Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy

The cases of 496 women treated for ductal breast cancer with breast-conserving surgery were reviewed to determine those factors which best predicted the risk of local recurrence in the remaining breast tissue. Twenty-one different factors were studied. Nine factors were significantly associated with increased risk of local tumor recurrence: mononuclear cell reaction, high tumor grade, extensive intraductal component, tumor necrosis, macroscopic multiplicity, absence of estrogen receptors, tumor size, vascular invasion, and age under 40. Not all of these factors are independent, however. Upon multivariate analysis, the most significant factors were found to be mononuclear cell reaction, tumor grade, and intraductal component. It is interesting to consider the correlation of age under 40 years with increased risk of recurrence. Women under 40 are at significantly higher risk of local recurrence; this seems to be due to the fact that extensive intraductal components are more common among women under 50, and both mononuclear cell reaction and high tumor grade are more common in women under 40. Thus, virtually all of the important prognostic factors are related to the histopathological examination of the tumor rather than extrinsic factors, such as radiation dose or family history. The overall risk of local recurrence of ductal breast cancer was 12.3 percent. Patients with moderate or severe mononuclear cell reactions had a 28 percent chance of recurrence. The recurrence rate of premenopausal women without any risk factor was only 2.6 percent at five years. For postmenopausal women, risk was determined primarily by tumor grade and the adequate margins obtained during the surgery. Those with grade 3 tumor and tumor extending to the margin of the removed tissue had a 31 percent chance of local recurrence within five years. Clearly, careful pathological evaluation of the tumor tissue is by far the most important step in evaluating the risk of recurrence in patients with ductal breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)