Does radical mastectomy still have a place in the treatment of primary operable breast cancer?

This study (Alabama Breast Cancer Project) reports the ten-year surgical results of a prospective randomized trial comparing Halsted radical mastectomy (RM) with modified radical mastectomy (MRM) for breast cancer. We entered 311 patients in the study between 1975 and 1978. Patients with histologically positive axillary lymph nodes were randomized after operation to receive melphalan or intermittent intravenous cyclophosphamide, methotrexate, and fluorouracil for one year. After a median follow-up of ten years, there was no significant difference in the survival of the two groups (RM, 71%; MRM, 64%). Local recurrence after RM was significantly lower than after MRM. A subset of patients with more advanced cancers (T3 and T2 with clinically positive axillary nodes) experienced significantly better survival at ten years following RM compared with MRM (59% vs 38%, respectively). These results indicate that overall survival is similar for patients treated by either RM or MRM. However, there is subset of patients with more advanced cancers whose ultimate survival can be favorably influenced by RM.     

A comparison of modified radical mastectomy to radical mastectomy in the treatment of operable breast cancer.

This study compares the results of modified radical mastectomy (144 cases) to radical mastectomy (188 cases) in the treatment of operable breast cancer. Two hundred five patients had Stage I breast cancer, 60 had Stage II disease and 67 had Stage III disease (TNM System). There was no statistically significant difference in five year survival when the results of a radical mastectomy were compared to a modified radical mastectomy at any stage of disease. There was no statistically significant difference in the incidence of local recurrence in patients with Stage I and Stage II disease when the results of a radical mastectomy were compared to modified radical mastectomy. Those patients with Stage III disease who were treated by a modified radical mastectomy had a statistically significant higher incidence of local recurrence (chest wall and axilla) in comparison to patients treated by radical mastectomy. We have concluded that a modified radical mastectomy is the treatment of choice in patients with Stage I and Stage II diseases. In patients with Stage III disease, a radical mastectomy provides a better chance of local control of the disease but offers no increased chance of survival.     

Results of conservative operations for breast cancer

The results of conservative operations for breast cancer in 1,593 patients treated at the Cleveland Clinic between 1957 through 1975 are reported. During this period, we individualized our treatment of breast cancer depending on tumor size, location in the breast, and clinical stage of the disease. The following three principal operations were performed: modified radical mastectomy in 592 patients (37%), simple (total) mastectomy in 442 patients (28%), and partial (segmental) mastectomy in 291 patients (18%). Survival results at 5, 10, and 15 years are reported. Factors important in long-term survival included stage of the disease, number of lymph node metastases, delay in therapy, size of the tumor, histologic type, and estrogen receptor status; type of operation was not a significant factor. In this series, partial (segmental) mastectomy without radiation therapy provided five- to 15-year survival rates equal to modified radical mastectomy and simple (total) mastectomy.     

Breast conservation in patients with multiple ipsilateral synchronous cancers

BACKGROUND: Because breast cancer survival after breast conservation has proved comparable to mastectomy, contraindications to mastectomy are increasingly being challenged. We treated the majority of our patients with multiple synchronous ipsilateral cancers with breast conservation and we compared them with patients who underwent mastectomy for comparable disease during the same interval. STUDY DESIGN: Patients with multiple ipsilateral synchronous breast cancers between 1989 and 2002 were identified from prospective databases maintained by us. A comparison was made between 36 patients treated with lumpectomy and 19 patients treated with mastectomy. RESULTS: There were no significant (all p values >0.2) differences between mastectomy and breast conservation patients in age, racial distribution, size of cancers, pathology, tumor differentiation, nodal involvement, or hormone receptor positivity. The majority of patients treated with breast conservation underwent at least one reexcision to obtain clear pathologic margins, and they were more likely to receive postoperative radiotherapy than patients treated with mastectomy. There were no significant differences in the local (97% versus 100%, p = 0.54) or distant (97% versus 95%, p = 0.20) 5-year disease- free survival between the group treated with breast conservation and the group treated with mastectomy. One patient in each group developed distant metastases. One patient in the breast conservation group developed local recurrence at both primary sites simultaneously 39 months after lumpectomies. She is free of disease 78 months after mastectomy. The remaining 52 patients are alive and free of disease. CONCLUSIONS: Breast conservation is an effective treatment for patients with synchronous ipsilateral breast cancers.     

