Risk for late recurrence high in patients with breast cancer after adjuvant therapy

Issue: September 25, 2008

Patients with early-stage breast cancer who are disease free five years after adjuvant therapy are at increased risk for late recurrence, according to recent data.

Researchers from the University of Texas M.D. Anderson Cancer Center conducted a trial to determine the risk for recurrence in patients with stage I-III breast cancer treated with adjuvant and neoadjuvant systemic therapy.

The trial included 2,838 patients treated between January 1, 1985 and November 1, 2001 who remained disease-free for five years. The researchers estimated residual recurrence-free survival rates at five and 10 years.

At five years, residual recurrence-free survival was 89% and at 10 years the rate was 80%; 216 patients had a recurrence event.

The five-year residual risk for recurrence was 7% for those with stage I disease, 11% for those with stage II disease and 13% for those with stage III (P=.02).

Using multi-variate analysis, the researchers reported an association between late recurrence and disease stage, grade, hormone receptor status and endocrine therapy. They concluded that certain tumor characteristics may be associated with the risk for late recurrence. – by Stacey L. Adams

J Natl Cancer Inst. 2008;100:1-5.

It is interesting to see how differently the findings of this study were presented in the lay press, as compared to how they were presented by the researchers of the study. For example, the article in USA Today (8/13/08) stated that 'women who survive five years after being diagnosed with breast cancer have a good chance of remaining cancer-free,' whereas the study's researchers concluded that 'breast cancer patients have a substantial residual risk of recurrence.'

This is somewhat akin to viewing the glass as being half empty versus the glass being half full. Breast cancer patients, who often initially assume that their diagnosis is a death sentence, are understandably heartened to learn that the vast majority of women diagnosed with localized (stage I, II, III) breast cancer will be alive and free of their cancer at 10 and 15 years after their diagnosis. Breast cancer researchers like those who conducted this study, on the other hand, naturally feel that there is more work to be done when ‘only’ 80% of women so diagnosed are alive and breast cancer-free 15 years after diagnosis. These perspectives fit the respective roles, the former being hopeful survivors, the latter being scientists and doctors trying to conquer breast cancer.

Both perspectives are valuable and correct.

The clinical implications of the study findings are that it will be important to find better ways to reduce relapse risk that persists many years after initial breast cancer diagnosis. Identifying better strategies to reduce relapse risk will be particularly important for women with larger hormone receptor-expressing cancers that are found at the time of surgery to have spread to axillary lymph nodes.

– Donald W. Northfelt, MD, FACP

Associate Medical Director, Breast Clinic
Mayo Clinic Comprehensive Cancer Center, Ariz.