Breast cancer patients: long-term relapses.

The authors evaluated 200 cases of long-term relapses in patients subjected to mastectomy at least 8 years before and not given any hormonal or other therapy that would have significantly affected the course of the disease. A group of 200 mastectomy patients with early relapses (within 3 years) was used as a control. The following parameters were compared: histologic type, singularity or multiplicity of the relapses at the time of the diagnosis, the patient's age at the time of the mastectomy, the presence of metastatic lymphnodes at the axilla, the clinical course of the disease after the diagnosis of relapse, and the presence of estrogen receptors in the primary tumor. There was a significant higher incidence of lobular histologic type in the group of patients with long-term relapses (p < 0.001). The cases with long-term relapses showed a relatively lower number of relapses in local-region lymphnodes (p < 0.005) a higher number of cases with metastases to the axillary lymphnodes at the time of mastectomy (p < 0.001), a better clinical course (survival) after the diagnosis (mean 3 vs 2.6 years), and more cases with estrogen receptors (p < 0.001) than controls. Premenopausal or postmenopausal status at the time of mastectomy was not significant. After a review of the literature, the authors conclude that relapses that appear after 8 years from the mastectomy occur almost exclusively in patients with a cancer for which the hormonal factor is very important. They hypothesize that even the 18 cases of the series who were without estrogen receptors in reality had receptors saturated by circulating estrogens or receptors for other hormones.