From the Guidelines
The risk of breast cancer recurrence after lumpectomy is generally low, ranging from 5-10% over 10 years, especially for low-risk patients with estrogen receptor (ER)–positive tumors who receive lumpectomy, radiation therapy, and hormonal therapy. This is supported by a recent study published in the Journal of Clinical Oncology in 2020 1. Several factors influence recurrence risk, including:
- Tumor size
- Grade
- Hormone receptor status
- Lymph node involvement
- Age at diagnosis
- Surgical margin status
- Molecular subtype Patients with triple-negative or HER2-positive cancers typically face higher recurrence risks. To minimize recurrence risk, patients should complete the recommended adjuvant treatments, which may include radiation therapy, hormonal therapy, chemotherapy, and/or targeted therapies like trastuzumab for HER2-positive disease. Regular follow-up with oncologists, annual mammograms of the treated breast, and adherence to prescribed medications are essential components of post-lumpectomy care. Lifestyle modifications, including maintaining a healthy weight, regular exercise, limiting alcohol consumption, and not smoking, can also help reduce recurrence risk. The highest risk of recurrence typically occurs within the first five years after treatment, though some subtypes, particularly hormone receptor-positive cancers, can recur even after this period.
The use of effective systemic agents, improved imaging, and more sophisticated breast specimen processing and evaluation have contributed to the reduction in local recurrence rates 1. Whole-breast radiation therapy after lumpectomy reduces recurrence rates in DCIS by approximately 50% 1. However, the most recent and highest quality study suggests that the risk of local recurrence is low, around 5%, for low-risk patients with ER-positive tumors treated with lumpectomy, radiation therapy, and hormonal therapy 1.
In terms of management, lumpectomy with negative margins, followed by radiation therapy, is a recommended treatment approach for early-stage breast cancer. The National Comprehensive Cancer Network guidelines recommend whole-breast radiation therapy after lumpectomy to reduce recurrence rates in DCIS 1. However, the most recent study published in 2020 provides more up-to-date guidance on lumpectomy margins for invasive breast cancer and ductal carcinoma in situ, emphasizing the importance of negative margins and effective systemic therapy in reducing recurrence risk 1.
From the Research
Risk of Recurrence of Breast Cancer after Lumpectomy
The risk of recurrence of breast cancer after lumpectomy is a significant concern for patients and healthcare providers. Several studies have investigated this topic, providing valuable insights into the factors that influence recurrence rates.
Factors Influencing Recurrence Rates
- The use of adjuvant radiation therapy after lumpectomy has been shown to reduce the risk of local or regional recurrence in women with early-stage breast cancer 2, 3.
- Tamoxifen therapy has also been found to decrease the risk of recurrence, particularly when combined with radiation therapy 2, 4, 3.
- The detection method used to identify recurrence, such as mammography, can also impact outcomes, with earlier detection potentially improving relapse-free and overall survival 5.
- Patient age and tumor characteristics, such as estrogen receptor status and stage, can also influence recurrence rates 6, 4.
Recurrence Rates
- A study of women aged 70 years or older with early-stage breast cancer found that the 10-year rate of local or regional recurrence was 2% in the group receiving tamoxifen plus radiation therapy, compared to 10% in the group receiving tamoxifen alone 2.
- Another study of elderly patients (aged 65 years or older) who underwent lumpectomy found a locoregional recurrence rate of 5% at a median follow-up of 30 months 4.
- A study of patients with hormone receptor-positive breast cancer who received lumpectomy with intraoperative radiation therapy found a local recurrence rate of 10.5% in patients who did not receive whole breast radiation therapy, compared to 0% in those who did receive it 6.
Treatment Implications
- The use of adjuvant radiation therapy and tamoxifen can reduce the risk of recurrence in women with early-stage breast cancer 2, 4, 3.
- Lumpectomy plus tamoxifen with or without irradiation is a viable treatment option for women 70 years of age or older with early breast cancer 2, 3.
- Selective whole breast irradiation may be beneficial in reducing local recurrence rates in patients with high-risk features 6.