Long-term age-dependent failure pattern after breast-conserving therapy or mastectomy among Danish lymph-node-negative breast cancer patients.
To describe long-term failure pattern after early-stage breast cancer in relation to local treatment (breast-conserving therapy (BCT) or mastectomy) and age.



Cohort study with balanced 5-year age groups and prospectively collected data; 813 Danish lymph-node-negative breast cancer patients diagnosed in 1989-98 and treated with mastectomy (N=515) or BCT (N=298) and no adjuvant systemic treatment.



The 20-year local recurrence (LR) risk was 20% after BCT; 8.7% after mastectomy. LR developed in mastectomy patients within the first 10years; in BCT patients throughout the entire 20-year period. Younger patients' (⩽45years) 20-year LR risk was generally higher than older patients' (>45years) (19% vs. 5%, p<0.001). In younger patients, LR was significantly associated with distant metastasis (DM) (hazard ratio (HR)=2.7(1.8-4.2)) and 20-year breast-cancer mortality (HR=2.7(1.7-4.4)). BCT was associated with higher 20-year breast-cancer mortality (HR=1.5(1.0-2.4)) and higher 20-year all-cause mortality (HR=1.7(1.2-2.5)) than mastectomy. In older patients, LR was not associated with DM, and breast-cancer mortality was similar for BCT and mastectomy.



BCT patients with no adjuvant systemic treatment developed LR throughout 20-year period and faced higher LR risk than mastectomy patients. LR was associated with DM among younger patients, and younger BCT patients had higher mortality than younger mastectomy patients.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark. Electronic address: laurberg@oncology.au.dk.
Tinne
T
Laurberg
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Christina Daugaard
CD
Lyngholm
Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Denmark.
Peer
P
Christiansen
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Jan
J
Alsner
Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
Jens
J
Overgaard
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental / Q000401:mortality; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D017211:Treatment Failure
Breast cancer; Breast conserving therapy; Local recurrence; Mastectomy; Survival; Young age