Detection of local recurrence after conservative therapy for breast carcinoma

Background. Early detection of local recurrence after conservative therapy for breast cancer is associated with improved survival. This review was undertaken to determine the ability to detect recurrence and identify patterns of recurrence. Methods. Records of women with local tumor recurrence were retrospectively reviewed. Results. In 42 women with 43 local recurrences, tumors were detected by mammography alone in 18 instances (42), physical examination alone in 14 (33%), and by both in 11 (25%). Of 29 recurrences mammographically detected, 19 were diagnosed by microcalcifications, 9 by a mass and 1 by a mass with microcalcifications. Twenty of 25 tumors detected by physical examination were felt as a mass. Recurrences detected by mammography were more often in situ (72% or 13 of 18) than those detected by physical examination alone (7% or 1 of 14. Treatment failure at the site of the original tumor seemed to occur earlier than failures elsewhere in the breast and was more common in women younger than 43 years of age or with disease that was originally axillary node-positive. Conclusions. Mammography often detects more in situ recurrences than physical examination, but both are complimentary. Recurrence at the site of the original tumor is usually earlier and in younger women and may be associated with tumors that were originally node-positive. Cancer 1992; 70:493-496.