Individual risk profiling for breast cancer recurrence: towards tailored follow-up schemes

• Published in: British journal of cancer 2013-08, Vol.109 (4), p.866-871
• Main Authors: Kraeima, J, Siesling, S, Vliegen, I M H, Klaase, J M, IJzerman, M J
• Format: Article
• Language: English
• Subjects: 692/699/67/1347; 692/700/1750; Age Factors; Biological and medical sciences; Biomarkers - metabolism; Biomedical and Life Sciences; Biomedicine; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Cancer Research; Chemotherapy, Adjuvant; Clinical Study; Drug Resistance; Epidemiology; Female; Gynecology. Andrology. Obstetrics; Humans; Lymphatic Metastasis; Mammary gland diseases; Medical sciences; Middle Aged; Molecular Medicine; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Grading; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - pathology; Neoplasms, Multiple Primary - diagnosis; Neoplasms, Multiple Primary - metabolism; Neoplasms, Multiple Primary - pathology; Odds Ratio; Oncology; Prognosis; Radiotherapy, Adjuvant; Registries; Regression Analysis; Risk Assessment; Risk Factors; Time Factors; Tumor Burden; Tumors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2013.401

Background: Breast cancer follow-up is not tailored to the risk of locoregional recurrences (LRRs) in individual patients or as a function of time. The objective of this study was to identify prognostic factors and to estimate individual and time-dependent LRR risk rates. Methods: Prognostic factors for LRR were identified by a scoping literature review, expert consultation, and stepwise multivariate regression analysis based on 5 years of data from women diagnosed with breast cancer in the Netherlands in 2005 or 2006 ( n =17 762). Inter-patient variability was elucidated by examples of 5-year risk profiles of average-, medium-, and high-risk patients, whereby 6-month interval risks were derived from regression estimates. Results: Eight prognostic factors were identified: age, tumour size, multifocality, gradation, adjuvant chemo-, adjuvant radiation-, hormonal therapy, and triple-negative receptor status. Risk profiles of the low-, average-, and high-risk example patients showed non-uniform distribution of recurrence risks (2.9, 7.6, and 9.2%, respectively, over a 5-year period). Conclusion: Individual risk profiles differ substantially in subgroups of patients defined by prognostic factors for recurrence and over time as defined in 6-month time intervals. To tailor follow-up schedules and to optimise allocation of scarce resources, risk factors, frequency, and duration of follow-up should be taken into account.