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Patterns and predictors of first and subsequent recurrence in women with early breast cancer.
- Source :
-
Breast cancer research and treatment [Breast Cancer Res Treat] 2017 Oct; Vol. 165 (3), pp. 709-720. Date of Electronic Publication: 2017 Jul 04. - Publication Year :
- 2017
-
Abstract
- Purpose: Little is known about the occurrence, timing and prognostic factors for first and also subsequent local (LR), regional (RR) or distant (DM) breast cancer recurrence. As current follow-up is still consensus-based, more information on the patterns and predictors of subsequent recurrences can inform more personalized follow-up decisions.<br />Methods: Women diagnosed with stage I-III invasive breast cancer who were treated with curative intent were selected from the Netherlands Cancer Registry (N = 9342). Extended Cox regression was used to model the hazard of recurrence over ten years of follow-up for not only site-specific first, but also subsequent recurrences after LR or RR.<br />Results: In total, 362 patients had LR, 148 RR and 1343 DM as first recurrence. The risk of first recurrence was highest during the second year post-diagnosis (3.9%; 95% CI 3.5-4.3) with similar patterns for LR, RR and DM. Young age (<40), tumour size >2 cm, tumour grade II/III, positive lymph nodes, multifocality and no chemotherapy were prognostic factors for first recurrence. The risk of developing a second recurrence after LR or RR (N = 176) was significantly higher after RR than after LR (50 vs 29%; p < 0.001). After a second LR or RR, more than half of the women were diagnosed with a third recurrence.<br />Conclusions: Although the risk of subsequent recurrence is high, absolute incidence remains low. Also, almost half the second recurrences are detected in the first year after previous recurrence and more than 80% are DM. This suggests that more intensive follow-up for early detection subsequent recurrence is not likely to be (cost-)effective.
- Subjects :
- Adult
Aged
Aged, 80 and over
Breast Neoplasms mortality
Breast Neoplasms therapy
Combined Modality Therapy
Female
Humans
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Netherlands epidemiology
Patient Outcome Assessment
Prognosis
Registries
Tumor Burden
Breast Neoplasms epidemiology
Breast Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1573-7217
- Volume :
- 165
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Breast cancer research and treatment
- Publication Type :
- Academic Journal
- Accession number :
- 28677011
- Full Text :
- https://doi.org/10.1007/s10549-017-4340-3