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Hobson's choice and the need for combinations of new agents for the prevention and treatment of breast cancer.

The excellent article by O’Regan, Jordan, and colleagues in this issue of the Journal (1) highlights the “Hobson’s Choice” currently available for clinical prevention or treatment of early breast cancer.In the 1600s, Thomas Hobson ran a large stable and rented horses at Cambridge University.He compelled customers to rent the one horse that happened to be nearest the stable door or go without—hence the term “Hobson’s Choice.” In current parlance, it has the connotation of an apparently free choice when there is no real alternative.Presently, we are faced with the clinical equivalent of a Hobson’s Choice if we wish to use more than one experimental drug for prevention or adjuvant treatment of early breast cancer.In spite of numerous animal studies that indicate that treatment with combinations of two or more drugs is most effective, our current clinical choice appears to be the selection of a single experimental drug, not the oppor