Estimate of tumor growth time for breast cancer local recurrences: rapid growth after wake-up?

Abstract

To obtain an estimate of the subclinical tumor growth time (TGT) for breast cancer, a series of 31 patients with local recurrence as first event after mastectomy was evaluated. The recurrence diameter was measured, and the minimum growth rate (mGR) consistent with the sequence ‘no detection at the preceding physical examination → recurrence of diameter Dr’ was obtained. The growth rate for uninterrupted exponential growth from surgery (GRu) was also calculated. mGR was significantly higher than GRu (p < 0.0001), and unrelated to the recurrence-free survival (RFS). Therefore, starting points of local recurrence growth curves had to be set at times variously delayed after mastectomy. The estimate of the delay lower limit (mD), which was obtained from mGR and GRu, showed a strong linear correlation with RFS (R=0.984; p < 0.0001). From the regression equation, TGT for local recurrences could be estimated at 30 ± 8 weeks or less. These findings support the concept that the lag time between surgical treatment of breast cancer and clinical evidence of local recurrence may be explained by a period of tumor dormancy followed by a tumor growing phase. The TGT estimate is remarkably shorter than previously believed and could considerably change the current picture of breast cancer history.