Understanding patterns of failure in breast cancer treatment argues for a more thorough investigation of axillary lymph nodes in node negative patients

BACKGROUND: An understanding of the patterns of failure after potentially curative treatment of breast cancer patients can lead to the development of improved methods of patient management. METHODS: We compared two groups of patients in whom breast cancer recurred after potentially curative treatment. Patients were assigned to their groups based on the status of their lymph nodes at the time of presentation. RESULTS: In all, 294 recurrences were analyzed to demonstrate that the patterns of failure for the two groups were identical. In the node-positive group, recurrence occurred sooner and their primary tumors were larger. CONCLUSIONS: The nearly identical patterns of treatment failure in lymph node negative and positive breast cancer patients suggests that metastasis in node negative patients occurs by a similar mechanism. The shorter time to recurrence and larger primary tumor may only reflect a lead time bias, in that node-positive patients have a greater tumor burden in their lymph nodes that facilitates identification by pathologists. (C) 2001 by Excerpta Medica, Inc.