The Importance of Local Control in Early-Stage Breast Cancer: A Historical Review and a Discussion of Ongoing Issues

Breast cancer: from the earliest times through to the end of the 20th century

Breast cancer is a daunting disease and constitutes a continuing medical health problem through the ages for millions of women worldwide. Physicians, from the early periods of recorded history have tried to heal breast cancer patients, with results that were fairly promising at times and disappointing at others. The science of medicine evolved through the ages under the careful scrutiny and critical thought of the many prominent scholars and researchers of their times who constantly added to the therapeutic armamentarium. Surgeons described new therapeutic approaches, and anatomists, through their elaborate descriptions, added useful insights on the art of healing. Theories about the origin of cancer change as new scientific data are presented and validated. Although the Middle Ages hindered temporarily any progress in the field of medicine, the Renaissance became the vaulting horse for science in its broadest sense. However, it was not until the 19th century, with the discovery of anesthesia, the introduction of antisepsis, and the establishment of microscopy that giant scientific leaps in the field of breast cancer treatment occurred. The 20th century with the development of chemotherapy and radiation and the undertaking of numerous clinical trials offered new insights regarding breast cancer management. This article attempts a historical journey through the ages unfolding the problem of breast cancer through the different eras.

Locoregional recurrence in breast carcinoma patients

AIMS

To assess the risk of locoregional recurrence (LRR) after mastectomy and to identify predictive and treatment factors that affect the risk of LRR.

METHODS

The primary endpoint was local recurrence. Univariate and multivariate Cox regression analyses were carried out in the data from 1217 patients.

RESULTS

The median follow-up was 74 months, and 63 (5.2%) patients experienced a LRR in their follow-up period. In the multivariate analysis, age group (< or =35 years vs. >35 years, p<0.0001; Hazard Ratio [HR], 5.0; 95% Confidence Interval [95% CI], 3.0-8.3), tumour size (>2 cm vs. < or =2 cm, p=0.03; HR, 2.2; 95% CI, 1.2-4.7) and LVI (yes vs. no, p<0.0001; HR, 3.2; 95% CI,1.9-5.2) were the independent prognostic factors for LRR. This analysis, in the final model, indicated that adjuvant radiotherapy and adjuvant tamoxifen were associated with a reduced risk of LRR by 90% and 75%, respectively, across the follow-up period, whereas age group remained as an important risk factor (p=0.002; HR, 3.0; 95% CI, 1.5-6.2).

CONCLUSIONS

Although adjuvant therapies reduce the risk of LRR, young age is an independent risk factor for LRR.