title: Annual Hazard Rates of Recurrence for Breast Cancer During 24 Years of Follow-Up: Results From the International Breast Cancer Study Group Trials I to V.
abstract: OBJECTIVE
  Predicting the pattern of recurrence can aid in the development of targeted surveillance and treatment strategies. We identified patient populations that remain at risk for an event at a median follow-up of 24 years from the diagnosis of operable breast cancer.
  
  
  METHODS
  International Breast Cancer Study Group clinical trials I to V randomly assigned 4,105 patients between 1978 and 1985. Annualized hazards were estimated for breast cancer-free interval (primary end point), disease-free survival, and overall survival.
  
  
  RESULTS
  For the entire group, the annualized hazard of recurrence was highest during the first 5 years (10.4%), with a peak between years 1 and 2 (15.2%). During the first 5 years, patients with estrogen receptor (ER)--positive disease had a lower annualized hazard compared with those with ER-negative disease (9.9% v 11.5%; P = .01). However, beyond 5 years, patients with ER-positive disease had higher hazards (5 to 10 years: 5.4% v 3.3%; 10 to 15 years: 2.9% v 1.3%; 15 to 20 years: 2.8% v 1.2%; and 20 to 25 years: 1.3% v 1.4%; P < .001). Among patients with ER-positive disease, annualized hazards of recurrence remained elevated and fairly stable beyond 10 years, even for those with no axillary involvement (2.0%, 2.1%, and 1.1% for years 10 to 15, 15 to 20, and 20 to 25, respectively) and for those with one to three positive nodes (3.0%, 3.5%, and 1.5%, respectively).
  
  
  CONCLUSIONS
  Patients with ER-positive breast cancer maintain a significant recurrence rate during extended follow up. Strategies for follow up and treatments to prevent recurrences may be most efficiently applied and studied in patients with ER-positive disease followed for a long period of time.
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland. marco.colleoni@ieo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Zhuoxin
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Karen N
authors.initials: KN
authors.lastname: Price
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Per
authors.initials: P
authors.lastname: Karlsson
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: John F
authors.initials: JF
authors.lastname: Forbes
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Thürlimann
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gianni
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Monica
authors.initials: M
authors.lastname: Castiglione
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gelber
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Coates
authors.affiliation: Marco Colleoni and Aron Goldhirsch, European Institute of Oncology and International Breast Cancer Study Group, Milan; Lorenzo Gianni, Ospedale degli Infermi and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Rimini, Italy; Zhuoxin Sun, Karen N. Price, and Richard D. Gelber, International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation; Zhuoxin Sun and Richard D. Gelber, Harvard T.F. Chan School of Public Health; Richard D. Gelber, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Per Karlsson, Institute of Selected Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden; John F. Forbes, Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle Mater Hospital, Newcastle; Alan S. Coates, International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia; Beat Thürlimann, Breast Center Kantonsspital, St Gallen, and Swiss Group for Clinical Cancer Research; and Monica Castiglione, International Breast Cancer Study Group, Bern, Switzerland.
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015996:Survival Rate; D055815:Young Adult