Predictors of Mortality after Local Recurrence

Multiple studies show that, after treatment of invasive breast cancer with breast-conserving surgery, the risk of developing subsequent distant metastases and death is greater for women who experience a local recurrence than for women without a local recurrence1–5. The mortality rate is increased by a factor of 2 or 3 after local recurrence, but the risk varies between patients. For some patients, chemotherapy is given at the time of local recurrence with the goal of preventing progression (“salvage therapy”), but there are no standard indications for chemotherapy use6. Recently, investigators of the calor study, a randomized trial, reported that disease-free survival was improved if chemotherapy was given, in particular for women with estrogen receptor (er)–negative disease7. The identification of factors that predict distant recurrence and death after a woman experiences local recurrence might help to guide treatment recommendations and to illuminate the natural history of breast cancer. It is expected that some of the risk factors that predict mortality from the time of the initial diagnosis will overlap with factors that predict mortality after local recurrence, but some factors might be distinct to one or the other process. The identification of discordant factors could promote a better understanding of the steps in cancer progression. Much research has been conducted on risk factors for recurrence of breast cancer, but relatively little on risk factors for mortality after a local recurrence, or on how various treatments given after a local recurrence affect mortality. Factors that have been associated with a poor outcome after local ABSTRACT