Risk of developing local recurrence.
Measured Factor Detail
The index Breast Cancer Recurrence Risk After Mastectomy is a predictive index containing three variables that help predict the likelihood of local recurrence after a simple mastectomy and node biopsy for primary operable breast cancer. The index is calculated based on tumor grade, nodal status and the presence of vascular or lymphatic invasion in the primary tumor. The index provides the recurrence risk as a percentage and each variable is assigned a different weight. Women with tumor grade I, no lymph node involvement and no vascular or lymphatic invasion have an 8.5% recurrence risk. Meanwhile, women with a tumor grade III, lymph node involvement and vascular or lymphatic invasion have a 48% risk of recurrence.
Measured Factor High Impact
- Critical High: 48% recurrence risk
- Normal: 8.5% recurrence risk
- Normal Adult Female: 8.5% recurrence risk
- Normal Geriatric Female: 8.5% recurrence risk
This index was created in a specific population, thus limiting its ability to be extrapolated to women that do not meet the inclusion criteria of the study. Women older than 70 years of age or treated with adjuvant radiotherapy, systemic hormonal treatment or chemotherapy were not included. Therefore, this index might not be as reliable in women with these characteristics.
Study Validation 1
Retrospective study intended to determine the clinical significance of local recurrence after simple mastectomy and node biopsy for primary operable breast cancer, without irradiation or systemic adjuvant therapy. Recurrence was defined as having histologically proven lesions in or deep in the mastectomy skin flaps. Prognostic factors included tumor size, histological grade, tumor type and the presence or absence of tumor invasion in the lymphovascular spaces. A total of 966 patients were enrolled in the study and were followed by a median of 7 years. A total of 223 patients (23%) developed local recurrence. Results showed a significant association with tumor grade, nodal status and presence of lymphovascular invasion in the primary tumor. As a result, a predictive index containing these variables was created. The ability to predict local recurrence predicts reduced patient survival.
Study Additional 1
This review article discussed local recurrence after mastectomy or breast-conserving surgery and radiation. Among incidence and factors associated with recurrence, the article summarizes the study by O'Rourke et all to highlight the importance of high histological grade as a factor associated with increased risk of local, regional recurrence after a mastectomy. O’Rourke et al reported about 966 patients treated with mastectomy for breast cancer tumors and how more than half of the patients were node positive. Based on their findings, the risk of a chest wall recurrence was 16%, 21%, or 27% for grades I, II, or III tumors, respectively. O’Rourke et al also reported 36% risk of chest wall recurrence with lymphovascular invasion and 19% risk without lymphovascular invasion following mastectomies for T1-2 tumors. These differences, as well as lymph node status remained significant factors for recurrence on multivariate analysis.
Study Additional 2
This review article discussed the role and significance of accurate prognostic information for breast cancer. There is a large range of therapeutic options for treating breast cancer, therefore it is very important for clinicians to have tools available to determine which patients are undertreated or overtreated. This has led to a search for the ideal prognostic factors in primary breast cancer and despite the high advances in technology histopathological examination of breast cancer specimens yields useful information. The recognition of the presence or absence of vascular (blood vessel or lymphatic) invasion is a valuable prognostic factor that is utilized in many risk indexes, including the Breast Cancer Recurrence Risk After Mastectomy index. Specifically, vascular invasion helps predict survival and local recurrence in patients who have had breast conservation and for flap recurrence in those women who have undergone mastectomy. Other histological variables discussed include lymph node stage, histological grade and type, and tumor size. New genetic markers and technologies continue to become commonplace, but as of right now traditional morphological factors remain the prognostic factors.