Wednesday, November 17, 2010

Risk: Facts and Figures

Risk factors for local recurrence after breastconserving treatment of early breast cancer have not previously been evaluated in settings where mammography has been a major pathway to diagnosis of both primary tumour and recurrences, or in patients treated surgically by a formal sector resection.

this is from 15 years ago, though,

Low age, comedo and lobular cancers and mammographic appearance of the tumour as a stellate lesion with microcalcifications inside the lesion indicate an increased risk for local recurrence after sector resection in stage I tumours at five years.

1) increased from what?
2) 6/190 w/ radiation vs. 42/190 w/o. 3.1% risk of recurrence with radiation.

Patients >60 years of age without comedo or lobular cancers are at low risk for local recurrence at five years even without postoperative radiotherapy.

Premenopausal women are at higher risk of recurrence than postmenopausal women after lumpectomy + radiation (ONLY 10 years ago!):

But what are those risks:

"Fortin et al[5] reported a ... 10% [IBTR rate] for T1 or T2 tumors"

Lymphovascular Invasion—Lymphovascular invasion has been associated with an increased risk of IBTR in many [13,14,59,62,94] but not all [4,12,65] series.

A new genetic test (Oncotype DX) can help determine the likelihood of late recurrence (for example, recurrence in 5 or 10 years) in newly diagnosed patients whose breast cancer is stage I or II, node negative, estrogen receptor positive {went on to say, and tamoxifin, but I cut that out because I'm not going to take it, but the test seems like a good idea anyway -- I'm going to ask about it.

Doesn't mention stage, or "grade" -- just invasive, which can mean many things. However, since this seems about as bad as it can get, here it is:

"For patients treated initially for invasive breast cancer, 5 percent to 10 percent will be found to have distant metastases at the time of discovery of the breast recurrence. The same proportion will have recurrences that are too extensive to be operated on. These patients are rarely, if ever, cured. Five-year cure rates for patients with relapse after breast conservation therapy are approximately 60 percent to 75 percent if the relapse is confined to the breast and a mastectomy is then performed."

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