Using loco-regional recurrence as an indicator of the quality of breast cancer treatment

The aim of our study was to compare the loco-regional recurrence (LRR) rates after breast-con serving surgery and mastectomy between the time periods of 1985-1992 and 1993-1999. The first period reflects the early experiences with breast conservation. The second period covers the years when a mammographical screening programme was introduced for women 50-69 years of age. We collected data on 1212 patients with 1264 resectable breast cancers (i.e. stage I, IIA, IIB and IIIA), of which 385 were removed by breast conserving surgery and 879 by mastectomy. During follow-up, 47 loco-regional recurrences developed after breast conservation, and 67 after mastectomy. The 5- and 10-year loco-regional recurrence rates were 5.7% (95% Confidence Interval (CI) 4.0-7.4) and 11.0% (95% CI 8.0-14.0), respectively, after mastectomy and 7.3% (95% CI 4.5-10.1) and 15.8% (95% CI 11.2-20.4), respectively, after breast conservation. The 8-year loco-regional recurrence rate after breast conservation decreased from 20.1% (95% CI 14.7-26.5) in the period of 1985-1992 to 5.4% (95% CI 1.8-9.0) in the period of 1993-1999 (P=0.0018). Despite the more favourable stage distribution of the patients undergoing mastectomy, no significant decrease was observed in the LRR risk in the latter period (P=0.18). Improvements in patient selection and treatment techniques are the most likely explanations of the decreasing LRR rate after breast conservation in our teaching hospital. (C) 2003 Elsevier Ltd. All rights reserved.