Evidence map›Paper›PMID 29117498›Full record

SynthesisThe New England journal of medicine2017

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years.

Hongchao Pan, Richard Gray, Jeremy Braybrooke, Christina Davies, Carolyn Taylor, Paul McGale, Richard Peto, Kathleen I Pritchard, Jonas Bergh, Mitch Dowsett and 2 more

2 registry-linked trialsAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The New England journal of medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 1,032 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,032citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06613516 phase2withdrawnnot on this mapstarted 2025, after this paper: background citation

CaptAin - Effect of Capivasertib on ctDNA in ER Positive Breast Cancer

TypeinterventionalSponsorImperial College LondonRan2025 to 2025Enrolled0ConditionsBreast Cancer, Oestrogen Receptor Positive Breast CancerArmsCapivasertib
NCT07521397 completednot on this map

Pooled Analysis of Individual Patient Data of Patients With Early-stage Breast Cancer Treated With Adjuvant Dose-dense Sequential Chemotherapy (Ddsc): a Hellenic Cooperative Oncology Group (HeCOG) Study

TypeobservationalSponsorHellenic Cooperative Oncology GroupRan1996 to 2022Enrolled5,358ConditionsBreast Cancer, Early Stage Breast Cancer, Adjuvant Chemotherapy, Prognosis Breast Cancer
3 · Its place in the literature

Who cites it

1,032 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  3. Progression-free survival prediction and comparative metastasis detection accuracy ofEuropean journal of nuclear medicine and molecular imaging · 2026
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  8. Final outcomes of the SOFT and TEXT phase III trials in premenopausal hormone receptor-positive early breast cancer.Annals of oncology : official journal of the European Society for Medical Oncology · 2026
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972 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Hongchao PanFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Richard GrayFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Jeremy BraybrookeFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Christina DaviesFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Carolyn TaylorFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Paul McGaleFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Richard PetoFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Kathleen I PritchardFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Jonas BerghFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Mitch DowsettFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
Daniel F HayesFrom the Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford (H.P., R.G., J. Braybrooke, C.D., C.T., P.M., R.P.), and Royal Marsden Hospital and Institute of Cancer Research, London (M.D.) - both in the United Kingdom; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto (K.I.P.); Karolinska Institutet and Karolinska University Hospital, Stockholm (J. Bergh); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (D.F.H.).
EBCTCG

Funding

University of Florida Older Americans Independence Center (OAIC)P30AG028740 · NIA · UNIVERSITY OF FLORIDA · PI Karyn A Esser, Todd Manini · 2007 to 2026
$22.8M
Rehabilitation Research Career Development ProgramK12HD055929 · NICHD · UNIVERSITY OF TEXAS MED BR GALVESTON · PI BROWN, DAVID A · 2007 to 2021
$11.7M
Cancer Research UK 15955Cancer Research UK 16896Cancer Research UK 21133Medical Research Council MC_U137686850Medical Research Council MC_U137686858Medical Research Council MC_UU_12026/1NIA NIH HHS P30 AG028740NICHD NIH HHS K12 HD055929
6 · The paper itself

Abstract

backgroundThe administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment.

methodsIn this meta-analysis of the results of 88 trials involving 62,923 women with ER-positive breast cancer who were disease-free after 5 years of scheduled endocrine therapy, we used Kaplan-Meier and Cox regression analyses, stratified according to trial and treatment, to assess the associations of tumor diameter and nodal status (TN), tumor grade, and other factors with patients' outcomes during the period from 5 to 20 years.

resultsBreast-cancer recurrences occurred at a steady rate throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status. Among the patients with stage T1 disease, the risk of distant recurrence was 13% with no nodal involvement (T1N0), 20% with one to three nodes involved (T1N1-3), and 34% with four to nine nodes involved (T1N4-9); among those with stage T2 disease, the risks were 19% with T2N0, 26% with T2N1-3, and 41% with T2N4-9. The risk of death from breast cancer was similarly dependent on TN status, but the risk of contralateral breast cancer was not. Given the TN status, the factors of tumor grade (available in 43,590 patients) and Ki-67 status (available in 7692 patients), which are strongly correlated with each other, were of only moderate independent predictive value for distant recurrence, but the status regarding the progesterone receptor (in 54,115 patients) and human epidermal growth factor receptor type 2 (HER2) (in 15,418 patients in trials with no use of trastuzumab) was not predictive. During the study period from 5 to 20 years, the absolute risk of distant recurrence among patients with T1N0 breast cancer was 10% for low-grade disease, 13% for moderate-grade disease, and 17% for high-grade disease; the corresponding risks of any recurrence or a contralateral breast cancer were 17%, 22%, and 26%, respectively.

conclusionsAfter 5 years of adjuvant endocrine therapy, breast-cancer recurrences continued to occur steadily throughout the study period from 5 to 20 years. The risk of distant recurrence was strongly correlated with the original TN status, with risks ranging from 10 to 41%, depending on TN status and tumor grade. (Funded by Cancer Research UK and others.).

Indexed as

Breast NeoplasmsAdultAgedChemotherapy, AdjuvantDrug Administration ScheduleEstrogen AntagonistsFemaleHumansKaplan-Meier EstimateLymphatic MetastasisMiddle AgedNeoplasm GradingNeoplasm MetastasisNeoplasm Recurrence, LocalPrognosisProportional Hazards ModelsEstrogen AntagonistsReceptors, Estrogen

Identifiers

PMID29117498
PMCPMC5734609

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.