The tumor burden of locally recurrent breast cancer is a neglected prognostic factor

BACKGROUND: Local recurrence following breast-sparing surgery for breast cancer is no longer considered to be an ominous sign. Why this should be the case is not understood, and it poses a dilemma for the surgical oncologist. When does local recurrence represent an independent threat to survival? DATA SOURCES: I reviewed the few studies that have considered the size or tumor burden of locally persistent breast cancer, and the results of the Guy's Hospital Trials. CONCLUSIONS: Locally persistent breast cancer is seldom a risk to patient survival. The surgical literature is seriously deficient in its consideration of the tumor volume of locally persistent cancer. All available evidence suggests that a recurrent tumor is a risk only if its volume exceeds that of the original tumor. Patients appear to have a stable level of host defense against metastasizing tumor cells. Those who survive one breast cancer without developing distant disease can be expected to survive the local persistence of a similar volume of tumor. Investigators should compare the size of each persistent lesion to the size of the patient's primary cancer. Excess deaths will occur only among patients whose persistent disease exceeds the volume of the primary.