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.
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].
3, 4, 9, 10 The peak risk of recurrence of these tumors happens between the first and third years after diagnosis, and most deaths occur within the first 5 years after therapy starts.
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].
Follow-up of about 200 patients diagnosed with TN in Toronto between 1987 and 1997 showed a peak of recurrence rate much greater than that of nontriple-negative (nTN) tumors during the first and third years, as well as a higher 5-year mortality rate [ 18].
Although there is a peak of recurrence within the first 3 years, much of this is accounted for by distant disease.
The authors' explanation for the early peak of recurrence is that surgery triggers the release of micrometastases from a dormant state either by stimulating the release of angiogenic factors or inhibiting angiogenic inhibitors.
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.
Different authors have described the maximum peak of recurrence risk at 12 to 24 months after surgery [ 16- 22] and the occurrence of a second peak at approximately the fifth year in some cases [ 17, 18, 20, 22].
