Recurrence and Death from Breast Cancer after Complete Treatments: An Experience from Hospitals in Northern Thailand
Rungnapa Chairat MNS*,***, Adisorn Puttisri MD**, Asani Pamarapa MD***, Nongnoot Wongrach MNS****, Chamaiporn Tawichasri MSc*****, Jayanton Patumanond MD, PhD******, Apichat Tantraworasin MD, PhD*******, Chaiyut Charoentum MD********
Affiliation : * PhD Program in Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ** Department of General Surgery, Sawanpracharak Hospital, Nakorn Sawan, Thailand *** Department of General Surgery, Uttaradit Hospital, Uttaradit, Thailand **** Department of General Surgery, Lampang Hospital, Lampang, Thailand ***** Clinical Epidemiology Society at Chiang Mai, Chiang Mai, Thailand ****** Clinical Research Center, Faculty of Medicine, Thammasart University, Bangkok, Thailand ******* Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ******** Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective : To describe the pattern of disease progression and to describe locoregional recurrence, distant recurrence, and
death rates in breast cancer patients after complete treatment.
Material and Method: Medical records of women diagnosed with breast cancer at two university affiliated tertiary care
hospitals in the Northern Thailand that had complete treatments between 2006 and 2010 were traced. Extracted key
information included patient clinical profiles and documented recurrence of cancer. The causes of death were verified from
breast cancer case registration database, death certificates through The Ministry of Internal Affairs’ civil registration, by
direct telephone contact, or by distributed prepaid postcards.
Results : Medical records of 829 women diagnosed with breast cancer without prior evidence of distant metastasis, and had
complete recommended treatment were included. Six hundred thirty seven women had not experienced any events up to the
end of the follow-up (76.8%). The first occurring events were focused and categorized into three distinct types, locoregional
recurrence (n = 83, median follow-up time = 34.2 months), distant recurrence (n = 78, median follow-up time = 35.4 months),
and death without any evidences of locoregional or distant recurrences (n = 12, median follow-up time = 36.7 months).
Distant recurrence after locoregional recurrence was reported (n = 33). There were109 patient who had died (breast cancer
related death) up to the end of the follow-up (13.2%). The three types of consecutively occurring deaths were death after
locoregional recurrence without any distant recurrences (n = 15), death after distant recurrence with locoregional recurrence
(n = 21), and death after documented distant recurrence without any locoregional recurrences (n = 61).
Conclusion : The trend was that the rate of the first occurring locoregional recurrence was slightly higher than that of
distant recurrence. The death rate in patients without any recurrences was much lower than in those experiencing prior
recurrences. The rates of disease progression from local recurrence to distant recurrence and to death were approximately
5 to 7 times faster in patients who had experienced earlier progressions.
Keywords : Breast cancer, Locoregional recurrence, Distant recurrence, Survival, Death
