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Survivors of early breast cancer remain at elevated risk for late recurrence after the landmark of five years of treatment with adjuvant systemic therapy, according to research.

Survivors of early breast cancer remain at elevated risk for late recurrence after the landmark of five years of treatment with adjuvant systemic therapy (AST), according to research conducted at the University of Texas MD Anderson Cancer Center in Houston.

"Limitations in the ability to predict the magnitude of the risk of late recurrence may contribute to some patients receiving unnecessary extended adjuvant endocrine therapy and others receiving no treatment," Dr. Abenaa M. Brewster and co-investigators note the August 20 issue of the Journal of the National Cancer Institute, posted August 12 online.

Dr. Brewster's team evaluated recurrence risk and prognostic factors among 2838 women with stage I, II or III breast cancer who underwent surgery and received AST between 1985 and 2001 and were alive and disease-free five years from the start of AST.

A total of 216 patients developed recurrence. The recurrence-free survival rate was 89 per cent and 80 per cent at five and ten years, respectively, after the completion of five years of AST. Residual five-year risk of recurrence was seven per cent for stage I, 11 per cent for stage II, and 13 per cent for stage III disease.

Although low-grade and positive hormone receptor status are associated with favorable short-term prognosis, both factors were associated with higher residual risk of recurrence in the current study.

The higher risk for hormone-receptor-positive tumors - which was independent of menopausal status - "has important clinical implications," Dr. Brewster and colleagues point out, particularly since extended adjuvant endocrine therapy is not recommended for premenopausal women who have completed five years of tamoxifen therapy.

"The magnitudes of the residual risk of recurrence for pre- and postmenopausal patients were within the range (eight per cent to 20 per cent) considered appropriate to recommend AST at the time of diagnosis," they maintain, "indicating a need for the continued development of risk reduction strategies for these survivors."

J Natl Cancer Inst 2008;100