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A small study sheds new light on the outcome of women who experience recurrences of breast cancer after their initial diagnoses.
Three factors, the woman’s age at diagnosis, the grade
of her original cancer, and length of time before the recurrence, were found to be
significant in assessing the risk of death from a breast cancer recurrence. Interestingly,
the study also revealed that the type of surgery an early-stage breast cancer patient
receives does not impact her chances of surviving a recurrence of the disease.
The idea that breast cancer may return (recur) after the initial treatment is a worry
for many women. Breast cancer can recur locally at the same site as the original diagnosis
or distantly in other body organs, such as the lungs, liver, or bones. Local recurrences
typically occur from a few cancer cells that remain in the breast after the initial
treatment. Over time, these cells form a new tumor. Distant recurrences, on the other
hand, can signal that the cancer has spread past the breast and axillary (armpit) lymph nodes. The chances of survival decrease with when
distant recurrences (or "metastases") occur. Another issue that physicians and
patients face when breast cancer returns after the primary treatment is determining
whether the newly discovered tumor is really a new cancer or part of the first cancer.
To help understand the issues with breast cancer recurrences, Monique G. Lê, MD, of
the Institut Gustave-Roussy in Villejuif, France, and her colleagues analyzed the outcome
of 105 early-stage breast cancer patients who experienced a local breast cancer recurrence
sometime after their initial diagnosis. These patients were compared with 335 women who
experienced distant breast cancer recurrences (i.e., breast cancer had spread to other
areas, such as the bones).
The following characteristics were assessed among the women who experienced local
breast cancer recurrences. The characteristics marked with asterisks (*) were identified
by the researchers to be significant factors that impact a patient’s outcome.
- the size of the first breast cancer tumor
- the histologic grade of the first breast cancer
tumor*
- the extent of spread of the first breast cancer tumor to the nearby lymph nodes (or lack
of spread)
- when the first breast cancer tumor was diagnosed (date)
- the patient’s age at the time of the first diagnosis*
- the length of time between the first and second breast cancer diagnoses*
- the type of treatment the patient received for the first and second breast cancers
The patient’s age at the time of the initial diagnosis, the cancer’s grade (a
classification based on cellular analysis that can help determine its aggressiveness), and
the amount of time between the initial diagnosis and the recurrence clearly impacted the
outcome of the women in the study.
Specifically, Dr. Lê and her colleagues found that the women who were initially
diagnosed with breast cancer after age 60 were at a higher risk of death than patients who
had been diagnosed at an early age. Likewise, women with original grade 3 breast cancer
tumors (the most aggressive type) had a higher risk of death than patients with lesser
grade tumors. Finally, women with at least eight years between their initial breast cancer
diagnosis and the recurrence had a lower risk of death from the disease than women whose
cancer recurred in shorter times.
Dr. Lê and her team also found that the type of surgery an early-stage breast cancer
patient received for their initial cancer diagnosis did not affect their risk of death
from a recurrence. For example, early-stage breast cancer patients who only had the tumor
and a margin of normal breast tissue removed (lumpectomy)
had the same chances of survival as patients who had their breasts removed (mastectomy).
In pre-menopausal women, the researchers found that the removal of the ovaries or chemotherapy (which affects the function of the ovaries) did
decrease the risk of death from breast cancer. In post-menopausal women, these treatments
did not affect the chances of survival.
Though the study is small, its results help physicians and patients understand that the
local recurrence of early-stage breast cancer is associated with a fairly good prognosis
in most cases. Furthermore, the study underscores the fact that most early-stage breast
cancer patients have a choice in the type of treatment they receive since initial
treatments do not generally impact the odds of long-term survival.
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