When breast cancer occurs a second time in the same area where it was first found and treated, long-term survival is common, according to researchers in the journal Cancer (Vol. 94, No. 11:2813-2820). This is true for women who received older therapies before newer treatments were developed.

And the length of survival is not dependent on whether women choose mastectomy (breast removal) or lumpectomy (removal of only the tumor, followed by radiation) to treat the original breast cancer or its recurrence, the researchers said.

"Isolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis, not affected by the type of initial treatment or local salvage treatment," said lead author Monique G. Le, MD.

Le studied 105 women with breast cancer who had been treated either with mastectomy or by lumpectomy followed by radiation therapy. Each of the women in the study had a recurrence of their cancer in the breast or the chest wall after having tumors there removed earlier.

The survival of these women was compared to another group of 335 women from the same hospital whose first recurrence of breast cancer was at a distant site, not the breast or mastectomy site.

All the patients were treated at the Institut Gustave-Roussy in Villejuif, France, between 1954 and 1983, and all had breast tumors that were about one inch or less in size. In some of the patients, the cancer had spread to the axillary (underarm) lymph nodes, but in others, it had not.

About half the women had mastectomy at the time their breast cancer was first diagnosed, and the other half chose lumpectomy and radiation.

All the women had all their axillary lymph nodes removed at their initial treatment.

More than half (56%) of the women with local recurrence survived 10 years or more after cancer was found again in the area in which it originally occurred. This was regardless of whether they were originally treated with mastectomy or lumpectomy, or which of those options they chose when the cancer occurred in the same area again.

This compared to a 10-year survival of only 9% in the women where the first evidence of recurrent cancer was at a distant site.

In premenopausal women, the use of chemotherapy or lowering patients' exposure to estrogen by removing or radiating the ovaries significantly reduced the women’s chances of death from cancer.

In the same premenopausal group, Le found no benefit from the use of tamoxifen. In fact, there was a suggestion that tamoxifen may have actually been harmful in this group. However, the number of premenopausal women who received tamoxifen in this study was far too small to draw any conclusions in this regard.

In contrast, according to Le, in postmenopausal women “the use of systemic treatment [hormonal therapy or chemotherapy] after local recurrence did not change the risk of death…significantly in our series.”

Patients with high-grade, aggressive tumors or whose cancer came back relatively soon after initial treatment did not live as long as others.

The study contradicts the common belief that women who have a local recurrence will also have distant metastasis and die from it, Le said.

And it confirms other studies showing most patients who have a local recurrence are still alive 10 years later, Le said.

An American Cancer Society (ACS) breast cancer expert said the findings should be interpreted with caution, because only a relatively small number of women were involved, and their treatments were not randomly assigned and then compared for outcome.

And some patients in the survey began therapy so long ago that the data may not be the best to predict survival today, said researcher-physician Jeanne A. Petrek, MD, director of breast cancer surgery at Memorial Sloan-Kettering Cancer Center in New York and an ACS advisory board member.

But there is good news implied, too, by the long-term survival of women on older therapies, said Petrek.

"The last of these women began treatment before doctors routinely determined whether a patient's tumors are estrogen-sensitive, and before tamoxifen was available, and we know tamoxifen can help prevent recurrences to begin with in many women," said Petrek.

Newer chemotherapy drugs, new combinations of drugs, and other new therapies, such as herceptin for patients whose tumors have certain characteristics, are also likely to continue to improve survival of breast cancer patients, Petrek said.

"Today's better treatments mean that fewer patients are likely to recur to begin with, and that more of those who do are likely to survive longer than in this survey," she said.