Dormancy of Mammary Carcinoma After Mastectomy : Journal of the National Cancer Institute (original) (raw)

Theodore G. Karrison
Donald J. Ferguson
Paul Meier

Journal of the National Cancer Institute

(

)

January 6, 1999

Background

The longest interval between primary treatment of breast cancer and tumor recurrence, i.e., the limit ofbreast cancer dormancy, defines the appropriate length of follow-up,the effectiveness of treatment, and curability (no excess mortalityrisk for patients relative to the general population) for the disease.To determine this limit, we analyzed long-term follow-up data frompatients who underwent a radical mastectomy during a four-decade periodat the University of Chicago Hospitals.

Methods

For 1547patients operated on during the period from 1945 through mid-1987, thenumber of recurrences and deaths occurring within each postoperativeyear were tabulated, and the hazard rate for first recurrence or deathfrom breast cancer was estimated by use of the actuarial method. Theexcess mortality rate was calculated for successive 5-year intervals,beginning at the time of mastectomy, by use of U.S. life tables andmatching on the basis of age, race, and sex.

Results

Mostrecurrences occurred within the first 10 years after mastectomy.Recurrences were rare after 20 years; only one recurrence was reportedamong 192 patients followed for 26–45 years. Patients who had arecurrence within 5 years following mastectomy had shortersubsequent survival times than those whose recurrence appeared after5 years (two-sided _P_=.0001). The excess death rate increasedwith pathologic stage of the primary tumor. Overall, there was evidenceof excess mortality up to 20 years postsurgery (two-sided _P_=.009).

Conclusions

The limit of breast cancer dormancy in thispatient population appears to be between 20 and 25 years. After thistime, recurrences were rare, and the mortality rate was no longerstatistically significantly different from that of the generalpopulation. Patients surviving to this time without evidence ofrecurrence or contralateral breast cancer are probably cured.