The implications of local recurrence of breast cancer as the first site of therapeutic failure

Sixty patients who had ipsilateral chest wall recurrence of breast cancer and no detectable distant metastases were evaluated retrospectively to determine the implications of chest wall recurrence as the first site of therapeutic failure. Mean time intervals between treatment of the primary breast cancer and discovery of local recurrence, between treatment of local recurrence and distant metastases, and between treatment of local recurrence and death in order and, respectively, in years for pathologic Stages I, II, and III patients were 6.2, 4.3 and 2.1; 4.2, 3.5, and 1.2; and 7.2, 6.0, and 2.5. Surgical resection resulted in the best local control. All patients eventually died of metastatic breast cancer, one as late as 23 years after treatment of the local recurrence. No Stage I patients recurred before two years. An arbitrary delay of two years before recommending breast reconstruction to avoid masking local recurrence seems unjustified for pathologic Stage I patients.