ABSTRACT
Acknowledgments ............................................................................................................... 16
References ........................................................................................................................... 16
Cancer recurrence after treatment of the primary tumor is a major cause of mortality among
cancer patients. It may take years to decades before local or distant (i.e., metastatic) recur-
rence becomes clinically detectable as cancer. This ‘‘disease-free’’ period is a time of uncer-
tainty for patients who appear ‘‘cured.’’ For example, Demicheli et al.1 have demonstrated
two hazardous peaks of breast cancer recurrence in patients undergoing mastectomy alone
without adjuvant therapy. In a group of 1173 patients, the first peak of cancer recurrence
occurred at ~18 months after surgery. A second peak in cancer recurrence developed at
~5 years after surgery and was associated with a plateau-like tail extending up to 15 years.1
Patients experiencing cancer recurrences within 5 years following surgery have a shorter
overall survival than those with recurrences occurring at a later time point.2
