Ipsilateral local recurrence of breast cancer: determinant or indicator of poor prognosis?

The importance of ipsilateral local recurrence within a conserved breast depends on the micrometastatic environment at the time of initial clinical presentation. In the absence of micrometastases, local recurrence would be a determinant of distant disease; however, in the presence of micrometastases, it represents a marker of distant relapse. Maximum locoregional treatment at primary diagnosis would be appropriate in the former group, whereas minimum treatment would be sufficient in the latter group, with full treatment prescribed at the time of local recurrence. As an indicator of poor prognosis, the presence of local recurrence permits a more selective approach to therapies that would otherwise result in overtreatment for some patients. We, therefore propose a trial that compares conventional treatment with minimum therapy at presentation plus maximum therapy at local relapse in postmenopausal women with small tumours.