Does Breast Conservation Therapy in Young Women with Breast Cancer Adversely Affect Local Disease Control and Survival Rate? The M. D. Anderson Cancer Center Experience

Abstract: Historically, it was thought that young women with breast cancer had a poor prognosis and a high local disease recurrence rate after breast-conservation therapy. To determine the effect of breast-conservation therapy, the outcomes of young women with breast cancer who were treated at a single institution were retrospectively reviewed.
Between 1978 and 1993, 219 women ≤35 years of age with breast cancer were treated at the University of Texas M. D. Anderson Cancer Center and met the following criteria: no evidence of distant metastasis at the time of diagnosis, no prior treatment, and no concurrent cancers. The variables analyzed included demographics, type of surgery, TNM stage, use of adjuvant therapy, locoregional disease recurrences, distant metastases, and vital status. The median length of follow-up among surviving patients was 7.9 years (range, 1–17 years). Univariate analyses were performed using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards model.
Seventy-nine patients underwent breast-conservation therapy (BCT) and 140 patients underwent modified radical mastectomy (MRM). Locoregional disease recurrences were identified in 27 cases: 12 in the BCT group and 15 in the MRM group. When patients were matched stage for stage, the type of local treatment did not correlate with the loco-regional recurrence rate (p = 0.236) or the disease-specific survival rate (p = 0.915). The five-year disease-specific survival rate was 84.2%. In the multivariate analysis, only TNM stage correlated with locoregional recurrence rate (p = 0.019) and disease-specific survival rate (p = 0.002).
This study shows no significant difference in locoregional recurrence rates or disease-specific survival rates in young women with breast cancer treated with BCT versus MRM.     

Simple mastectomy for early and advanced mammary carcinoma

Simple mastectomy was used to treat 111 women with invasive mammary carcinoma. In none of eighteen patients with cancer clinically confined to the breast did local recurrence develop after simple mastectomy, but metastases developed in the axilla in three. Adjuvant irradiation, castration, or drug therapy did not improve the survival or ultimate local control achieved by simple mastectomy.No significant difference was demonstrated in survival after simple and radical mastectomy for comparable clinical stages of disease.     

The significance of local control in the primary treatment of breast cancer. Lucy Wortham James clinical research award

Two sequential clinical trials were carried out to compare wide excision with radical mastectomy in patients with early breast cancer with clinically negative nodes. In the first study there was an increased incidence of local recurrence in patients who had wide excision, but distant recurrence and survival were unaltered. In the second study, the distant recurrence and survival rates were also significantly impaired. A new analysis showed that there were significantly more patients with T1 tumors in the second study than in the first. Comparison of treatments by T status indicates that radical mastectomy gives significantly better results in patients with T1 tumors. There is no difference between the results of the two treatments in patients with T2 tumors. We comment on the implications of these findings for conservation treatment of early breast cancer.     

Male breast carcinoma

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy. Ten patients underwent incisional or excisional biopsy with or without radiation because of locally advanced disease or distant metastases. Survival was comparable in the groups of patients treated with simple mastectomy (mean, 70 months), modified radical mastectomy (mean, 61 months), and radical mastectomy (mean, 78 months). Local recurrence occurred in 25 per cent of all patients, and this rate was not dependent on the operation performed. The data suggest that modified radical mastectomy is adequate therapy for local control and staging of the disease without reducing survival from that observed after radical mastectomy.     

Survival following locoregional recurrence after breast conservation therapy for cancer.

We postulated that locoregional recurrence after limited surgery and radiotherapy for breast cancer might be associated with an additional survival hazard, similar to that of a second primary tumor with the same extent of local and regional disease. Using this hypothesis we examined the likely resultant effect on survival. Our calculations indicated that no statistically significant survival deficit due to such recurrence would be detectable until a randomized controlled trial comparing breast conservation with mastectomy had monitored more than 10,000 patients for more than 10 years. A simple mathematical model predicted 5-year survival rates in a cohort of patients treated with breast conservation of 75%, compared to 83% in those without locoregional recurrence. From the date of locoregional recurrence, a 61% 5-year survival rate was predicted, compared to 83% if no hazard was associated with locoregional recurrence. These predictions were compared with the actuarial survival rates of 499 patients with unilateral breast cancer, 49 of whom had developed locoregional recurrence. From the date of initial treatment, the 5-year survival rate of those whose disease recurred was 79%, compared to 88% for those without locoregional recurrence (p = 0.19). The actuarial 5-year survival rate from the date of locoregional recurrence was 63%. The similarity between the patient data and the predictions of the mathematical model indicates that locoregional failure after breast conservation therapy may result in reduced survival. The lack of a significant survival deficit in our cohort or in controlled trials comparing breast conservation therapy with mastectomy is compatible to the small size of the overall effect.     

