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. 2017 Oct;165(3):709-720.
doi: 10.1007/s10549-017-4340-3. Epub 2017 Jul 4.

Patterns and predictors of first and subsequent recurrence in women with early breast cancer

Y M Geurts  1 , A Witteveen  2 , R Bretveld  1 , P M Poortmans  3 , G S Sonke  4 , L J A Strobbe  5 , S Siesling  6   1
Affiliations

Patterns and predictors of first and subsequent recurrence in women with early breast cancer

Y M Geurts et al. Breast Cancer Res Treat. 2017 Oct.

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.

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.

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.

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.

Keywords: Breast cancer; Follow-up; Prognostic factors; Recurrence patterns; Recurrence risk.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of first and subsequent recurrences. Abbreviations: LR local recurrence, RR regional recurrence, DM distant metastasis
Fig. 2
Fig. 2
Hazard of a all first recurrences, and b first LR and RR during 10 years of follow-up. Abbreviations: LR local recurrence, RR regional recurrence, DM distant metastasis
Fig. 3
Fig. 3
Hazard of subsequent (second) recurrence after a first LR, and b first RR. Abbreviations: LR local recurrence, RR regional recurrence, DM distant metastasis
See this image and copyright information in PMC

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