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Breast Cancer Research and Treatment

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Open Access 01-10-2017 | Epidemiology

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

Authors: Y. M. Geurts, A. Witteveen, R. Bretveld, P. M. Poortmans, G. S. Sonke, L. J. A. Strobbe, S. Siesling

Published in: Breast Cancer Research and Treatment | Issue 3/2017

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.

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Title: Patterns and predictors of first and subsequent recurrence in women with early breast cancer
Authors: Y. M. Geurts
A. Witteveen
R. Bretveld
P. M. Poortmans
G. S. Sonke
L. J. A. Strobbe
S. Siesling
Publication date: 01-10-2017
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4340-3

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