The relationship between local recurrence and death in early-stage breast cancer

To examine the relationship between local recurrence and breast cancer mortality in women with early-stage breast cancer. We studied 1675 women with stage 0 (DCIS), stage I or stage II breast cancer who were treated with breast-conserving surgery at Women's College Hospital between 1987 and 2009. For each patient, we obtained information on age at diagnosis, tumour size, lymph node status, tumour grade, lymphovascular invasion, oestrogen receptor status, progesterone receptor status, HER2 status and treatments received (radiotherapy, chemotherapy and tamoxifen). Patients were followed from the date of diagnosis until local recurrence, death from breast cancer or the date of last follow-up. We used the Kaplan-Meier method to estimate 15-year local recurrence-free and breast cancer-specific survival rates for each stage at diagnosis. For each stage, the two rates were compared. After a mean follow-up of 13.1 years, 243 women (14.5 %) experienced a local recurrence and 281 women (16.8 %) died of breast cancer. The 15-year actuarial rate of local recurrence was 16 % for women with DCIS, 15 % for women with stage I cancer and 16 % for women with stage II cancer. The 15-year breast cancer-specific mortality rate was 3 % for women with DCIS, 10 % for women with stage I breast cancer and 30 % for women with stage II breast cancer. After experiencing a local recurrence, the 15-year breast cancer mortality rate was 16 % for women with DCIS, 32 % for women with stage I breast cancer and 59 % for women with stage II breast cancer. Across the spectrum of the early stages of breast cancer, the risk of local recurrence does not correlate with the risk of death from breast cancer. After local recurrence, the risk of death from breast cancer depends on the initial stage at diagnosis.