Breast Cancer Patients Still Have Risk of Relapse After Five Years of Systemic Therapy

Breast Cancer Patients Still Have Risk of Relapse After Five Years of Systemic Therapy
J. Natl. Cancer Inst. 2008 100: 1119
Abenaa M. Brewster, Gabriel N. Hortobagyi, Kristine R. Broglio, Shu-Wan Kau, Cesar A. Santa-Maria, Banu Arun, Aman U. Buzdar, Daniel J. Booser, Vincente Valero, Melissa Bondy, and Francisco J. Esteva

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Adjuvant and neoadjuvant systemic therapy (AST) improves the survival of breast cancer patients, but there is still a risk that the disease will recur years later.
Disease recurrence among breast cancer patients who were disease free 5 years after AST (the landmark) was estimated 5 and 10 years after landmark. Multivariable analysis was used to identify factors associated with recurrence.

Rates of recurrence-free survival at 5 years and 10 years after landmark were 89% and 80%, respectively. The risk of recurrence 5 years after therapy increased with tumor stage (stage 1: 7%, stage II: 11%, and stage 3: 13%) and was also associated with tumor grade, hormone receptor status, and endocrine therapy.Breast cancer patients who undergo AST are at risk of late recurrences, and this risk is associated with certain characteristics of the original tumor.

Limitations
HER2/neu status was not included in the analysis because the data were not available; aromatase inhibitor treatment was not included because too few women received it.

Two Different Breast Cancer Screening Strategies Are Equally Effective

Comparing Screening Mammography for Early Breast Cancer Detection in Vermont and Norway
Solveig Hofvind, Pamela M. Vacek, Joan Skelly, Donald L. Weaver, and Berta M. Geller
J Natl Cancer Inst 2008 100: 1082-1091

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Most screening mammography in the United States differs from that in countries with formal screening programs by having a shorter screening interval and interpretation by a single reader vs independent double reading. We examined how these differences affect early detection of breast cancer by comparing performance measures and histopathologic outcomes in women undergoing opportunistic screening in Vermont and organized screening in Norway.

The age-adjusted recall rate was 9.8% in Vermont and 2.7% in Norway (P < .001). The age-adjusted screen detection rate per 1000 woman-years after 2 years of follow-up was 2.77 in Vermont and 2.57 in Norway (P = .12), whereas the interval cancer rate per 1000 woman-years was 1.24 and 0.86, respectively (P < .001). Larger proportions of invasive interval cancers in Vermont than in Norway were 15 mm or smaller (55.9% vs 38.2%, P < .001) and had no lymph node involvement (67.5% vs 57%, P = .01). The prognostic characteristics of all invasive cancers (screen-detected and interval cancer) were similar in Vermont and Norway.

Screening mammography detected cancer at about the same rate and at the same prognostic stage in Norway and Vermont, with a statistically significantly lower recall rate in Norway. The interval cancer rate was higher in Vermont than in Norway, but tumors that were diagnosed in the Vermont women tended to be at an earlier stage than those diagnosed in the Norwegian women