Question 3 of 5

(demo test)

 To most accurately answer this question, one should use the results of the recently published Pan et al. NEJM 2017 experience. In this analysis, they performed a meta-analysis of individual patient data from 88 trials and 500,692 women from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) database. 

Of these, 62,923 women were less than 75 years of age and met inclusion criteria of having T1-2 estrogen-receptor positive tumors, 0-9 lymph nodes (LN) involved, were scheduled to receive endocrine therapy for 5 years, and had at least 5 years of follow-up. 

The goal of the study was to characterize the rate of distant recurrence, rate of any breast cancer event (distant recurrence, locoregional recurrence, or contralateral primary tumor), and the rate of death from breast cancer.

The risk of distant recurrence by 20 years in T1 tumors was: 

• 13% for 0 LN+
• 20% for 1-3 LN+
• 34% for 4-9 LN+

• 19% for 0 LN+
• 26% for 1-3 LN+
• 41% for 4-9 LN+

Clinical Pearl: Discussing the risks of long-term distant recurrence in patients with T1/T2 tumors is critically important to demonstrate the importance of long-term hormonal therapy within this patient population.