Rationale and Objectives
To compare the mammographic appearance of recurrent breast cancer to the primary tumor in patients treated with breast conservation therapy.
Materials and Methods
The charts of women with American Joint Committee on Cancer Stage I or II breast cancer who underwent breast conservation therapy between 1977 and 2001 at our institution were reviewed. A total of 132 patients were diagnosed with local recurrence.
Results
The mammographic appearance of the local recurrence often varied from the appearance of the original breast cancer. This was especially true for women who had mammographically occult primary breast cancer. In these women, the recurrence was detected mammographically 76.9% of the time.
Conclusions
Given the variable appearance of the local recurrence after breast conservation therapy, any suspicious finding needs to be carefully evaluated regardless of the mammographic appearance of the original tumor.
Breast conservation therapy (BCT) is an accepted standard of care for clinical Stage I and Stage II breast cancer as an alternative to mastectomy with no adverse effect on long-term survival ( ). The local recurrence rate in patients after breast conservation therapy is approximately 1%–2% per year ( ). Because most local recurrence can be salvaged with mastectomy, patients need to be closely followed as part of their surveillance. Mammography and clinical evaluation play important roles in following these patients and in detecting recurrent disease ( ). Although it is accepted that mammography and clinical breast examination play complementary roles in detecting recurrent breast cancer, little has been written about the mammographic appearance of the recurrent cancer in comparison to the original cancer. The purpose of our study was to compare the mammographic appearance of the original cancer with the mammographic appearance of the recurrent cancer.
Material and methods
The retrospective study population was derived from women diagnosed with American Joint Committee on Cancer Stage I or Stage II between 1978 and 2001 treated with breast conservation at our institution ( ). Institutional review board approval was obtained. The study patients underwent breast conservation surgery followed by radiation therapy. The method of BCT has been previously described ( ). Briefly, all patients underwent surgical excision of their tumor. Axillary staging was performed with either axillary nodal dissection or sentinel lymph node biopsy. After completion of surgery, the patients underwent whole breast radiation plus a boost to the primary tumor site to a minimum total dose of 6,000 cGy. Adjuvant systemic therapy was given as indicated. The patients were followed clinically every 3–6 months for 5 years, and yearly thereafter. The asymptomatic patients had annual bilateral mammograms as part of their routine surveillance.
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Results
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Table 1
Ages of Patients at Time of Diagnosis of the Original Cancer, Age at the Time of Recurrence, and Time to Recurrence ( n = 95)
Patient Age at Time of Diagnosis (y) Patient Age at Time of Recurrence (y) Time to Recurrence (y) Mean 48.0 53.2 6.7 Range 21–76 22–93 0.3–20.8 Median 47.0 53.0 5.4
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Table 2
Comparison of Mammogram Appearance of the Primary Breast Cancer to Mammogram Appearance of Recurrent Breast Cancer
Mammogram Appearance of the Primary Tumor Mammogram Appearance of the Recurrent Breast Cancer Negative No. (%) Mass No. (%) Calcifications No. (%) Mass and Calcifications No. (%) Total No. (%) Negative 6 (23.1) 6 (23.1) 10 (38.4) 4 (15.4) 26 (100) Mass 7 (19.4) 21 (58.3) 4 (11.1) 4 (11.1) 36 (100) Calcifications 2 (14.3) 1 (7.1) 8 (57.1) 3 (21.4) 14 (100) Mass and calcifications 4 (21.0) 4 (21.0) 8 (42.1) 3 (15.8) 19 (100) Total 19 (20.0) 32 (33.7) 30 (31.6) 14 (14.7) 95 (100)
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Discussion
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