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No, you are NOT dumb
localized disease is used in distinction to metastatic disease, in this case, probably (distant) metastatic disease.
In breast cancer, in distinction to some other cancers, they usually use the term locoregional disease(rather than localized disease) as breast cancers with metastases to the lymph nodes are still considered to have an entirely different prognosis (better) than those with distant metastases (lung, liver, brain, bones).
When one gets a chance to read the entire articles, these things are usually spelled out much more clearly.
Hope this helped!!
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risk of second nonhematologic cancer among 376,825 breast cancer survivors
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