Breast cancer survivors continue to have a substantial risk of disease recurrence after five years of systemic therapy, according to a study published in the August 12 online issue of the Journal of the National Cancer Institute.
Among breast cancer patients who were cancer-free five years after initiating systemic therapy, 89 percent remained recurrence-free at five years (approximately 10 years after a woman's initial diagnosis) and 80 percent remained recurrence free at 10 years (approximately 15 years after diagnosis).
Women who receive chemotherapy, hormone therapy, or both, in addition to surgery, have a higher rate of relapse-free survival than women who do not receive adjuvant or neoadjuvant therapy. However, even following systemic therapy, breast cancer survivors remain at risk for relapse. Few studies have evaluated the magnitude of that risk or the patient and tumor characteristics that are associated with disease recurrence.
In the current study, Abenaa Brewster, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston and colleagues examined the recurrence rate in 2,838 breast cancer patients who had been treated between 1985 and 2001 at the cancer center and were included in the center's tumor registry. To determine the magnitude of residual risk following adjuvant therapy, which might include five years of hormone therapy, the researchers looked at what happened to the women five years after the start of treatment.
After a median follow-up period of 28 months, 216 women developed recurrent disease. The five-year risk of relapse for women with stage I disease was 7 percent, 11 percent for women with stage II disease, and 13 percent for women with stage III disease. Tumor grade, hormone receptor status, and endocrine therapy were all statistically significantly associated with risk of recurrence.
The increased risk of disease recurrence after five years of therapy for women with hormone receptor positive cancer points to an area of unmet clinical need. While there are risk-reduction options for postmenopausal women who have completed five years of tamoxifen therapy, none exist for premenopausal women. New strategies need to be developed for these women to further reduce their risk.
"In conclusion, this study demonstrates that patients with early stage breast cancer who are disease free at five years after [adjuvant systemic therapy] have a substantially increased residual risk of recurrence," the authors write.
- Brewster et al. Residual Risk of Breast Cancer Recurrence 5 Years After Adjuvant Therapy. JNCI Journal of the National Cancer Institute, 2008; DOI: 10.1093/jnci/djn233
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