Receptor Status And Recurrence: Early And Late
In discussing receptor status and recurrence rates it’s important to note that no two tumors are the same, and breast cancerseven those with the same receptor statusare a heterogeneous group of tumors. That said, receptor status plays a significant role in when recurrences may occur.
With estrogen receptor-negative tumors , the risk of recurrence peaks at around two years post-diagnosis, and is relatively uncommon after five years.
Estrogen and/or progesterone receptor-positive tumors, in contrast, are more likely to recur more than five years post-diagnosis than in the first five years in people treated with hormonal therapy. That said, some hormone positive tumors are more likely to recur late than others.
With estrogen receptor-positive breast cancer , more than half of recurrences occur after five years.
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.
How Does This Breast Cancer Recurrence Risk Calculator Work
This health tool evaluates recurrence risk in the case of patients with a recurrence of breast cancer or metastatic disease.
The risk factors accounted for in this breast cancer recurrence calculator are:
Grade of tumor the higher the grade, the more likely a recurrence is. For instance, grade 4 contains increasingly abnormal and rapid growth cancer cells that are more likely to recur
Lymph nodes inflammation of lymph nodes is indicative of higher risk
Lymphatic or vascular invasion presence or absence of breast cancer cells in the lymphatic or vascular system.
Breast cancer recurrence can take place at the original site or spread to other parts of the body, indicating metastasis or distant recurrence .
Most recurrences occur within the first five years after first treatment with average risk rates of about 11%. This percentage increases in the case of patients with cancer family history or BRCA gene mutations.
Diagnosis of localized recurrence takes place through physical exam and mammogram while diagnosis of metastasis depends on types of symptoms and available testing.
Recurrence cancer treatment depends on the initial treatment, for example in the case of a lumpectomy, local recurrence is treated with mastectomy while in case the initial treatment was mastectomy, an attempt to remove the second tumor surgically is made, followed by radiation therapy.
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Local Recurrence Of Breast Cancer
Breast cancer is a malignant tumor that develops in the breast tissue. Malignant tumors have cancer cells that invade surrounding tissues or spread to other areas within the body. There are several types of breast cancer, and most are found in women, although men can get it too.
Unfortunately, breast cancer can reoccur after the initial treatment. Cancer recurrence can be:
- Local within the original area
- Regional near the primary site or
- Distant spreading to distant organs or tissues, such as lungs.
The Omni breast cancer recurrence risk calculator accounts for local breast cancer recurrence, which is usually diagnosed through a physical exam and mammogram.
What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
References
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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.
Why Was The New Tool Developed
Currenttherapy for breast cancer standardtreatment OncologistsTargeting and inhibiting a glucose-regulated protein GRP78 helps to enhance and restore sensitivity in estrogen targeted therapy-resistant cells.Hormone-sensitive breast cancer
- The new tool was devised to address this problem – to decide which patients are at high enough risk of their cancer returning after receiving the hormone therapy, and so could benefit from the continuation of treatment.
- The tool has another benefit of predicting which patients are at low risk of recurrence, and so can avoid any further therapy along with the potential adverse side effects.
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What Are The Types Of Breast Cancer Recurrence
If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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What This Means For You
If youve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.
If you were diagnosed with hormone receptor-positive, early-stage breast cancer, its likely that your doctor will recommend you take some type of hormonal therapy medicine either tamoxifen or an aromatase inhibitor depending on your menopausal status for five to 10 years after surgery.
Chemotherapy after surgery is usually completed in three to six months. If youre also receiving a targeted therapy, such as Herceptin , with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.
Radiation therapy after surgery can be completed in one to seven weeks.
So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either dont start taking the medicine or stop taking it early, in many cases because of side effects.
Learn more about Staying on Track With Treatment. You can read about why its so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.
Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
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Coping With The Fear Of Recurrence
Coping with the fear of recurrence can be challenging, especially when the risk of recurrence persists as with estrogen receptor-positive breast cancers. In the past, many people sensed that if they hit the five-year mark, the chances they were home free were high. Longer-term research has, unfortunately, dispelled this belief.
Some degree of fear can be a good thing. An awareness that breast cancer can come back often prompts people to be careful with follow-up appointments and to pursue healthy lifestyle changes to reduce risk. Yet, too much fear can be paralyzing.
If you’re struggling with this fear, seeking professional help can be wise. And in fact, there have even been studies linking psychological support with survival.
Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor, who is familiar with your situation, about how these numbers may apply to you.
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When Cancer Recurs After 5 Years
When cancer recurs at a distant site it is no longer early-stage breast cancer. The characteristics of cancer may change as well. Tumors that are initially estrogen receptor-positive may now be negative and vice versa . HER2 status can also change.
For this reason, and because there are now a number of alterations that can be targeted , it’s important for people to have a biopsy and genetic testing of their tumor .
What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
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What Are The Symptoms Of Breast Cancer Recurrence
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- Nipple changes, such as flattening or nipple discharge.
- Swollen skin or skin that pulls near the lumpectomy site.
- Thickening on or near the surgical scar.
