Metastatic disease of the breast and local recurrence of breast cancer

The two main aims of the treatment of early breast cancer are to achieve control of locoregional disease and to treat micrometastatic disease. Patients often have micrometastatic disease at presentation, but many subjects can be potentially cured by locoregional treatment alone. Prevention of local recurrence is important. A small percentage of patients develop metastases from a local recurrence which would not otherwise have occurred. Local recurrence of breast cancer should occur in <10% of cases within 10 years of surgery with adequate local and systemic therapies. About 35% of breast cancer cases develop metastatic disease within 10 years of surgery. Patients with local recurrence in the breast or chest wall may survive long term with appropriate locoregional therapy. Metastatic breast cancer is incurable, but long-term and worthwhile short-term responses can be achieved by appropriate treatment. Some patients with hormone-sensitive disease survive many years after sequential hormone manipulation. Patients with hormone-insensitive disease have much shorter survival. In all cases of recurrent or metastatic disease, a multidisciplinary approach is required to achieve the primary goal of management: maximize the quality of life with palliation of symptoms without unnecessary side effects.