, first consideration should be given to the degree of responsiveness to hormonal therapies.

Three categories were acknowledged: endocrine responsive, endocrine non-responsive, and tumors of uncertain endocrine responsiveness. The three categories were further divided according to menopausal status. Only then did the experts consider three categories of risk of relapse: low-, intermediate-, and high-risk.

The panel recommended that patients be offered chemotherapy for endocrine nonresponsive disease, endocrine therapy as the primary therapy for endocrine responsive disease, and adding chemotherapy for some intermediate- and all high-risk groups in this category, and both chemotherapy and endocrine therapy for all patients in the uncertain endocrine response category except those in the low-risk group.

The experts updated new information from trials which tested adjuvant trastuzumab (Herceptin®). These were added to the algorithm of treatment choice, but will be discussed more thoroughly during the 2007 edition.

The first St. Gallen Conference with an "official" expert consensus session was the third such St. Gallen meeting on "Adjuvant Therapy of Breast Cancer" and occurred in February, 1988. I was personally involved in presenting crucial questions on controversial issues and continued this activity in several editions of the conference, sharing responsibility with Dr. John H. Glick, Director of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA, and Dr. William C. Wood, Chief of the Department of Surgery, Emory University Hospital, School of Medicine, NE Atlanta, GA, USA. Significant merits in the process are to be ascribed to Dr. Richard D. Gelber, Professor of Biostatistics, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, USA, and Dr. Alan S. Coates, former Chief of the Cancer Council Australia, Sydney, Australia.