Have changing treatment patterns affected outcome for operable breast cancer? Ten-year follow-up in 1288 patients, 1965 to 1978.

From 1965 to 1978, 1288 patients with primary operable breast cancer were treated by the senior author, using extended radical (ERM), radical (RM), and modified radical (MRM) mastectomy operations exclusively. Results were analyzed for trends in overall and disease-free survival, and patterns of local and distant relapse, the years 1965 to 1970 versus 1971 to 1974 versus 1975 to 1978. Significant changes (p less than 0.00001) from 1965 to 1978 included progressively earlier stage of disease, less frequent use of RM and ERM, a decline in the use of postoperative radiotherapy, and the introduction in 1975 of multidrug adjuvant chemotherapy. Ten-year disease-free survival rates improved significantly for all patients (by 11%, p = 0.00004) and for node-negative (by 12%, p = 0.0024), node-positive (by 8%, p = 0.012), clinical stage II (by 15%, p = 0.0022), and pathologic stage II (by 12%, p = 0.016) disease. Ten-year local recurrence for all patients was 3% (local only) and 2% (local with distant metastasis), and survival from date of recurrence for all patients failing treatment increased two times (p less than 0.0001) for patients treated most recently. As the primary surgical treatment of breast cancer continues to become more moderate, the promise of systemic adjuvant therapies can be realized only with continued emphasis on earlier diagnosis and maximal local control of disease.     

Recurrence rates in patients with central or retroareolar breast cancers treated with mastectomy or lumpectomy.

BACKGROUND: Although breast conservation with lumpectomy and radiation treatment has become a commonly used treatment for breast cancer, there are little data to support the use of lumpectomy for central and retroareolar breast cancers. In this study, we investigate the local and distant recurrence rates of patients with central or retroareolar breast cancers treated with lumpectomy compared with mastectomy. METHODS: This study provides a retrospective analysis of 99 patients, from 1981 to 2000, with central or retroareolar breast cancers treated with mastectomy or lumpectomy to determine the frequency of local and distant recurrence. The mastectomy and lumpectomy patients were compared with respect to recurrence and other prognostic factors including: tumor location, tumor size, axillary nodal status, and final surgical margins. RESULTS: The overall frequency of local recurrence was 5 of 99 (5.0%) in the entire group, 3 of 67 (4.5%) and 2 of 32 (6.3%) of patients who underwent mastectomy and lumpectomy, respectively (P >0.99). Overall, 3 patients experienced a distant recurrence as a first event, with 2 patients (3.0%) in the mastectomy group and 1 patient (3.1%) in the lumpectomy group (P >0.99). The type of surgical management was not statistically significant related to either local or distant disease recurrence, with median time to local recurrence of 3.0 years for the mastectomy patients and 5.0 years for lumpectomy patients. Of the patients with central tumors who underwent mastectomy 2 of 42 (4.8%) developed local recurrences compared with those who had a lumpectomy, 1 of 21 (4.8%). Similarly for retroareolar tumors, the local recurrence rate was 1 of 25 (4.0%) for patients undergoing mastectomy and 1 of 11 (9.1%) for those undergoing lumpectomy (P >0.99). CONCLUSIONS: In this study there was no significant difference in local or distant failure rates of those patients with central or retroareolar tumors treated with mastectomy versus lumpectomy. We conclude lumpectomy to be a reasonable treatment option for selected patients with central or retroareolar breast cancers.     

Adenoid cystic carcinoma of the breast. Data from the Connecticut Tumor Registry and a review of the literature.

