Skip to main content
Log in

Factors associated with local breast cancer recurrence after lumpectomy alone

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: The purpose was to determine the rate of local breast relapse in patients with breast cancer uniformly treated with partial mastectomy but without postoperative radiotherapy and without systemic adjuvant therapy. We also systematically examined the factors associated with local recurrence to determine whether a low-risk subgroup existed.

Methods: A retrospective review of a prospectively followed (median, 8 years) cohort of 293 patients was performed. The end-point was ipsilateral local breast cancer recurrence. The patient's age, tumor size, nodal status, estrogen and progesterone receptor status, histology, and tumor and nuclear grade were studied, as were the presence and amount of carcinoma in situ and the presence of tumor emboli using univariate Kaplan-Meier and Cox step-wise multivariate analyses.

Results: The overall local relapse rate was 26% (77 recurrences). Univariate factors significantly associated with decreased local relapse included older age, negative nodes, small tumor size, positive estrogen receptor status, and absence of tumor emboli. Significant multivariate variables were age, nodal status, estrogen receptor status, absence of comedo carcinoma in situ, and tumor emboli. A low-risk subgroup of 66 patients was defined with a 6% 10-year local recurrence rate.

Conclusion: Important patient and tumor variables associated with local breast cancer relapse after breast-conserving surgery can define a low-risk subgroup.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fisher B, Wickerham DL, Deutsch M, Anderson S, Redmond C, Fisher ER. Breast tumor recurrence following lumpectomy with and without breast irradiation: an overview of recent NSABP findings.Semin Surg Oncol 1992;8:153–60.

    CAS  PubMed  Google Scholar 

  2. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher ER, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1989;320:822–8.

    CAS  PubMed  Google Scholar 

  3. Clark RM, McCulloch PB, Levine MN, et al. Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer.JNCI 1992;84:683–9.

    CAS  PubMed  Google Scholar 

  4. Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast.N Engl J Med 1993;328:1587–91.

    Article  CAS  PubMed  Google Scholar 

  5. Moffat FL, Ketcham AS, Robinson DS, Legaspi A, Ghandur-Mnaymneh L, Hilsenbeck S. Segmental mastectomy without radiotherapy for T1 and small T2 breast carcinomas.Arch Surg 1990;125:364–9.

    CAS  PubMed  Google Scholar 

  6. Crile G, Esselstyn CB. Factors influencing local recurrence of cancer after partial mastectomy.Cleveland Clin J Med 1990;57:143–6.

    Google Scholar 

  7. Greening WP, Montgomery CV, Gordon AB, Gowing NFC. Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of Stage I breast cancer.Eur J Surg Oncol 1988;14:221–5.

    CAS  PubMed  Google Scholar 

  8. Clark RM, Wilkinson RH, Miceli PN, MacDonald WD. Breast cancer: experiences with conservation therapy.Am J Clin Oncol 1987;10:461–8.

    CAS  PubMed  Google Scholar 

  9. Cady B, Stone MD, Wayne J. New therapeutic possibilities primary invasive breast cancer.Ann Surg 1993;218:338–49.

    CAS  PubMed  Google Scholar 

  10. Nemoto T, Patel JK, Rosner D, Dao TL, Schuh M, Penetrante R. Factors affecting recurrence in lumpectomy without irradiation for breast cancer.Cancer 1991;67:2079–82.

    CAS  PubMed  Google Scholar 

  11. Hermann RE, Esselstyn CB, Cooperman AM, Crile G. Partial mastectomy without radiation therapy.Surg Clin North Am 1984;64:1103–13.

    CAS  PubMed  Google Scholar 

  12. Kurtz JM, Jacquemier J, Amalric R, Brandone H, et al. Risk factors for breast recurrence in premenopausal and post-menopausal patients with ductal cancers treated by conservation therapy.Cancer 1990;65:1867–78.

    CAS  PubMed  Google Scholar 

  13. Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen R. Pathologic predictors of early local recurrence in stage I and II breast cancer treated by primary radiation therapy.Cancer 1984;53:1049–57.

    CAS  PubMed  Google Scholar 

  14. Sawka CA, Pritchard KI, Lickley HLA, et al. The Henrietta Banting Breast Centre Database: a model for clinical research utilizing a hospital-based inception cohort.J Clin Epidemiol 1995;48:779–86.

    Article  CAS  PubMed  Google Scholar 

  15. McCready DR, Hanna W, Kahn H, Mobbs BG, Fish EB, Lickley HLA, Chapman JW. What factors are important for local breast cancer recurrence following lumpectomy alone?Can J Surg 1993;36:380.

    Google Scholar 

  16. McCready DR, Fish EB, Hiraki GY, Ross TM, Wall JL, Lickley HLA. Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone.Can J Surg 1992;35:485–8.

    CAS  PubMed  Google Scholar 

  17. McCready DR, Chapman JAC, Wall JL, Lickley HLA. Characteristics of local recurrence following lumpectomy for breast cancer.Cancer Invest 1994;12:568–73.

    CAS  PubMed  Google Scholar 

  18. Early Breast Cancer Trialists Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic or immune therapy.Lancet 1992;339:1–15.

    Google Scholar 

  19. Hanna W, McCready DR, Chapman JW, Mobbs BG, Trudeau ME, Lickley HLA. The predictive value of ERICA in breast cancer recurrence a univariate and multivariate analysis.Mod Pathol 1993;6:748–54.

    CAS  PubMed  Google Scholar 

  20. Chapman JW, Mobbs BG, Hanna WM, et al. The standardization of estrogen receptors.J Steroid Biochem Mol Biol 1993;45:367–73.

    Article  CAS  PubMed  Google Scholar 

  21. Prentice RL, Marek P. A qualitative discrepancy between censored data and rank tests.Biometrics 1979;35:861–7.

    CAS  PubMed  Google Scholar 

  22. Deutsch M. Radiotherapy after breast-conservation surgery: how much is enough?Semin Surg Oncol 1992;8:140–6.

    CAS  PubMed  Google Scholar 

  23. Fisher ER, Anderson S, Redmond C, Fisher B. Ipsilaterial breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP Protocol B-06.Semin Surg Oncol 1992;8:161–6.

    CAS  PubMed  Google Scholar 

  24. Fisher ER, Sass R, Fisher B, et al. Pathologic findings from the National Surgical adjuvant Breast Project (protocol no. 6). II: Relation of local recurrence to multicentricity.Cancer 1986;57:1717–24.

    CAS  PubMed  Google Scholar 

  25. Fisher ER, Redmond GR, Vellis C, Sommers VF, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol no. 4). I: Observations concerning the multicentricity of mammary cancer.Cancer 1975;35:247–54.

    CAS  PubMed  Google Scholar 

  26. Fisher B, Anderson S, Fisher ER, et al. Significance of ipsilateral breast tumor recurrence after lumpectomy.Lancet 1991;338:327–31.

    Article  CAS  PubMed  Google Scholar 

  27. Fisher B, Costantino J, Redmond C, et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors.N Engl J Med 1989;320:479–84.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCready, D.R., Hanna, W., Kahn, H. et al. Factors associated with local breast cancer recurrence after lumpectomy alone. Annals of Surgical Oncology 3, 358–366 (1996). https://doi.org/10.1007/BF02305665

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02305665

Key Words

Navigation