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Patterns of breast cancer second recurrences in patients after mastectomy

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Abstract

Introduction

Little is known about second recurrences in breast cancer patients, especially in patients with mastectomy. We aimed to determine the risk factors, prevalence and patterns of second recurrence in mastectomy patients after first recurrence.

Methods

Stage I–III breast cancer patients treated at a tertiary institution from 1st September 2005 to 31st October 2017 and developed first and second recurrences after mastectomy were retrospectively reviewed. We excluded patients with bilateral cancers and patients who were lost to follow-up. The demographics, pathological and recurrence data were collected from a prospectively maintained database and analysed.

Results

Of the 1619 mastectomy patients, 214 (13.2%) patients developed recurrences at a mean 39.9 months from primary cancer diagnosis. 23, 8 and 183 had isolated chest wall recurrences (CWR), regional and systemic metastases, respectively. Excluding 2 CWR patients without surgery, second recurrences occurred in 3/21 (14.3%) and 3/8 (37.5%) in patients with CWR and regional metastasis at 27.7 months (range: 5–42) and 32 months (range: 18–40), respectively. In both groups, systemic metastasis as second recurrence occurred within 2 years after first recurrence, whilst locoregional second recurrences occurred later. No risk factors for second recurrence were identified.

Conclusion

In patients with mastectomy, second recurrences occurred in 20.7% of patients with treated locoregional first recurrence, with no risk factors identified. Systemic metastases manifesting as second recurrence occurred in the first 2 years after first recurrence. Continued clinical surveillance and restaging patients in the first 2 years after first locoregional recurrence may enable early prognostication and treatment with the newer metastatic drugs.

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Data availability

The data are available from the corresponding author upon request.

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Breast Department, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Geok Hoon Lim, Veronica Siton Alcantara, Me Me Win Htein, Swee Ho Lim, Zhiyan Yan & Qing Ting Tan

  2. Duke-NUS Medical School, Singapore, Singapore

    Geok Hoon Lim & John Carson Allen

  3. Division of Nursing, KK Women’s and Children’s Hospital, Singapore, Singapore

    Ruey Pyng Ng

  4. Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Raymond Ng

Authors
  1. Geok Hoon Lim
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  2. Veronica Siton Alcantara
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  3. Ruey Pyng Ng
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  4. Raymond Ng
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  5. John Carson Allen
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  6. Me Me Win Htein
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  7. Swee Ho Lim
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  8. Zhiyan Yan
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  9. Qing Ting Tan
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Contributions

Conceptualization: GHL, Formal analysis: GHL, JCA and RN; Project administration: MMWH and RPN; Data collection: Zhiyan Yan, Veronica Siton Alcantara, RPN, SHL, QTT and GHL. Writing—original draft: GHL. Writing—review & editing: All authors. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Geok Hoon Lim.

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Lim, G.H., Alcantara, V.S., Ng, R.P. et al. Patterns of breast cancer second recurrences in patients after mastectomy. Breast Cancer Res Treat 196, 583–589 (2022). https://doi.org/10.1007/s10549-022-06772-4

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  • DOI: https://doi.org/10.1007/s10549-022-06772-4

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