Breast cancer recurrence rate in patients treated for early breast cancer
Date of Award
Master of Medicine (MMed)
Prof. Ronald Wasike
Dr. Miriam Mutebi
Dr. Mukuhi Ng’ang’a
General Surgery (East Africa)
Background: Breast cancer, the leading cause of cancer in Kenya among women, has a prevalence of 57.1 per 100,000 women and an annual mortality of 3.7 per 100,000. Early breast cancer is curable, but has a residual risk of recurrence of 10.4% in the first 5 years. Fifty percent of the recurrences occur after the first 5 years after diagnosis. Recurrent breast cancer is associated with poorer prognosis and higher mortality rates.
Objectives: The primary objective was to determine the breast cancer recurrence rates for women managed for DCIS and early breast cancer at Aga Khan University Hospital. Secondary objectives included identifying risk factors to recurrence after standard treatment.
Study design: Retrospective study
Methodology: We reviewed records for all women who were managed for early breast cancer, staged as per the AJCC TNM criteria 7th edition, from 2010 to 2017.
Results: Two hundred and thirty nine patients managed for early breast cancer were identified. The median age was 50 years (range 23 - 84 years) with 44.6% being premenopausal, 28.9% reporting contraception use within the past 5 years, and only 7.9% reporting a family history of breast cancer. Seventy one percent (71%) of the women had stage 2 breast cancer, with 98% of all women presenting with a breast mass. Eighty four percent (84%) of the women had hormone receptor positive breast cancer, and 12% had triple negative breast cancer. Forty one percent (41%) of the women had breast conserving surgery. Hormonal therapy compliance was at 78%. Factors found to be associated with invasive breast cancer were higher grade (OR 9.3), Lymphovascular invasion (P<0.001) and HER2 positivity (P<0.006).
The overall recurrence rate was 7.5%, with 83% of total recurrences occurring within the first five years. Seventy percent (70%) of recurrences were locoregional while 30% were metastatic cancer. Sixty one percent (61%) of recurrences were detected by either a self-breast exam or a clinical breast exam. There were no statistically significant factors associated with recurrence.
Conclusion: Early breast cancer has a recurrence of 7.5% which falls within documented recurrence of 7 – 18%. Majority of the recurrences - 82% (14/17) occurred within the first five years and were first detected by either self-breast examination or clinical examination during follow up visits.
Munguti, C. (2020). Breast cancer recurrence rate in patients treated for early breast cancer (Unpublished master's dissertation). Aga Khan University, East Africa.