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. 2021 Apr;186(3):863-870.
doi: 10.1007/s10549-020-06040-3. Epub 2021 Mar 10.

Conditional local recurrence risk: the effect of event-free years in different subtypes of breast cancer

M Moossdorff  1   2 , Marissa L G Vane  3   4 , T J A van Nijnatten  5 , M C van Maaren  6   7 , B Goorts  1   2   5 , E M Heuts  1   2 , L J A Strobbe  8 , M L Smidt  1   2
Affiliations

Conditional local recurrence risk: the effect of event-free years in different subtypes of breast cancer

M Moossdorff et al. Breast Cancer Res Treat. 2021 Apr.

Abstract

Background: After breast cancer treatment, follow-up consists of physical examination and mammography for at least 5 years, to detect local and regional recurrence. The risk of recurrence may decrease after event-free time. This study aims to determine the risk of local recurrence (LR) as a first event until 5 years after diagnosis, conditional on being event-free for 1, 2, 3 and 4 years.

Methods: From the Netherlands Cancer Registry, all M0 breast cancers diagnosed between 2005 and 2008 were included. LR risk was calculated with Kaplan-Meier analysis, overall and for different subtypes. Conditional LR (assuming x event-free years) was determined by selecting event-free patients at x years, and calculating their LR risk within 5 years after diagnosis.

Results: Five-year follow-up was available for 34,453 patients. Overall, five-year LR as a first event occurred in 3.0%. This risk varied for different subtypes and was highest for triple negative (6.8%) and lowest for ER+PR+Her2- (2.2%) tumors. After 1, 2, 3 and 4 event-free years, the average risk of LR before 5 years after diagnosis decreased from 3.0 to 2.4, 1.6, 1.0, and 0.6%. The risk decreased in all subtypes, the effect was most pronounced in subtypes with the highest baseline risk (ER-Her2+ and triple negative breast cancer). After three event-free years, LR risk in the next 2 years was 1% or less in all subtypes except triple negative (1.6%).

Conclusion: The risk of 5-year LR as a first event was low and decreased with the number of event-free years. After three event-free years, the overall risk was 1%. This is reassuring to patients and also suggests that follow-up beyond 3 years may produce low yield of LR, both for individual patients and studies using LR as primary outcome. This can be used as a starting point to tailor follow-up to individual needs.

Keywords: Breast cancer; Breast cancer subtypes; Conditional survival; Local recurrence.

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Conflict of interest statement

M.L. Smidt, has been awarded a grant from Servier Pharma for microbiome research in breast cancer treatment. The remaining authors have no disclosures or conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimator plot of risk of local recurrence as a first event within 5 years after diagnosis in different subtypes of breast cancer
See this image and copyright information in PMC

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