The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis

• Type of Material: Article
• Authors: Rikke N Pedersen, Aarhus University; Buket Öztürk Esen, Aarhus University; Lene Mellemkjaer, Danish Cancer Society; Peer Christiansen, Aarhus University Hospital; Bent Ejlertsen, Copenhagen University Hospital; Timothy Lash, Emory University; Mette Nørgaard, Aarhus University; Deirdre Cronin-Fenton, Aarhus University
• Language: English
• Date: 2021-12-03
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/jnci/djab202
• Title of Journal or Parent Work: JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
• Volume: 114
• Issue: 3
• Start Page: 391
• End Page: 399
• Grant/Funding Information: This work was supported by grants to DCF from the Danish Cancer Society (“Knæk Cancer” R147-A10100) and by Aarhus University (RNP).
• Keywords: COOPERATIVE GROUP; CLINICAL DATABASE; EXPERIENCE; TREATMENT GUIDELINES; DISSEMINATION; Life Sciences & Biomedicine; REGISTRY; THERAPY; GROUP DBCG; FAILURE PATTERN; TAMOXIFEN; Science & Technology; Oncology
• Research Categories: Health Sciences, Oncology; Health Sciences, Epidemiology

Abstract

Background: Extended, more effective breast cancer treatments have increased the prevalence of long-term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary breast cancer diagnosis. Methods: Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early breast cancer diagnosed during 1987-2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after breast cancer diagnosis date until late recurrence, death, emigration, second cancer, or December 31, 2018. We calculated incidence rates per 1000 person-years and cumulative incidences for late BCR, stratifying by patient and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks. Results: Among 36 924 women with breast cancer, 20 315 became 10-year disease-free survivors. Of these, 2595 developed late BCR (incidence rate = 15.53 per 1000 person-years, 95% confidence interval = 14.94 to 16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8% to 17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node-positive disease, and estrogen receptor-positive tumors were associated with increased cumulative incidences and hazards for late BCR. Conclusions: Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size, and estrogen receptor-positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.