The case records of the Connecticut Tumor Registry were reviewed from 1952-1982. There were 37 cases of adenoid cystic carcinoma of the breast (ACC) from a total of 40,350 invasive breast tumors. Patient survival, complications, and pathologic sections were reviewed. Only 14 of 27 surgical pathology slides available for review could be confirmed histologically as ACC. All patients were white females with a mean age of 64 years. The tumor remained localized to the breast in all cases. Nine patients had either radical or modified radical mastectomy, four patients had either simple mastectomy or lumpectomy, and one patient refused treatment. There was no evidence of axillary node involvement, metastases, or local recurrence after excision. At the time of follow-up, nine patients were alive and disease free and four died of disease unrelated to their breast cancer. The one patient who died of breast cancer had a radical mastectomy and survived 11.7 years after diagnosis. It is concluded that ACC has a favorable biologic behavior characterized by a prolonged clinical course and good prognosis. Simple mastectomy is all that is required as initial treatment, and a chest x-ray and thorough physical examination looking for local recurrence is all that is needed for follow-up.     

早期乳腺癌保乳手术与改良根治术的对比研究

目的探讨保乳手术与改良根治术对早期乳腺癌的治疗效果。方法回顾性分析86例早期乳腺癌患者的临床资料,比较两组患者术后生存率、复发率、转移率及焦虑和对美容效果的满意度。结果改良根治术和保乳手术后患者的3、5、10年生存率、复发率和转移率差异无统计学意义,而保乳手术组患者术后1年的焦虑情况显著低于改良根治术组,美容效果显著优于改良根治术组。结论保乳手术能够取得与改良根治术相似的治疗效果和远期疗效,且能够满足女性形体美的要求,患者的满意度高,值得临床推广应用。     

The treatment of breast cancer: II. A 20-year follow-up and reappraisal of the en bloc principle

This retrospective study of the extended Oregon Series (1940 to 1965) of patients with breast cancer, first reported in 1961, compares the now long-term results of treatment of pathologic stage T2/3 NO breast cancers with intent to cure by the following two en bloc ablative operative procedures of variable extent and completeness: standard radical mastectomy vs ultraradical mastectomy. The extent and completeness of the en bloc procedure are shown again to be critical determinants of local control and survival. The local recurrence rate for standard radical mastectomy is 12.4% (8/70) and for ultraradical mastectomy it is 0% (0/78). Proportionate survival at 20 years for standard radical mastectomy was 59.8% (95% confidence limits, 0.598 +/- 0.14) and for ultraradical mastectomy it was 98.1% (95% confidence limits, 0.981 +/- 0.04).     

Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer

BACKGROUND: Breast conservation surgery with radiotherapy is a safe and effective alternative to mastectomy for early-stage breast cancer. This retrospective study examined the outcome of patients with isolated local recurrence following conservative surgery and radiotherapy in node-negative breast cancer. METHODS: Between November 1979 and December 1994, 503 women with node-negative breast cancer were treated by conservation surgery and radiotherapy without adjuvant systemic therapy. RESULTS: After a median follow-up of 73 months the 5-year rate of freedom from local recurrence was 94 per cent. Thirty-five patients developed an isolated local recurrence within the breast as a first event. Thirty-three patients were treated with salvage mastectomy and two patients were treated with systemic therapy alone. The 5-year rate of freedom from second relapse was 46 per cent and the overall 5-year survival rate was 59 per cent for patients who had salvage mastectomy. Patients who developed breast recurrence as a first event had a 3.25 greater risk of developing distant metastasis (P < 0.001) than those who did not have breast recurrence as a first event. CONCLUSION: Salvage mastectomy after local recurrence was an appropriate treatment if there was no evidence of distant metastasis. Breast recurrence after conservative surgery and radiotherapy in node-negative breast cancer predicted an increased risk of distant relapse.     

