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It is unusual for a patient with breast cancer to have two or more tumor masses in the same breast. Often a high risk of local cancer recurrence is assumed for these patients, and they are therefore not treated with breast-conserving therapy. An analysis of breast-conserving therapy carried out in this group of patients is presented. There were 586 patients treated conservatively (wide excision of only the tumor, followed by radiotherapy); 61 patients had two or more tumors. After an average follow-up of 71 months, 15 of the 61 patients (25 percent) had developed recurrence of the cancer in the treated breast; patients who had single tumors had an 11 percent incidence of recurrence. The recurrence rate for patients with two tumors was 16 percent, whereas those with three or more had a recurrence rate of 35 percent. If the multiple tumor could be diagnosed by a clinician or by mammography, it was more likely to recur (36 percent) than if it could only be diagnosed at the time of pathological study of the tissue specimen (18 percent). When the excised tissue margins were clearly free of tumor, only in one of 22 patients did the cancer recur. It is concluded that multiple breast cancers are at higher risk for local recurrence, especially if the multiplicity is apparent, of if there are three or more nodules present. If a good result is to be achieved, negative surgical margins are essential. (Consumer Summary produced by Reliance Medical Information, Inc.)

The cases of 496 women treated for ductal breast cancer with breast-conserving surgery were reviewed to determine those factors which best predicted the risk of local recurrence in the remaining breast tissue. Twenty-one different factors were studied. Nine factors were significantly associated with increased risk of local tumor recurrence: mononuclear cell reaction, high tumor grade, extensive intraductal component, tumor necrosis, macroscopic multiplicity, absence of estrogen receptors, tumor size, vascular invasion, and age under 40. Not all of these factors are independent, however. Upon multivariate analysis, the most significant factors were found to be mononuclear cell reaction, tumor grade, and intraductal component. It is interesting to consider the correlation of age under 40 years with increased risk of recurrence. Women under 40 are at significantly higher risk of local recurrence; this seems to be due to the fact that extensive intraductal components are more common among women under 50, and both mononuclear cell reaction and high tumor grade are more common in women under 40. Thus, virtually all of the important prognostic factors are related to the histopathological examination of the tumor rather than extrinsic factors, such as radiation dose or family history. The overall risk of local recurrence of ductal breast cancer was 12.3 percent. Patients with moderate or severe mononuclear cell reactions had a 28 percent chance of recurrence. The recurrence rate of premenopausal women without any risk factor was only 2.6 percent at five years. For postmenopausal women, risk was determined primarily by tumor grade and the adequate margins obtained during the surgery. Those with grade 3 tumor and tumor extending to the margin of the removed tissue had a 31 percent chance of local recurrence within five years. Clearly, careful pathological evaluation of the tumor tissue is by far the most important step in evaluating the risk of recurrence in patients with ductal breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)