Breast Cancer Recurrence Risk Calculator

How does this breast cancer recurrence risk calculator work?

This health tool evaluates recurrence risk in the case of patients with a recurrence of breast cancer or metastatic disease.

The risk factors accounted for in this breast cancer recurrence calculator are:

■ Grade of tumor – the higher the grade, the more likely a recurrence is. For instance, grade 4 contains increasingly abnormal and rapid growth cancer cells that are more likely to recur;

■ Lymph nodes – inflammation of lymph nodes is indicative of higher risk;

■ Lymphatic or vascular invasion – presence or absence of breast cancer cells in the lymphatic or vascular system.

Breast cancer recurrence can take place at the original site (breast, chest or lymph nodes in the armpit) or spread to other parts of the body, indicating metastasis or distant recurrence (usually in the bones, liver or lungs).

Most recurrences (second primary cancer) occur within the first five years after first treatment with average risk rates of about 11%. This percentage increases in the case of patients with cancer family history or BRCA gene mutations.

Diagnosis of localized recurrence takes place through physical exam and mammogram while diagnosis of metastasis depends on types of symptoms and available testing.

Recurrence cancer treatment depends on the initial treatment, for example in the case of a lumpectomy, local recurrence is treated with mastectomy while in case the initial treatment was mastectomy, an attempt to remove the second tumor surgically is made, followed by radiation therapy.

Distant recurrences are treated through systemic therapy followed by radiation therapy or surgery where necessary.

Recurrence risk factors

The recurrence risk can be lowered during therapy with tamoxifen or aromatase inhibitors and also by simple lifestyle changes such as a balanced and healthy diet, regular exercise, no smoking or excessive drinking.

Breast cancer survivors are recommended regular mammograms, if possible by 3D in addition to the traditional digital ones.

The most common prognostic indicators are:

■ Lymph node involvement;

■ Tumor size;

■ Hormone receptors – significant levels of estrogen receptors;

■ Histologic grade of the tumor;

■ Nuclear grade – rapidity at which tumor cells divide and form new cells, also known as proliferative capacity;

■ Oncogene expression of the cancer gene.

Breast changes consistent with a recurrence include:

■ Changes in the size, shape, or contour of the breast;

■ Change in the feel or appearance of the skin on the breast or nipple;

■ Dimpled, scaly, red, swollen breast skin;

■ Lump or thickening in or near the breast or in the underarm;

■ Secretions of blood or clear fluid coming out of a nipple.

Recurrence risk interpretation

The following table presents the possible scores obtainable in the calculator above and the associated cancer recurrence risks:

References

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

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

3) Gerber B, Freund M, Reimer T. (2010) Treatment Strategies for Maintaining and Prolonging Good Quality of Life. Recurrent Breast Cancer. Dtsch Arztebl Int; 107(6): 85–91.

4) Christiansen P, Al-Suliman N, Bjerre K, Moller S; Danish Breast Cancer Cooperative Group. (2008) Recurrence pattern and prognosis in low-risk breast cancer patients--data from the DBCG 89-A programme. Acta Oncol; 47(4):691-703.

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