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Breast Cancer Recurrence After 5 Years

Lifestyle Changes Can Reduce The Risk Of Breast Cancer Returning

Cancer Education Series: Reducing the Risk of Breast Cancer Recurrence

Surviving breast cancer diagnosis, treatment and recovery can cause uncertainty and concern that the cancer will come back or that a new cancer will occur. Addressing self-care after breast cancer and tending to your overall well-being can help restore a more positive outlook, and might even reduce your chances of facing cancer again.Does using deodorant increase your breast cancer risk? Learn about breast cancer myths and facts

We are experts in managing local breast cancer recurrence and metastatic disease, Lange says. As a comprehensive breast center, our patients range from the newly diagnosed to those with advanced metastatic disease.

Our goal is to find treatment and management options for all patients, using all the healing modalities that evidence-based medicine has proven to be beneficial in the treatment of breast cancer.

Breast Cancer: Moving Beyond the Fear of Recurrence

Being a Survivor

Lifestyle Changes After Breast Cancer

What Exactly Does Recurrence Mean

In simple terms, it means the return of the same cancer.

It could also mean the cancer has spread to other parts of the body. Doctors call this âmetastaticâ recurrence. This is generally more serious than a simple return of cancer cells to the breast itself, which is also a recurrence.

Though some people use ârecurrenceâ and âmetastasisâ to mean the same thing, they are different. Recurrence is more general. It simply means that cancer has returned â either as a metastasis or to the original breast. Metastasis is a specific type of recurrence. It means your original cancer has spread to other parts of your body.

Sometimes new cancer shows up in the opposite breast and nowhere else. Doctors consider this a ânewâ cancer diagnosis, not a recurrence.

How Long Before Recurrence Is Off The Table

Recurrence is a risk for up to 32 years after a first diagnosis of breast cancer, according to a recent study. Your risk of recurrence after 10 years of remission depends on a number of things like:

  • The size of the tumor
  • The number of lymph nodes with cancer
  • Whether cancer is estrogen receptor-positive

In general, once you have a breast cancer diagnosis, even if you are years in remission, itâs a good idea to be watchful and consult your doctor for regular breast exams and other screenings they think are appropriate. Early detection is the best way to get the best outcome from treatment. Talk to your doctor about the best schedule of checkups for you.

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Treatment For Local Recurrence

Treatment for local recurrence will depend on a number of factors, including what treatments you have previously had.

Surgery

If you had breast-conserving surgery then you will usually be offered a mastectomy. For some people it may be possible to repeat the wide local excision.

If you previously had a mastectomy, surgery may be possible to remove the affected areas.

Nearby lymph nodes may also be removed.

Radiotherapy

Radiotherapy is usually only an option if you havent previously had radiotherapy in the same area.

The way radiotherapy is given for a recurrence is similar to how its given to someone newly diagnosed.

Radiotherapy may be offered if surgery isnt possible.

Hormone therapy

If the cancer is oestrogen receptor positive you may be offered hormone therapy.

Which treatment you are offered depends on whether you have gone through the menopause and any hormone therapy you have previously had or are currently taking.

Chemotherapy

Its not clear how much benefit chemotherapy will be to you if you have a local recurrence, but it might be offered in some cases.

If you have previously had chemotherapy then different chemotherapy drugs may be used.

Targeted therapy

The most widely used targeted therapies are for HER2 positive breast cancer.

How Long After Breast Cancer Treatment Do Recurrences Occur

Triple Negative Breast Cancer Recurrence After 5 Years

The risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.

The late recurrence or relapse of breast cancer refers to cancers that come back after five years, but may not return for 10 years, 20 years, or even more. For people who have estrogen receptor-positive tumours, the cancer is actually more likely to recur after five years than in the first five years.

In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumours there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumours.

An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who dont understand this risk are often less likely to be supportive as you cope with the fear of recurrence.

Bone Metastases

  • The long bones of the arms and legs

Symptoms and Detection

Treatment

Liver Metastases

Treatment

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Understanding Breast Cancer Recurrence

Australia has one of the best survival rates of breast cancer in the world, with 91% of women surviving at least five years past their diagnosis. New Zealand is not far behind with 88% of women surviving five years past their first diagnosis.

