ANTHRACYCLINE-CONTAINING schedules are challenging classical CMF (cyclophosphamide, methotrexate, 5-fluorouracil) for the treatment of women with early breast cancer, especially in young or high risk individuals. Is this the result of careful testing or just good marketing? The question is important because anthracyclines and radiotherapy are a potentially dangerous mix. Everyone agrees that anthracyclines are effective in women with early breast cancer [l], but their superiority to classical CMF is neither certain nor quantified. Some randomised trials report statistically significant survival advantages for anthracycline-containing regimens compared with CMF, but in each case other confounding factors may have contributed to the benefits [2-41. Other randomised trials report no survival advantages for anthracycline regimens [2, 5, 61. Until lingering doubts are removed, uncertain benefits need to be weighed against the real dangers of prescribing anthracyclines and radiotherapy, especially for women with left-sided cancers. Whereas there is no doubt regarding the efficacy of adjuvant radiotherapy in reducing local recurrence, its long-term effect in terms of overall survival remain controversial, with no significant benefit demonstrated so far [7-l 11. Postmastectomy radiotherapy is associated with a reduced risk of breast cancer deaths (a few less deaths per 100 women irradiated), but is undermined by fatal radiationinduced heart disease (relative risk of 1.6 in trials started before 1975, representing l-2 excess cardiac deaths per 100 women irradiated) [7, 121. The latency period for ischaemic heart disease is 5 years and the risk is greatly influenced by technique and the volume of heart irradiated [13]. Radiotherapy practices have improved over the years. Direct photon fields to the chest wall or mediastinum, which point directly at the heart, are no longer used unless there is a special indication to treat the internal mammary chain. Tangential fields to the breast or chest wall are much safer, and accurate field localisation ensures the minimum ex