Euxton Hall Hospital

Abstract Aim: Local recurrence may precede distant relapse and death. Many factors which predict local recurrence also predict death. Few studies have investigated the contribution of local recurrence to mortality independent of prior prognostic factors such as nodal status. We wished to estimate the extent to which overall survival is affected specifically by local recurrence. Methods: 114 of of 2945 patients aged 19 to 94 years (mean 58.3) who had either mastectomy or breast conservation for breast cancer between 1991 and 2011 subsequently suffered an ipsilateral local recurrence. We matched, with one exception (due to extreme young age), each patient who had a local recurrence with 2 controls matched for calendar year of presentation, age, nodal status, grade, and tumour size. A Cox regression analysis of survival from the first therapeutic operation was done on the case matched subset with local recurrence coded dichotomously and age coded continuously as the absolute deviation from the population mean (as both young and old age affect survival adversely) as predictors. To confirm independence of the effect of local recurrence on the hazard of death a further Cox regression analysis of survival as above was done for the whole series with local recurrence, Grade 3, >3 nodes involved, tumour diameter >40mm, coded dichotomously, and age coded as above as independent variables. Results: The results of the analyses are given in the table below. The estimate of hazard of death associated with local recurrence was similar in both analyses suggesting minimal confounding effect. As expected large tumour size, high grade and heavy nodal involvement predicted survival independently. Conclusion: Local recurrence was associated with only a modest increase of about 50% in the hazard of death independent of tumour stage, size and grade which remained the most significant predictors within this model. Extremes of age were associated with increasing hazard of death and should be similarly coded when analysing unadjusted survival. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-13.

Forty years on, it is difficult to remember and feel again accurately what it was like in those faraway days of personal ignorance when one was young, newly graduated, and beginning a career in research. Perhaps the effort to remember is comparable with trying to return to the feelings of the first days at boarding school when one was another person in another world. Here follows a summary of my road to neuroendocrinology. It was at the age of about 11 that I decided to become a doctor. None of the family were medical and I have no idea what decided me except an overpowering curiosity in all aspects of living. From the first I was encouraged by an uncle in whose family I was brought up. (My father worked in India so I was left at “home.”) A year or so later I decided I wanted to do research, knowing no more about it than that it was a seeking for the why and how. In this ambition I received stimulation of a sort from a family friend, Sir Cooper Perry, who at the time was Superintendent of Guy’s Hospital and later became Principal of the University of London. On being told I wanted to do research he said, “Don’t think of it. Women are no use at that kind of thing.” I said nothing, thought a great deal, and was more than ever determined! When the time came to leave school, there was some opposition to the idea of medicine but physiology was acceptable. This gave me a taste for the subject.