This information may come as a relief for those diagnosed with early stages of the disease, as many recurrences appear within five years after the initial treatment, the exception being ER positive breast cancer, as many recurrences will occur after the first five years as within the first five years. But the fear of recurrence , is a common issue faced by women who have had early stage breast cancer. The chance of recurrence is not the same for all breast cancer patients. Understanding the risk of recurrence for your type of breast cancer may help to ease some anxiety.

Tumour Dormancy And Reawakening

Tumour dormancy is generally defined as a prolonged state of asymptomatic micrometastatic disease. In cancer of the breast or prostate, cancer cells can remain dormant for years and even decades before recurring as metastatic disease. During this latent period, patients are considered to be disease-free due to the lack of any symptoms of illness and because they have no detectable neoplasms by clinical imaging. Often described as one of the most wicked cancer cell misbehaviours, tumour dormancy shares many features in common with chronic diseases. Yet, its nature appears to be reversible, as myriad mechanisms have been shown to induce a switch to reawaken indolent DTCs . Furthermore, tumour dormancy is not exclusively a phenomenon of end-stage tumorigenesis, as it can apply to the presence of occult neoplasms until clinical diagnosis , and/or to MRD left behind after treatment . Attention, however, must be paid to the molecular underpinnings of these two scenarios as mechanistic differences between primary and metastatic dormancy might exist.

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What Is The Risk For Breast Cancer Recurrence

The risk of recurrence depends on the type of breast cancer and its stage. Timing matters, too: The highest risk of recurrence for breast cancer patients is during the first few years after treatment.

At the Johns Hopkins Breast Center, our team of breast cancer specialists monitors patients who are at risk of recurrence, Lange explains. The follow-up schedule depends on the stage of cancer, what kind of treatment has been received and prognostic factors. The risk of recurrence decreases as time goes on, but never gets down to zero.

How Is Breast Cancer Recurrence Managed Or Treated

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Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.

Treatments for local and regional breast cancer recurrence may include:

  • Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
  • Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
  • Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
  • Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
  • Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
  • Targeted therapy: Treatments target specific cancer cell genes or proteins.

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Disseminated Tumour Cells As Culprits For Metastatic Recurrence

Metastatic relapse is attributed to the outgrowth of cancer cells that have escaped from the primary tumour and take up residence in secondary sites. Cancer cells that physically detach from a primary source and seed distant sites are known as disseminated tumour cells . The process whereby DTCs transform a localised cancer into a systemic disease is called the metastatic cascade . In the next few sections, the seven key steps comprising this complex biological process are discussed with the goal to shed light on the when and how of DTC dissemination. Importantly, while depicting the metastatic cascade as an orderly series of sequential eventsstarting from the primary tumour and ending in a distant metastatic siteit should be noted that DTC spread can take place through multiple routes and different directions. Accordingly, clinical evidence of self-seedingwhereby a metastatic cell re-infiltrates its primary tumourand of metastasis-to-metastasis spread, has been documented, with one such study in HR+ breast cancer patients reporting a common origin between lymph node and distant metastases in up to 25% of cases.

Fig. 2: Tumour cell dissemination: the route to metastatic success or failure.

Will Your Breast Cancer Recur

Breast cancer can recur in anyone who has had breast cancer. Itâs highly unlikely to be a result of anything you did or failed to do.

There are, however, some things that seem to raise your risk of recurrence. These include:

Stage: Scientists use several things to come up with your breast cancer stage . They look at the grade of tumor. This is a measure of how abnormal the cells look compared to similar noncancerous cells. After that, they look at the size of the tumor and how far cancerous cells have spread from the original site to other parts of the body. The higher the stage of your original tumor, the more likely it is to recur.

Age: If youâre a woman and you get breast cancer before age 35, youâre more likely than older women to get it again.

Tumor type: Some types of breast cancer are more aggressive and therefore more likely to return and spread to other parts of your body. These include inflammatory breast cancer and triple-negative breast cancer. This also includes hormone-receptive types. Not only are these more likely to come back, theyâre also harder to treat.

Certain cancer cell behavior: Hormone-receptive cancer cells that donât respond to hormone therapy or cancer cells that donât respond to targeted treatments for the HER2 gene could be a sign of more likely recurrence.

High BMI: Lots of body fat as measured by the body mass index, or BMI, can raise your risk of breast cancer recurrence.

