Breast Cancer Recurrence Risk Calculator

Factors considered and result interpretation

This calculator evaluates recurrence risk in the case of patients suffering from breast cancer or metastatic disease.

The three risk factors found to have predictive value are:

■ Grade of tumor;

■ Lymph nodes;

■ Lymphatic or vascular invasion.

The higher the grade of breast tumor, the higher the risk of recurrence because the cells are more prone to subsequent activation and proliferation.

Lymphatic or vascular invasion refers to the presence of breast cancer cells in the lymphatic or vascular system.

There are two types of recurrence:

■ At the original site (breast, chest or lymph nodes in the armpit);

■ Metastasis or distant recurrence (most common in the bones, liver or lungs).

The first five years after treatment are the years with the highest recurrence risk (11%). However, the percentage increase where the patient has a family history of malignancy or presents BRCA gene mutations.

Localized recurrence is diagnosed through physical exam and mammogram whilst metastasis is usually recognized after specific symptoms and testing of the suspected affected organ.

The table below introduces the correlation between scores from the calculator and the associated cancer recurrence risks:

About the study

The original study from 1994 involved analysis of data on a cohort of 966 patients with median follow up period of seven years. The outcome was the following:

■ 223 developed local recurrence (appx 50% of cases were small single lesions);

■ 70 developed multiple discrete lesions;

■ 21 developed diffuse carcinomatous dermal infiltration.

This led O'Rourke et al. to the creation of a predictive index with three variables.

In the case of women scoring high, adjuvant irradiation should be recommended to decrease the likelihood of malignancy recurrence.

Breast cancer recurrence factors

Beside lymph node involvement and tumor histologic grade, there are other prognostic indicators such as:

■ Tumor size;

■ Hormone receptors – significant levels of estrogen receptors;

■ Nuclear grade or proliferative capacity;

■ Oncogene expression of the cancer gene.

A local recurrence may be suspected following changes in the size, shape or contour of the breast along with changes in the feel or appearance of the breast or nipple.

In some cases, the skin may be dimpled, red or swollen. A lump or thickening may or may not be observed near the breast or in the underarm.

To lower recurrence risk, therapy with tamoxifen or aromatase inhibitors may be initiated. Lifestyle changes may also help, such as healthy dieting, regular exercise and no excessive drinking.

In order to increase chances of rapid diagnostic and intervention, breast cancer survivors are recommended regular mammograms, preferably 3D in addition to the traditional digital ones.

Original source

O'Rourke S, Galea MH, Morgan D, Euhus D, Pinder S, Ellis IO, Elston CW, Blamey RW. Local recurrence after simple mastectomy. Br J Surg. 1994; 81(3):386-9.

Other references

1. Pinder SE, Ellis IO, Elston CW. Prognostic factors in primary breast carcinoma. J Clin Pathol. 1995; 48(11): 981–983.

2. Neri A, Marrelli D, Rossi S, De Stefano A, Mariani F, De Marco G, Caruso S, Corso G, Cioppa T, Pinto E, Roviello F. Breast cancer local recurrence: risk factors and prognostic relevance of early time to recurrence. World J Surg. 2007; 31(1):36-45.