الفهرس 
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Abstract
Breast cancer is the most common cancer in women,and over 1.6 million cases are diagnosed annually . (Ferlay J, et al, GLOBOCAN, 2012 )
It is a highly heterogeneous disease with respect to clinical and molecular characteristics. Both adjuvant endocrine therapy and chemotherapy, after initial surgery, have proven to be highly effective methods to reduce the risk of disease recurrence, preventing both local and distant metastasis and reducing mortality. Despite the proven benefits of adjuvant therapy. (Early Breast Cancer Trialists’ Collaborative group (EBCTCG), Lancet, 2005)
Breast cancer patients remain at risk of recurrence even years after intial therapy, the maximum risk is in the first two years with a steep reduction to 5 years and then it gradually moves on to 12 years .(Devita VT, et al, Lippincott Williams and Wilkins, 2008)
Distant metastasis is the most prevalent form of recurrence and the main cause of death in breast cancer patients. Prognostic factors estimated to cause recurrence and distant metastasis following the treatment of breast cancer, include molecular pathology of breast cancer, tumor grade, tumor size, involvement of lymph node, and hormone receptors’ status of ER, PR, and HER2 .(Popoola AO, et al, Asian J Med Sci, 2012)
In our study we investigated pattern of breast cancer recurrence , factors affecting early and late recurrence and factors affecting site specific metastasis.
Patients and methods:
In our reterospetive study 600 patients presented to oncology department ,sohag university hospital between January 2000 and December 2014 diagnosed with invasive breast cancer 141patients developed recurrence after underwent surgery either modified radical mastectomy,simple mastectomy or breast conservative surgery then received adjuvant systemic therapy chemotherapy,endocrine therapy or both.Adjuvant radiotherapy was given when indicated.
Results:
90% (n=127) of our patients develop recurrence in first 5 year with 64.5%(n=91) of total number of patient in first 3 year. Patients still have risk of recurrence even after 10 years after primary treatment as 2 patients develop recurrence after 10 years.
Among 141 patients with recurrence, 116 patients (82.2%) and 32 (22.6%) were involved with distant and loco regional recurrence, respectively.The most prevalent distant metastasis was seen in bone metastasis (43% of patients) with liver , lung and brain metastasis were 7. 1%, 7.1% and 6.3% respectively,others including contralateral breast and axilla (n=11),malignant ascites(n=2)and malignant pleural effusion(n=7) with 1case show subcutaneous nodule at scalp. Multiple organ metastasis was detected in 36% of patients.
In our study ,in early recurrence group 70% (n=89) had tumor size more than 2 cm ,88%(n=113) had positive axillary lymph node ,98%(n=125) had high tumor grade indicate that tumor size larger than 2 cm, axillary lymph node involvement ,high tumor grade are important prognostic factors in early recurrence .
The present study has demonstrated that there is no significant tumor or patient characteristic associated with the site-specific risks of metastases.
Conclusion:
●Most breast cancer recurrence occur during first 5 year with peak incidence in1and 2 year .
●Tumor size larger than 2 cm, lymph node involvement and high tumor grade are important prognostic factors in early recurrence before 5 year.
● The most common exclusive first site of metastasis was bone and the least common is the brain.
●The current clinical practice of screening for site-specific metastatic disease based on concerning patient-specific signs or symptoms is supported.