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Effects of Breast Cancer Recurrences on Women Initially Diagnosed with Early-Stage Breast Cancer (dateline October 9, 2002)

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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