- Unusually firm breast tissue.
- Biopsy of the site of suspected recurrence.
Lisa Fought Breast Cancer For 8 Years Heres Her Story
In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumors there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumors.
Overall, the chance that an estrogen receptor-positive tumor will recur between five years and 20 years after diagnosis ranges from 10% to over 41%, and people with these tumors remain at risk for the remainder of their lives.
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 don’t understand this risk are often less likely to be supportive as you cope with the fear of recurrence.
While chemotherapy has little effect on the risk of late recurrence hormonal therapy does, and estimating this risk may help determine who should receive extended hormonal therapy . Finally, late recurrences can differ from early relapse with regard to sites of metastases and survival.
Factors such as initial tumor size, number of nodes involved, and receptor status play into the risk of late recurrence, but tumor biology appears to have the greatest effect, and research is actively looking for ways to look at gene expression and copy number to predict risk.
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Tool Predicts Risk For Late Breast Cancer Recurrence
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An online prognostic tool accurately determined the risk for late distant recurrence among women with ER-positive breast cancer, according to a single-arm, prospective study.
The Clinical Treatment Score post-5 years tool could be used to determine whether patients should continue endocrine therapy 5 years after initial treatment.
Hormone-sensitive breast cancer is one of the few cancers where late recurrence is common, and predicting who is at high risk is particularly important so that they can continue hormone treatment,Jack Cuzick,PhD, director of the Wolfson Institute of Preventive Medicine and head of the Centre for Cancer Prevention Centre for Cancer Prevention at Queen Mary University of London, said in a press release. While our ability to predict this type of cancer is highly likely to improve in the future, we’re providing a simple tool which is available now, and is easily used and well tested.
To develop CTS5 a web-based calculator researchers used the Arimidex, Tamoxifen, Alone or in Combination, or ATAC, dataset to determine rates of delayed metastasis 5 to 10 years after endocrine therapy.
The tool defines the risk for distant recurrence within the next 5 to 10 years as low , intermediate or high .
The tool appeared significantly prognostic for late distant recurrence in the ATAC cohort and the BIG 1-98 validation cohort .
How Is Breast Cancer Recurrence Managed Or Treated
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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Early Recurrence Vs Late Recurrence
A recurrence of breast cancer at any time can be devastating. While 6% to 10% of breast tumors are diagnosed when the disease is already metastatic , 90% to 94% of metastatic breast cancers represent a distant recurrence of previous early-stage breast cancer .
Since distant metastases are responsible for around 90% of breast cancer deaths, finding ways to reduce the risk of recurrence is critical in improving the survival rate from the disease. Overall, it’s estimated that around 30% of breast cancers will recur at distant sites.
Integrative Subtypes And Late Recurrence
Researchers recently developed a model to identify 11 integrative subtypes of breast cancer with different risks and timing of recurrence, according to the findings of a 2019 study published online in Nature.
Four integrative subtypes were identified that were associated with a high risk of late recurrence . Altogether, these four subtypes accounted for roughly 26% of breast cancers that were estrogen receptor-positive and HER2 negative.
These subtypes included tumors that had an enriched copy number alterations in genes that are thought to drive the growth of cancer , including:
They were also able to identify a subgroup of triple-negative tumors that were unlikely to recur after five years as well as a subgroup in which people continue to be at risk of late recurrence. A Breast Cancer Recurrence Calculator including integrative subtypes has been developed but, at the current time, this is meant for research purposes alone.
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What Women Can Do Themselves
There are some things women can do themselves to lower their risk of late recurrence:
- Regular exercise is associated with a lower risk of death from breast cancer as well as death from all causes.
- It’s important for everyone to have their vitamin D level tested, although the role of vitamin D is still uncertain. Vitamin D deficiency is associated with bone loss, a concern for most people who have coped with breast cancer.
- Losing weight if you are overweight, or maintaining a healthy weight is important as well.
New Online Tool Could Predict Risk Of Breast Cancer Returning
A simple web-based calculator for clinicians could predict long-term risk of cancer recurrence.
A new, simple web-based calculator that could better predict the long-term risk of breast cancer returning in other areas of the body has today been published online by researchers at Queen Mary University of London.
The tool CTS5 was developed with colleagues at The Royal Marsden NHS Foundation Trust and could be used to determine which patients are at high enough risk of their cancer returning and could benefit from continuing their hormone therapy beyond the standard five years.
Over the last three decades, there has been a major increase in the rate of invasive breast cancer in Western countries. Approximately 85 percent of patients are now diagnosed as oestrogen receptor positive, which means that the cancer grows in response to the hormone oestrogen. Almost all of these patients are prescribed five years of hormone therapy after having standard treatment , to lower the risk of the cancer returning.
However, hormone therapy can have significant side effects for some patients, including weakness of bone tissue, and exacerbation of menopausal symptoms. Oncologists along with patients have to decide after five years of hormone treatment whether extending this type of therapy is worthwhile and appropriate.
Important to predict which women are at risk
A simple and accurate tool designed for doctors
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