Purpose: Young age is known to be an independent factor for developing local recurrence (LR) in breast cancer patients. It has also been shown that the occurrence of LR negatively affects patient outcome, especially if LR occurs within 3 years after treatment of the primary tumour. The question whether the impact of LR on patient outcome differs according to the patient’s age has not been addressed before. The purpose of the present study is to investigate cancer-specific survival (CSS) as well as overall survival after LR in young patients (<50 years old) and to compare it to older patients. The age cut-off level was taken as 50 to avoid strong imbalance in patient numbers between the 2 groups. Patients and Methods: Between 1974 and 2003, 2,130 breast cancer patients were treated with conservative surgery and axillary dissection. All of them received post-operative radiotherapy. Adjuvant chemo- and/or hormonal therapy was given according to the prognostic factors and the treatment policy at the time of diagnosis. Only biopsy-confirmed ipsilateral LRs were taken into account. Early LRs were those observed within 36 months after surgery, and late LRs were those which occurred thereafter. The median follow-up was 100 months. Survival analysis was conducted with the Kaplan-Meier method. Results: The median age was 59 years. There were 472 patients aged <50 years versus 1,658 older patients. Pathological tumour size, hormone receptor status and lymph node involvement were evenly distributed in the 2 groups. The 5- and 10-year CSS was 92.3 and 83.9% in young patients, and 94.4 and 87.6% in older patients (p = 0.061), respectively. Overall, 200 LRs were observed; 52 of them (26%) were early LRs. The rate of LR was significantly higher in young patients: at 5 years, it was 10.5 versus 3.7% in patients ≧50 years; the respective rates at 10 years were 17.8 and 8.8% (p < 0.0001). The 5- and 10-year CSS in patients who developed LR was 86.8 and 76.0%, versus 94.7 and 88.2% in patients who did not develop LR (p < 0.0001). The 5-year CSS after LR in young and older patients was 77.6 and 65.7%, respectively (p = 0.028). Conclusion: Although young patients experience more LR than older ones, once LR occurs, young patients have a better outcome than the others. Possible hypotheses are: (1) more aggressive treatment in young patients after LR; (2) the treatment is better sustained in young patients; (3) biological differences in the characteristics of LR.

Keywords:
Breast cancer, Local recurrence, Young age, Specific survival
1.
Arriagada R, Lê MG, Contesso G, Guinebretière JM, Rochard F, Spielmann M: Predictive factors for local recurrence in 2006 patients with surgically resected small breast cancer. Ann Oncol 2002;13:1404–1413.
2.
Botteri E, Bagnardi V, Rotmensz N, Gentilini O, Disalvatore D, Bazolli B, Luini A, Veronesi U: Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol 2010;21:723–728.
3.
de Bock GH, Putter H, Bonnema J, van der Hage JA, Bartelink H, van de Velde CJ: The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model. Breast Cancer Res Treat 2009;117:401–408.
4.
Elkhuizen PH, van Slooten HJ, Clahsen PC, et al: High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: a European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group study. J Clin Oncol 2000;18:1075–1083.
5.
Jobsen JJ, van der Palen J, Meerwaldt JH: The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy. Eur J Cancer 2001;37:1820–1827.
6.
Jones HA, Antonini N, Hart AA, et al: Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol 2009;27:4939–4947.
7.
Kirova YM, Savignoni A, Sigal-Zafrani B, et al: Is the breast-conserving treatment with radiotherapy appropriate in BRCA1/2 mutation carriers? Long-term results and review of the literature. Breast Cancer Res Treat 2010;120:119–126.
8.
Komoike Y, Akiyama F, Iino Y, et al: Ipsilateral breast tumor recurrence (IBTR) after breast-conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer 2006;106:35–41.
9.
Veronesi U, Marubini E, Del Vecchio M, et al: Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 1995;87:19–27.
10.
Zhou P, Recht A: Young age and outcome for women with early-stage invasive breast carcinoma. Cancer 2004;101:1264–1274.
11.
Anderson SJ, Wapnir I, Dignam JJ, et al: Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols (NSABP) of node-negative breast cancer. J Clin Oncol 2009;27:2466–2473.
12.
