Posted: November 11, 2017

Breast cancer can recur years after definitive treatment.  Everyone knows this.  Previously it had been thought that recurrences tapered off over time.  Dr. Richard Peto, one of the world’s greatest epidemiologists, has led a blue-ribbon task force in the production of a landmark study, published in November, 2017, in the New England Journal of Medicine.  Click here for the abstract.  If you want the entire article request it from Dr. Stark in the box to the right.  What does this mean?  Over 62,000 women from 88 different clinical trials were analyzed.  They had all been treated with five years of endocrine therapy after their breast cancer treatment.  They were from a variety of institutions and had a variety of clinical presentations — from node negative to up to nine positive lymph nodes.  The striking thing about the paper is that the rate of recurrence tapered off very little from year to year.  Conventional wisdom had been that most breast cancer recurrences — mostly metastatic disease — occurred within five years of diagnosis.  This study belies that long-held belief.  As you can see from the article the reurrences were fairly steady out to year 20.  There was a little bend in the curve but not much.

Does this have any practical impact?  Dr. Stark weighs in: “In my practice it was customary for me to tell patients after five years that it was so likely that they were cured that they could stop seeing me.  I would instead rely on their primary care physician to notify me if there were anything suspicious, knowing that recurrence was unlikely.  Were I still practicing I would revise that view: since non-oncologists are not as adept at picking up recurrence, I would suggest that patients remain in an oncology practice indefinitely.  This clutters up women’s lives but may now be appropriate given the new reality.  The good news is that health-care costs will probably fall, since oncologists as a group are less likely to order a bunch of tests if they are not suspicous of trouble.”