Development and Trends of Surgical Modalities for Breast Cancer in China: A Review of 16-Year Data

Background Surgery is the most important treatment for nonmetastatic breast cancer; however, the utilization of modern surgical techniques in management of breast cancer in mainland China has not been reported. Methods The medical records of 5887 consecutive breast cancer patients treated surgically in the past 16 years were reviewed retrospectively; the utilization of different surgical modalities and associated clinical outcomes were analyzed. Results Median age of all patients was 50 (range 16–92). About 1015 patients were staged as 0–I, 3569 stage II, 517 stage III, and 786 cases could not be staged. Extensive radical mastectomy (ERM), radical mastectomy (RM), modified radical mastectomy (MRM), simple mastectomy (SM), and breast-conserving surgery (BCS) were used in 8%, 27.2%, 55.7%, 1.5%, and 6.3% of patients, respectively. In addition, 1.3% of patients received breast reconstruction. The proportion of early-stage breast cancer increased, and the surgery patterns varied. MRM gradually replaced ERM and RM. The prevalence of BCS began to increase from the mid-1990s and currently represents about 12%. The prevalence of reconstruction also increased and now accounts for 5%. Age, pathologic pattern, and TNM staging affected the choice of surgery modalities markedly. Although patients receiving RM/ERM had worse survival than those receiving BCS/MRM, the survival outcomes of these four groups were similar in the early-stage population. Conclusions MRM remains the most-used surgical modality in operable breast cancer, although the utilization of BCS for early-stage disease has increased rapidly in last decade. Reconstruction following mastectomy as an alternative to BCS is available. Breast-conserving therapy (BCT) and MRM provide similar local controls and long-term survival for breast cancer. Selection of appropriate candidates for a certain surgery requires an assessment of the patient’s age and clinical and pathological characteristics of the tumor.     

Stage 0 to stage III breast cancer in young women

BACKGROUND: Breast cancer survival is improving because mammography is leading to diagnosis at earlier stages of the disease. Because young women with breast cancer rarely undergo mammography before diagnosis, outcomes for breast cancer in young women may not be improving. In addition to advanced stage, young age at diagnosis is associated with biologically more aggressive cancers with higher rates of local and distant recurrence. STUDY DESIGN: Risk factors, clinical presentations, pathologic findings, tumor characteristics, extent of disease, treatment, and outcomes for 101 women under age 36 treated for breast cancer between 1989 and 1997 were compared with 631 patients 36 years and older treated by us during the same interval. Stage IV patients were excluded. RESULTS: Patients younger than 36 years were more likely to present with a palpable mass (87% versus 55%, p < 0.001) and were less likely to undergo spot localization breast biopsy for mammographic findings (40% versus 6%, p < 0.001). Patients younger than 36 years had larger tumors (median 2.0 cm versus 1.5 cm, p < 0.001), more nodal involvement (50% versus 37%, p = 0.022), more nodes involved (median 1.0 versus 0, p = 0.010), and were more likely to be diagnosed with stage II or III cancer (60% versus 43%, overall p < 0.001). Young patients' cancers were more poorly differentiated (80% versus 44%, overall p < 0.001), estrogen receptor-negative (52% versus 31%, p < 0.001), aneuploid (70% versus 49%, p = 0.013), and had higher S-phase fractions (59% versus 29%, p = 0.001). Patients less than 36 years were treated more often with mastectomy (59% versus 22%, p < 0.001) and adjuvant chemotherapy (80% versus 54%, p < 0.001) and less often with tamoxifen (36% versus 58%, p = 0.001). Cumulative 5-year local and distant disease-free survival were significantly worse for patients younger than 36 years (p = 0.011 and p = 0.044, respectively). The higher rate of local recurrence in patients less than 36 years was from an excess number of local recurrences in patients treated with breast conservation. After consideration for nodal involvement, chemotherapy, and tamoxifen using the Cox proportional hazards model, no other variable, including age, was significantly related to local disease-free outcomes. After consideration for tumor size and nodal involvement, no other variable was significantly related to distant disease failure rates. CONCLUSIONS: Patients diagnosed with breast cancer before age 36 differ from older patients in numerous respects. They present more often with a palpable mass rather than a mammographic finding and their cancers are more advanced with features that are more aggressive. Despite aggressive treatment, most commonly with mastectomy and chemotherapy, local and distant failure rates are higher than for patients 36 and older. The higher rate of local recurrence in patients less than 36 years reflects an excess number of local recurrences in patients treated with breast conservation.     

