Risk Factors for Local Recurrence of Breast Cancer - Essay Example

BC324229 Risk factors for Local recurrence of Breast cancer A woman has 8 -10% chances of developing breast cancer in her life time. With over 1million cases of breast cancer reported annually, it comprises 18% of all cancers in women. Age is an independent risk factor with middle age being most vulnerable. In United Kingdom, the incidence reaches 2 per 1000 among 50 year old women. Hormonal levels also play an important role. Long exposure to oestrogen as in case of early menarche, late menopause and late first pregnancy increases risk for breast cancer. The oral contraceptive and hormone replacement therapy are also risk factors to some extent. The lifestyle such as obesity, alcohol consumption is also related to breast cancer (Singletary et al 2004; McPherson et al 2000). The paper reviews literature to identify risk factors for local recurrence of breast cancer. Local recurrence (LR): LR is revival of original tumor in ipsilateral breast, chest wall or overlying skin. The risk factor for LR, common to breast conservation therapy (BCT), is margin status. The highest rate (27%) of IBTR was found in patients with positive margin having tumor with three low power microscopic fields and lowest for those with either close (4 cm) and locally advanced breast cancers using a combination of primary chemotherapy, surgery and radiotherapy. However, the presence of residual tumor in the axillary lymph nodes after chemotherapy is a predictor of local recurrence and patients with a better clinical response were also less likely to experience local disease recurrence (Mcintosh et al 2003). The National Surgical Adjuvant Breast Project (NSABP) B-04 trial concluded that axillary dissection has no effect on survival. However, there is substantial evidence that dissection provides excellent local control of disease in the axilla, with a local recurrence rate of 2% or less. Complete axillary dissection is still an effective method in several cases of breast carcinoma. Particularly for patients with multi-centric tumors, have tumor diameter larger than 2.5 cm, and patients with clinical involvement of axillary nodes (Luini et al 2005). RADIOTHERAPHY: A boost or supplementary radiation at the primary site is recommended. After BCT, the patient receives 45-50 Gy whole breast irradiation followed by 10-16 Gy boost irradiation at the tumor bed. The reason is that largest recurrences occur in the excision area and boost reduces incidences of LR (De Vitta et al (2008). Though a number of randomized trials have demonstrated that breast irradiation markedly reduces the rate of local recurrence after BCT, but these studies did not elaborated upon the dose or fractionation of radiation. The decision to administer boost dose of irradiation correlates with the fact, stated above, that most local recurrences occur around the primary tumor. An additional dose to the primary tumor area reduced the chances of local recurrence to half. The additional dose particularly benefitted patients of 40 years or younger. It is established that for local recurrence younger age is a risk factor. For patients 40 years old or younger the cumulative five-year rate of local recurrence was 19.5 percent without an additional dose which dropped to10.2 percent with an additional dose (Bartelink et al 2001p.1383-). Conclusion: The breast cancer risk factors are younger age, family history, and prolonged exposure to hormones such as oestrogen. Various treatment options have different degree of success in outcomes. The discussion indicated that the outcomes of a treatment depends on a number of factors and what holds good for one patient may not bring same result for other patient. The adjuvant systemic therapy with hormones or drugs is advised despite Surgery (BCT, mastectomy or axillary dissection) and subsequent radiotherapy. The re-emergence of tumor at primary site is local recurrence while at a different site in same breast is most likely to be a new primary. True Local recurrence shows in efficiency of treatments. References Bartelink, Harry , Horiot,Jean-claude, Poortmans, Struikmans,Philip, Bogaert, Hens Walter van den, Barillot, Isabelle et al. (2001). 'Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation'. N. Engl J. Med,vol. 345, no. 19, p. 1378-1388. DeVita, Vincent T., Lawrence, Theodore S. and Rosenberg, Steven A. (2008). DeVita, Hellman, and Rosenberg's cancer: principles & practice of oncology, Volume 2(2nd Ed., Lippincott Williams & Wilkins) Gulben, K, Berberoglu , E. U., Cengiz, E.A. (2007). 'Prognostic Factors Affecting Locoregional Recurrence in Patients with Stage IIIB Noninflammatory Breast Cancer', World J Surg Vol., 31, pp.1724-1730 Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. (1995). 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