LOCAL RECURRENCE IN THE CONSERVATIVELY TREATED BREAST-CANCER PATIENT - A CORRELATION WITH AGE AND FAMILY HISTORY

BACKGROUND The purpose of this study was to evaluate the relationships among young age at diagnosis, family history status, and local recurr ence in breast cancer patients treated with lumpectomy and radiation t herapy. METHODS Between January 1970 and December 1990, 984 early-stag e breast cancer patients were treated with conservative surgery and ra diation therapy at Yale-New Haven Hospital. All patient data, includin g demographics, staging information, treatment, and outcome variables were entered into a computerized database. The current study focused o n the relationships between young age, family history, and local relap se. A group of 52 patients who experienced a local recurrence in the c onservatively treated breast and 52 matched control patients who had n ot experienced a local recurrence were asked to participate in a study to determine whether local recurrence was associated with family hist ory. Detailed family history interviews were conducted, and pedigrees were analyzed by a genetic counselor who was blind to the clinical his tory of the patients. RESULTS As of September 1997, with a median foll ov-up of 12.3 years for the 984 patients in the database, the overall actuarial 10-year survival is 73%, and the 10-year distant metastasis- free survival is 78%. Of the 984 patients, 112 have experienced a loca l relapse in the conservatively treated breast, resulting in a 10-year actuarial breast relapse rate of 15%. The 10-year survival after brea st relapse is 63%. Patient age tested as a continuous variable correla ted strongly,vith ipsilateral breast tumor relapse. Using age 40 as a cutpoint, patients aged 40 years or less had a significantly higher lo cal relapse rate than patients older than 40 years (P < 0.001). Althou gh the relationship between local relapse and young age was strong, no association was found between family history and local relapse in the detailed family history study. CONCLUSIONS Young age at diagnosis was a significant prognostic factor for local relapse. In a detailed fami ly history study using a case-control design, no significant differenc es in family history status were found between patients who had experi enced a local relapse and patients who had not.