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From what I have read, but I may be wrong on this, there are three types of potential recurrences: local, which can be either a recurrence from stray BC cells from the original tumor, or a new primary in the same (ipsilateral) or other (contralateral) breast; regional, such as in lymph nodes or chest wall; or distant meaning metastatic stage 4 BC that may have been from dormant or circulating BC cells. For ER/PR+ HR- BC with lumpectomy there is a tool to determine risk for ipsilateral recurrence with or without hormone, radiation, and chemotherapy treatment: https://www.tuftsmedicalcenter.org/ibtr/ The Oncotype score, and the PREDICT test, provide an estimate only for the risk of a metastatic recurrence. It is my understanding that radiation may be more effective for ipsilateral risk than anti-estrogen drugs, but that AI's or tamoxifen are more effective against new primaries and more distant recurrences by decreasing the estrogen environment favored by ER+ breast cancer. Thank you @callalloo for your research on the OncotypeDX scores!
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P.S. I used the 'calculator algorithm on the Tufts website and it yielded a very low risk of recurrence. Which is very reassuring as I declined radiation and anti-hormone drugs. And my oncologist didn't suggest chemo after the OncotypeDX results.
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I think you have this confusing stuff correct and thanks for the explanations. The only thing that I was told that might be different refers to the type of radiation I was offered after the lumpectomy.
The onco/radiologist offered a 5 session series (over 10 days) of radiation focusing only on the tumor site. She described as analogous to breaking a dish (tumor) and cleaning it up (surgerywith clean margins)...but then sweeping the area one more time (the radiation) just to ensure all the particles were fully removed. It was definitely to prevent any future spread from any remaining cancer cells in that exact area and independent of aromatase inhibitors that, in theory, provide broader systemic protection from spread or recurrence.