Keeping score on the risk of recurrence

This study investigated different scoring scales which could be used to determine the risk of recurrence among estrogen receptor-positive (ER+) breast cancer survivors.

Breast cancer survivors are at risk of developing distant recurrence of the cancer even many years after initial cancer treatments. Since usually treatments aimed at reducing the risk of recurrence are continued for 5 years following initial diagnosis, it is important to determine which women are at an increased risk of late recurrence. Cancer characteristics, such as the genetic profile of the tumor, different molecular signatures or size and lymph node involvement, may all be used to predict the likelihood of late recurrence and identify patients that may benefit from extended treatment.

Several scoring scales are commonly used to predict the risk of breast cancer recurrence. The immuno-histochemical score (IHC4) is based on the presence or absence of four molecular markers such as estrogen and progesterone receptors. The clinical treatment score (CTS) contains information regarding lymph node involvement, tumor size and patient age. Two scoring systems are used that determine the genetic profile of the cancer. The recurrence score (RS) is provided by the Oncotype DX test, and the risk of recurrence score (ROR) is provided by the PAM50 test.

This study analyzed the records of 940 women diagnosed with ER+ breast cancer. Additional information collected for each patient included the recurrence score (RS), the risk of recurrence score (ROR), an immuno-histochemical score (IHC4) and a clinical treatment score (CTS). The aim of this study was to determine if these scores were associated with the likelihood of recurrence either in the first 5 years (early recurrence), or 5 to 10 years (late recurrence), after the initial diagnosis.

Results showed that of the 940 women, 154 experienced distant recurrence. 71 of the cases were early recurrences and 83 were late recurrences. Lymph node involvement and tumor size were shown to be the only clinical variables providing information regarding the risk of both early and late recurrence. Genetic profiling using the ROR score was the strongest molecular prognostic factor for late recurrence. IHC4 and RS scores were found to be least strongly associated with the risk of late recurrence.

This study provided insight into clinical and molecular factors which may help identify patients who would benefit from extended hormonal treatment beyond 5 years.

Consult with your physician regarding risk of recurrence scores and the optimal length of hormonal treatment after surgery.