Breast-conserving therapy in breast cancer patients--a 12-year experience

INTRODUCTION: Twenty years ago prospective randomised controlled trials were initiated to compare conservative breast surgery plus radiation with radical mastectomy in the treatment of early-stage breast cancer. The results have shown no survival advantage for mastectomy over breast-conserving therapy (BCT). However, local recurrence of cancer after BCT has been reported to be as high as 14%, necessitating salvage mastectomy. METHODS: This retrospective study was performed on 165 breast cancer patients undergoing BCT in the 12 years up to August 2002. Resection and intraoperative cytological assessment were used to achieve clear excision margins. Adjuvant therapy (hormones, chemotherapy) was undertaken, and the incidence and times of local recurrence and distant metastases were recorded. RESULTS: Ninety-four per cent of patients had clear margins at the initial operation. This was achieved irrespective of ductal carcinoma in situ alone or surrounding the cancer in 62% of cases. At a median follow-up of 65 months one patient developed local recurrence (LR) in the breast synchronously with distant relapse. Two patients had non-nodal axillary recurrences but no patient suffered LR in isolation in the treated breast. CONCLUSION: BCT is a safe alternative to mastectomy provided that the tumour is completely excised. The segment containing the cancer should be resected from the nipple to the periphery of the breast. Intraoperative cytological assessment helps to ensure clear margins. Reexcision is recommended for patients with close/involved margins.     

Surgical treatment of ductal carcinoma in situ of the breast. 10- to 20-year follow-up.

Between 1967 and 1977, 36 patients received treatment at the Virginia Mason Medical Center in Seattle, Wash, for ductal carcinoma in situ of the breast. Twenty-five patients had modified radical mastectomies, 10 had radical mastectomies, and one had a simple mastectomy. Twenty-seven patients have been followed up for at least 10 years and are without known recurrence (mean follow-up, 17.7 years; range, 8 to 24 years), eight patients died without known recurrence (mean follow-up, 10.6 years; range, 6 to 14 years), and one patient with a prior contralateral mastectomy for infiltrating cancer of the breast had a recurrence in the scalene nodes on the side of the infiltrating cancer and died of metastatic cancer. No patients with ductal carcinoma in situ had local recurrences in the ipsilateral breast or chest wall, and no patients developed cancers in the contralateral breast; one patient had axillary metastasis. Twenty-eight (78%) of 36 patients had multicentric ductal carcinoma in situ in their mastectomy specimens. Twenty-three (88%) of 26 patients with comedocarcinoma-type ductal carcinoma in situ had multicentric lesions. Conversely, patients with low-grade nuclear papillary ductal carcinoma in situ did not have multicentric lesions. Five (14%) of 36 patients had incidental microinvasion discovered in the mastectomy specimens; all had comedocarcinoma. In summary, our study of patients with ductal carcinoma in situ revealed that (1) mastectomy provided excellent local and systemic control; (2) cancer in the contralateral breast was infrequent; (3) axillary metastasis was rare; and (4) histologic features of tumors markedly affected the frequency of multicentricity and chance for microinvasion.     

Local Recurrence After Mastectomy for Ductal Carcinoma In Situ

Abstract: Local recurrence after mastectomy for invasive cancer generally carries a poor prognosis. Local recurrence after mastectomy for ductal carcinoma in situ (DCIS) is rare and its impact on survival is unknown. Sixty-eight patients were treated with mastectomy for DCIS at the Fox Chase Cancer Center between 1985 and 1996, and only one of these developed a chest wall recurrence. An additional five patients treated with mastectomy at other institutions and referred to Fox Chase after local recurrence were also identified. These six patients had only DCIS as their primary pathology. Four of the six patients were premenopausal (median age 42 years). The median interval to local recurrence was 5.0 years (2.8–9.3 years). The median follow-up from initial diagnosis was 10.5 years (4.3–26.7 years) and 5.2 years (1.4–17.6 years) from recurrence. All of the recurrences were invasive and treatment included wide local excision with radiotherapy in all of the patients followed by adjuvant chemotherapy for the premenopausal patients. None of the patients had metastatic disease at presentation. The disease-free survival from initial recurrence was 83% and 63% at 5 and 10 years, respectively. The 5- and 10-year survival following local recurrence was 80%. One patient died 3.6 years after recurrence with metastatic disease, while a second patient developed metastatic disease 11.8 years after her initial recurrence. The remaining four patients are alive (NED), ranging from 1.4 to 10.7 years following their local recurrence. Local recurrence following mastectomy for DCIS is rare, usually invasive, and may have a long interval to failure. Salvage using conventional multimodality therapy appears to result in long-term survival.