A new Chinese retrospective study has reported that recurrence patterns after mastectomy and lumpectomy are different. The study results imply that surveillance visits should be reasonably frequent even four to six years after lumpectomy. The study included 6,135 patients with breast cancer in one breast who had surgery between 1998 and 2008. A total of 847 of the patients underwent lumpectomy, whereas 5,288 had a mastectomy. The authors also performed a literature-based review, which included seven relevant studies, to compare with their observations.
Among women who had a lumpectomy, 50.9% of recurrences occurred within three years and 30.2% of recurrences were diagnosed three to five years after surgery. Among women who underwent mastectomy, 64.9% of recurrences occurred within three years and 20.4% were diagnosed three to five years after surgery. The most frequent recurrence pattern after lumpectomy was recurrence in the original breast, which occurred for the most part within five years of surgery (81.3%) but had a relatively low incidence during the first three years (37.5%). Annual recurrence curves showed that relapse after mastectomy tended to happen during the first two years whereas recurrence rates after lumpectomy increased annually, with the highest peak near five years after surgery. The literature review confirmed the finding of divergent recurrence patterns for lumpectomy and mastectomy patients. Women treated with lumpectomy who had a recurrence within the first five years were more than four times as likely to die as those who relapsed after more than five years. The authors conclude that the different recurrence patterns between mastectomy and lumpectomy patients imply that scheduling of surveillance visits should be more frequent during years four to six after lumpectomy. Further prospective trials addressing the necessity of frequent and longer surveillance after lumpectomy are warranted.
Comments regarding the study
The study findings are relevant to U.S. women even though there are differences between Chinese and U.S. women with breast cancer, and treatment protocols also differ. The low rate (14%) of lumpectomy in the study population suggests that only women with very low risk of recurrence were selected for breast conserving surgery rather than mastectomy. Therefore, a pattern of increasing risk of recurrence during the first five years after lumpectomy is significant. As the authors indicate, the study results suggest that the schedule of follow-up mammograms and other forms of surveillance should not be scaled back for at least six years after a lumpectomy. Women with small, early stage tumors who are fortunate enough to be eligible for a lumpectomy might feel that they want to put the cancer patient experience behind them. However, moving on should not mean giving up the habit of annual mammograms, visits with their oncologists, and other forms of surveillance.