Also they said peak recurrences for breast cancer occur in years 2 and 3, offering in support that no recurrences were seen in year 4. At that time, critics expressed concern mainly about the immaturity of the data.
Although delayed recurrences and graphical representation to suggest a peak in recurrence several years after initial treatments is of great clinical and scientific interest, there is no doubt that the patients included in the above studies were treated by what would be considered now to be substandard therapy.
This theory is supported by Demicheli's persistent delayed peak in recurrence despite chemotherapy, as well as delayed recurrences seen in the more recent literature [ 1, 2, 14].
These tumors tend to have a peak of recurrence at 2-3 years from diagnosis, then a lower rate of recurrence, which have been uncovered with appropriate HER2 testing and interpretation [ 4- 8].
Studies with more than 5 years of follow-up have demonstrated that triple-negative breast cancer may not have the worst long-term survival outcomes among subtypes [ 16, 42- 45], perhaps because of an early peak of recurrence in the first few years after diagnosis and a sharp decrease in the recurrence rate in subsequent years [ 46].
Therefore, even if a few missed metastatic patients at primary tumour diagnosis might not have been excluded, they would have had little influence on the observed first peak of recurrence risk involving, for pre-menopausal node-positive patients, 22% of eligible patients and 37% of recurrences within 10 years.
HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%.
In addition, those patients with luminal HER2 subtype could benefit from a second treatment with trastuzumab to decrease the second peak of recurrence.
Retsky et al (2005) suggest 'surgery-induced angiogenesis' as an important cause of the frequently noted early peak in recurrence rates after breast cancer excision.
Although there is a peak of recurrence within the first 3 years, much of this is accounted for by distant disease.
