Metastatic presentations of previously treated early stage breast cancer patients.

Abstract

e23065 Background: Breast cancer (BC) patients on surveillance often suffer from a fear of recurrence. Given that routine surveillance imaging is not recommended, the ability to recognize metastatic disease early on requires a knowledge of recurrence patterns. The aim of this study was to analyze the most common presentations of metastatic disease. Methods: A retrospective review was conducted of all adult patients at the Holden Comprehensive Cancer Center that were initially diagnosed with early stage BC and later developed metastatic disease, from 2000-2017. Chi-squared tests, and logistic and Cox regression models were used. Results: Of the 2,033 patient charts reviewed, 372 were deemed adequate for analysis. While most metastatic diagnoses were made as a result of reported symptoms (77.6%), 3.2% were made with clinical exam findings and 7.8% incidentally on imaging. Among those with symptoms, musculoskeletal pain was the most common (33.7%) and more frequently noted at scheduled (48.9%) compared to unscheduled visits (26%, p < 0.01). Receptor status was associated with nervous system (NS) symptoms at metastatic diagnosis (p = 0.01), with higher odds of NS symptoms in triple negative (TN) (OR = 3.0) and HER2+ cases compared to ER/PR+ HER2- cases (OR for ER/PR+ HER2+ = 3.5, OR for ER/PR- HER2+ = 3.8). Bone pain was not associated with any specific receptor subtype (p = 0.12). Initial stage and receptor status were associated with time to recurrence (TTR) (both p < 0.01), with stage III disease (versus stage I, HR = 1.60) and TNBC (versus [ER/PR+ HER2-, HR = 2.52) having the shortest TTR. On multivariable analysis, initial stage (p = 0.03), receptor status (p < 0.01), age (p < 0.01), and TTR (p < 0.01) were significantly associated with 10-year survival after metastatic diagnosis whereas the presence of symptoms at metastatic diagnosis was not (p = 0.27). Conclusions: Providers of patients on surveillance for a history of early stage breast cancer should modify their threshold of suspicion for recurrence depending on the characteristics of the initial diagnosis and symptoms subsequently reported. Although most metastatic recurrences were diagnosed by symptoms, patients did not necessarily have a shorter survival as a result of presenting with symptoms.