Abstract
PurposeLittle 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.MethodsWomen 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.ResultsIn 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.ConclusionsAlthough 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.
Highlights
As a result of early detection and improved treatment, survival after breast cancer has improved significantly
Women diagnosed with stage I-III invasive breast cancer who were treated with curative intent were selected from the Netherlands Cancer Registry (N = 9342)
We identified prognostic factors for site-specific first recurrence and subsequent recurrences after LR or RR using extended Cox regression analysis
Summary
As a result of early detection and improved treatment, survival after breast cancer has improved significantly. The main aim of follow-up is the early detection of local (LR) or regional recurrences (RR) and secondary primary tumours [2]. Some studies demonstrated a second peak between 4–9 years after treatment, mainly in ER-positive patients [10,11,12,13,14,15,16]. These studies lack contemporary treatments [11] or report single-institution data [12,13,14,15,16]. The pattern of subsequent recurrence after the first is not yet analysed
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