Mammographic, pathologic, and treatment-related factors associated with local recurrence in patients with early-stage breast cancer treated with breast conserving therapy

Background: We retrospectively reviewed our institution's experience treati ng early-stage breast cancer patients with breast conserving therapy (BCT) to determine clinical, pathologic, mammographic, and treatment-related fact ors associated with outcome. Methods: Between January 1980 and December 1987, 400 cases of Stage I and I I breast cancer were managed with BCT at William Beaumont Hospital, Royal O ak, Michigan. All patients underwent at least an excisional biopsy. Radiati on treatment consisted of delivering 45-50 Gy to the whole breast, followed by a boost to the tumor bed to at least 60 Gy in all patients. The median follow-up in the 292 surviving patients is 118 months. Multiple clinical, p athologic, mammographic, and treatment-related factors were analyzed for an association with local recurrence and survival. Results: A total of 37 local recurrences developed in the treated breast, f or a 5- and 10-year actuarial rate of 4% and 10%, respectively. On univaria te analysis, patient age less than or equal to 35 years (25% vs. 7%, p = 0. 004), and positive surgical margins (17% vs. 6%, p = 0.018) were associated with an increased risk of local recurrence at 10 years. On multivariate an alysis, only age less than or equal to 35 years remained significant. A sub set analysis of 214 patients with evaluable mammographic findings was perfo rmed. On univariate analysis, age less than or equal to 35 years (38% vs. 8 %, p 0.0029) and the presence of calcifications on preoperative mammography (22% vs. 6%, p = 0.0016) were associated with an increased risk of local r ecurrence. On multivariate analysis, both of these factors remained signifi cant. The presence of calcifications on preoperative mammography did not af fect the rates of overall survival, disease-free survival, and cause-specif ic survival. Conclusion: In patients with early-stage breast cancer treated with BCT, ag e less than or equal to 35 years and calcifications on preoperative mammogr aphy appear to be associated with an increased risk of local recurrence. (C ) 1999 Elsevier Science Inc.