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The Wide Window Of Relapse In Breast Cancer

In contrast with other solid tumours in which metastatic recurrence can occur within a few weeks or a few years following diagnosis, breast cancer is characterised by a wide window of relapse, spanning months to decades after surgery. The basis of this peculiar pattern of recurrence is still elusive, but is likely to be linked to the aforementioned molecular differences underlying each subgroup, with basal-like and HER2-enriched patients experiencing early relapses , as opposed to patients with luminal cancers characterised by a more favourable prognosis.,, Nonetheless, patients with luminal B tumours tend to have shorter survival times than luminal A patients. In addition to the contribution of the molecular subtype of the primary tumour, the risk and timing of recurrence is also influenced by other tumour-related factors that constitute the pillars of the TNM classification system: tumour size and spread , regional lymph node involvement and the presence of distant metastasis . Based on the premise that the chance of survival is intimately linked to the anatomic extent of the disease, the TNM staging system stratifies cancer patients at diagnosis into four stageswith patients with Stage I disease having a much better prognosis as opposed to patients with Stage IV diseasethus representing the gold standard tool for prognostication.

Treatment Of Local Recurrence After Previous Mastectomy

Triple Negative Breast Cancer Recurrence After 5 Years

Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.

Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.

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The Myth And Stigma Of The 5

Many people still believe that breast cancer, even hormone-positive disease, is essentially cured after five years this can lead to misunderstandings in families. Loved ones who don’t understand late recurrence may downplay your feelings, or criticize you when you think “brain tumor” each time you get a headache.

Until information on late recurrence becomes more widely known, and even though it’s frustrating, you may need to educate loved ones about the risk, and why you should be concerned when you develop new or unexplained symptoms.

What Are The Signs Of Breast Cancer Recurrence

If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:

  • A new lump in the breast, armpit area or around the collarbone
  • A change in breast size or shape
  • Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
  • Clear or bloody nipple discharge
  • Changes to the skin including redness, puckering or dimpling
  • Breast tenderness or pain

If your breast cancer has spread to other parts to the body, known as distant recurrence, there are a number of possible symptoms, including:

  • Unexpected weight loss or change in appetite
  • Severe or ongoing headaches

However, symptoms will vary depending on where the secondary cancer presents, and some primary and secondary cancers may not present any obvious symptoms. Sometimes recurrence is identified on a scan or blood test that was done for a reason other than breast cancer.

If you have any health concerns or symptoms that are new or persistent, speak with you GP or treating physician.

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When Is Metastasis Found On A Mammogram

Local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm. Metastasis is usually found when symptoms are reported to a provider. If you have a local recurrence or metastasis, its not your fault.

What Is Recurrent Breast Cancer

Late Recurrence Breast Cancer Treatment Options and Implications

Recurrent breast cancer is breast cancer that comes back after initial treatment. Although the initial treatment is aimed at eliminating all cancer cells, a few may have evaded treatment and survived. These undetected cancer cells multiply, becoming recurrent breast cancer. Recurrent breast cancer may occur months or years after your initial

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What Types Of Breast Cancer Have The Highest Recurrence Rates

A study published in the Journal of Clinical Oncology found the risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.

Treatment For Locally Advanced Breast Cancer

Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .

This might be chemotherapy, hormone therapy or targeted therapy.

Chemotherapy

If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.

Hormone therapy

If the cancer is oestrogen receptor positive you may be offered hormone therapy.

If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.

Targeted therapy

Targeted therapies are a group of drugs that block the growth and spread of cancer.

The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.

Radiotherapy and surgery

You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.

If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.

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Should I Have Regular Routine Scans Or Blood Tests To Check For Distant Breast Cancer Recurrence

No. Routine scans to check for the presence of distant disease recurrence are not recommended in the absence of symptoms

Given the ominous nature of stage 4 disease, the obvious question is, why dont we scan for spread regularly after a first diagnosis, so that we can detect it early if it does return? The reason we dont scan or test for metastasis is that there really is no early stage 4 disease, and thus no real opportunity to intervene earlier and increase the chance of cure. Its also important to know that with recurrence, one does not progress from one stage to the next: a woman who was originally diagnosed with stage 1 breast cancer does not recur as stage 2, because once cells have taken up residence elsewhere, she is immediately considered to have stage 4 disease. And with stage 4 disease, either you respond well to treatment and the disease regresses, or you dont and it doesnt. Studies have shown that getting frequent scans after a first cancer diagnosis does not lead to improved survival, which is why we dont scan for stage 4even if we wish we could.

Current guidelines and evidence therefore recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on.

If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.

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