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Patterns and predictors of early recurrence in postmenopausal women with estrogen receptor-positive early breast cancer

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Abstract

Previous studies suggest that disease recurrence peaks at around 2 years in patients with early stage breast cancer (EBC), but provide no data regarding recurrence type. This retrospective analysis aimed to identify early recurrence types and risk factors in estrogen receptor-positive (ER+) EBC patients treated with adjuvant tamoxifen following breast cancer surgery. Postmenopausal women diagnosed with ER+ EBC from 1995 to 2004 were evaluated. Annual hazard ratios (HR) for recurrence at different sites were calculated. Time-dependent Cox regression analysis was used to identify predictors of recurrence within 2.5 years of diagnosis, including factors that were more strongly predictive of early than later recurrence. Of 3,614 patients evaluated, 476 developed recurrence during the 5-year median follow-up. Cumulative recurrence rates at 2.5 years (95% confidence interval) were: overall 6.3% (5.5–7.1), locoregional 1.1% (0.7–1.5), contralateral 0.5% (0.3–0.7), and distant 4.8% (4.0–5.6). The annual HR of overall recurrence peaked at 2 years (4.3% per annum). The majority of this peak represented distant recurrence (3.4% per annum). In Cox regression analysis, tumor size and grade, lymph node involvement, lymphovascular invasion, and symptomatic presentation were significant independent predictors of early recurrence. Age at diagnosis was independently predictive of recurrence within 2.5 years of diagnosis but not later recurrence. This study identified an early recurrence peak at 2 years, most of which were distant recurrences. Implementing an aromatase inhibitor after an initial 2–3 years of tamoxifen fails to address this early peak of distant recurrence and the potential breast cancer-associated mortality.

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Acknowledgments

We thank Sharon Thomas, PhD, of Phase Five Communications Inc. for editorial assistance with this manuscript. Financial support for editorial assistance was provided by Novartis Oncology.

Financial disclosures

Astra Zeneca provided an educational grant for this study. IJ Monypenny has received honoraria from Astra Zeneca. JC Doughty has received honoraria from Astra Zeneca, Novartis, Pfizer and Roche. R Carpenter has received honoraria from Astra Zeneca, Novartis, Pfizer and Roche. W Angerson has received lecture fees from Astra Zeneca.

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Authors and Affiliations

  1. University Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, Scotland, UK

    James Mansell, Christopher R. Wilson, Wilson J. Angerson & Julie C. Doughty

  2. University of Wales College of Medicine, Cardiff, UK

    Ian J. Monypenny

  3. Royal Bournemouth Hospital, Brompton, UK

    Anthony I. Skene

  4. Belfast City Hospital, Northern Ireland Cancer Centre, Belfast, UK

    Paul Abram

  5. St. Bartholomew’s Hospital, London, UK

    Robert Carpenter & Jennifer M. Gattuso

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  1. James Mansell
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  2. Ian J. Monypenny
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  3. Anthony I. Skene
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  9. Julie C. Doughty
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Correspondence to Julie C. Doughty.

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Mansell, J., Monypenny, I.J., Skene, A.I. et al. Patterns and predictors of early recurrence in postmenopausal women with estrogen receptor-positive early breast cancer. Breast Cancer Res Treat 117, 91–98 (2009). https://doi.org/10.1007/s10549-008-0291-z

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  • DOI: https://doi.org/10.1007/s10549-008-0291-z

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