title: Understanding patterns of failure in breast cancer treatment argues for a more thorough investigation of axillary lymph nodes in node negative patients.
abstract: 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.
authors.affiliation: Department of Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Brand
authors.forename: M M
authors.initials: MM
authors.lastname: Sawyer
authors.forename: T A
authors.initials: TA
authors.lastname: King
authors.forename: J S
authors.initials: JS
authors.lastname: Bolton
authors.forename: G M
authors.initials: GM
authors.lastname: Fuhrman
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D017211:Treatment Failure