Pattern of recurrence of early bc differs by intrinsic subtype & proliferation index

['lizbeth]

I'm still digging out nuggets from the article and found a couple more interesting pieces. The first is about Her2, margins & early recurrence:

The first peak of early relapses has been associated with surgery because the removal of the primary tumor could trigger the growth of clinically unapparent dormant micrometastatic foci[42].

Surgery could promote the growth of micrometastatic disease through several processes as an alteration in the angiogenic balance [42,43], surgical stress-induced neuroendocrine activation [44] or alteration of the immune response [45,46].

These mechanisms could influence particularly the disease course in intrinsic subtypes with a high expression of proliferation pathways such HER2 or basal-like tumors.

An increase of proliferation has been reported in HER2-positive patients with positive margins after conservative surgery between the first and the second tumor samples, as determined using Ki-67 immunohistochemistry; this was not the case with HER2-negative cases [47].