Elkhuizen PH, Hermans J, Leer JW, Van de Vijver MJ: Late local recurrences with high mitotic count and early local recurrences following breast-conserving therapy are associated with increased risk on distant metastasis. Int J Radiat Oncol Biol Phys 2001;50:387–396.
13.
Haffty BG, Reiss M, Beinfield M, et al: Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol 1996;14:52–57.
14.
Fortin A, Larochelle M, Laverdière J, et al: Local failure is responsible for the decrease in survival of patients with breast cancer treated with conservative surgery and postoperative radiotherapy. J Clin Oncol 1999;17:101–109.
15.
Kemperman H, Borger J, Hart A, et al: Prognostic factors for survival after breast conserving therapy for stage I and II breast cancer. The role of local recurrence. Eur J Cancer 1995;31:690–698.
16.
Touboul E, Buffat L, Belkacemi Y, et al: Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 1999;43:25–38.
17.
Cowen D, Jacquemier J, Houvenaeghel G, et al: Local and distant recurrence after conservative management of ‘very low-risk’ breast cancer are dependent events: a 10-year follow-up. Int J Radiat Oncol Biol Phys 1998;41:801–807.
18.
Engel J, Eckel R, Aydemir U, et al: Determinants and prognoses of locoregional and distant progression in breast cancer. Int J Radiat Oncol Biol Phys 2003;55:1186–1195.
19.
Vicini FA, Kestin L, Huang R, Martinez A: Does local recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast-conserving therapy? Cancer 2003;97:910–919.
20.
Fisher B, Anderson S, Fisher ER, et al: Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet 1991;338:327–331.
21.
Fourquet A, Campana F, Zafrani B, et al: Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys 1989;17:719–725.
22.
Van der Sangen M, Van de Poll-Franse L, Roumen RM, et al: The prognosis of patients with local recurrence more than 5 years after breast conservation therapy for invasive breast carcinoma. Eur J Surg Oncol 2006;32:34–38.
23.
Courdi A, Largillier R, Ferrero J-M, et al: Early versus late local recurrences after conservative treatment of breast carcinoma: differences in primary tumor characteristics and patient outcome. Oncology 2006;71:361–368.
24.
Engel J, Eckel R, Kerr J, et al: The process of metastasisation for breast cancer. Eur J Cancer 2003;39:1794–1806.
25.
Koscielny S, Tubiana M: The link between local recurrence and distant metastases in human breast cancer. Int J Radiat Oncol Biol Phys 1999;43:11–24.
26.
Punglia RS, Morrow M, Winer EP, Harris JR: Local therapy and survival in breast cancer. N Engl J Med 2007;356:2399–2405.
27.
Lu WL, Jansen L, Post WJ, Bonnema J, van de Velde JC, de Bock GH: Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat 2009;114:403–412.
28.
Clarke M, Collins R, Darby S, et al: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366:2087–2106.
29.
Colleoni M, Rotmensz N, Peruzzotti G, et al: Role of endocrine responsiveness and adjuvant therapy in very young women (below 35 years) with operable breast cancer and node negative disease. Ann Oncol 2006;17:1497–1503.
30.
Yildirim E, Dalgic T, Berberoglu U: Prognostic significance of young age in breast cancer. J Surg Oncol 2000;74:267–272.
31.
Bollet MA, Sigal-Zafrani B, Mazeau V, et al: Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first. Radiother Oncol 2007;82:272–280.
32.
Sigal-Zafrani B, Bollet MA, Antoni G, et al: Are ipsilateral breast tumour invasive recurrences in young (< or =40 years) women more aggressive than their primary tumours? Br J Cancer 2007;97:1046–1052.
33.
Courdi A, Héry M, Chauvel P, Gioanni J, Namer M, Demard F: Prognostic value of continuous variables in breast cancer and head and neck cancer. Dependence on the cut-off level. Brit J Cancer 1988;58:88–90.
34.
Neri A, Marrelli D, Rossi S, De Stefano A, et al: Breast cancer local recurrence: risk factors and prognostic relevance of early time to recurrence. World J Surg 2007;31:36–45.
35.
Kurtz JM, Spitalier JM, Amalric R, et al: The prognostic significance of late local recurrence after breast-conserving therapy. Int J Radiat Oncol Biol Phys 1990;18:87–93.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.