Strong Data Novel Tool
The evidence that powers the breast cancer outcome predictor comes from a study of 7,096 women who underwent mastectomy from 1995 to 2015 and were treated at five North American Institutions including Cleveland Clinic. All had stage pT1-2N1 breast cancer, one to three positive lymph nodes and no evidence of metastasis. None of the women had received neoadjuvant therapy.
To create the cohort, data from the institutions were collected retrospectively and pooled. A competing risk regression analysis was performed to identify factors associated with locoregional recurrence , distant metastases , overall recurrence and breast cancer mortality .
LRR was defined as recurrent breast cancer in the ipsilateral chest wall, axilla, supraclavicular or internal mammary lymph nodes. All other sites of disease recurrence were considered distant metastases. OR was defined as either LRR or DM, whichever occurred first.
In patients who had received PMRT, the hazard ratio for LRR was 0.28 . For DM, it was 0.79 and for OR, it was 0.69 . The HR for BCM was 0.81 .
This is the largest series to date in this subgroup to look at factors associated with increased risk of recurrence, says Sarah Sittenfeld, MD, radiation oncology resident and lead author of the study. It showed a significant benefit favoring radiation therapy in terms of local, distant and overall recurrence, and also breast cancer mortality.
Her2+ Status Cancer Stage And Survival
The importance of HER2 status for survival will depend on how far the cancer has spread. If itâs only in the breast, then it wonât make much difference. Most women in the early stage of the disease do well because a surgeon can remove the tumor.
Itâs when a breast tumor grows and spreads to lymph nodes or farther away in the body that HER2 status becomes more important for treatment and survival. Thatâs because there are now drugs that target HER2, but these work only for cancers that are HER2+. A common drug for HER2+ breast cancer is trastuzumab , but there are others. Because there are more treatments, women with more advanced HER2+ breast cancers today will on average have better survival rates than those with more advanced HER2- breast cancers.
Intrinsic Subtypes And Late Recurrence
A number of different methods have been evaluated for the ability to predict late recurrence. Some of these include:
Higher expression of estrogen-responsive genes: A 2018 study found that people with ER+/HER2 negative breast cancers who had higher expression of estrogen-responsive genes and were not treated with extended hormonal therapy had a high risk of recurrence after five years.
Multigene assays: Several multigene assays may help predict late recurrence, but using this information to figure out when to extend hormonal therapy requires more research. A 2018 evaluation of an 18-gene, 10-year signature found that the information regarding prognosis was similar to other tests including Oncotype DX Recurrence Score, Prosigna PAM50 risk of recurrence score, Breast Cancer Index and IHC4.
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Prognosis Of Late Vs Early Cancer Recurrence
Late recurrence is associated with a better prognosis than early recurrence in estrogen receptor-positive breast cancer. A 2018 study in Clinical Breast Cancer found that survival after recurrence was significantly longer in people with a late versus early recurrence . In this study, the lungs were the most common site of late distant recurrence.
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.
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What Is The Life Expectancy For Each Cancer Stage
Your outlook depends on thestage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage, because its when cancer has spread to other areas in the body.
Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.
Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.
Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.
Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.
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Distinct Patterns Of Metastasis
Curtis and her colleagues found that they could predict the course of the disease at different points during a patients clinical follow-up. They also found that the subgroups display distinct patterns of recurrence in terms of timing and the sites of metastasis.
Our model uniquely accounts for the chronology of a patients disease and is based on a genome-driven classification scheme that can inform personalized therapeutic approaches, Curtis said.
One unavoidable limitation of a retrospective study spanning decades such as this means the researchers are studying patients diagnosed and treated many years ago.
This is a retrospective, observational cohort, Curtis said. Since then, treatment paradigms have changed for some patient subgroups. Most notably, trastuzumab which specifically targets the HER2 receptor and has dramatically improved outcomes for patients with HER2-positive breast cancer since it was approved for use in early stage breast cancer in 2006 was not an option for many of the women in this study. It will be important to take what weve learned here and determine whether we can similarly improve the outcomes of these patient subgroups at high risk of recurrence with new therapies that target their specific genomic drivers.
The work is an example of Stanford Medicines focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.
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What Is The Prognosis For Grade 2 Breast Cancer Local Recurrence
The prognosis for grade 2 breast cancer local recurrence depends on several factors. For instance:
- For node-positive patients with lymphatic or vascular invasion present, the breast cancer recurrence risk is 33%.
- For node-negative with lymphatic or vascular invasion present, the breast cancer recurrence risk is 10%.
How Does Breast Cancer Recurrence Risk Calculator Work
The breast cancer recurrence risk calculator is relatively straightforward to use. All you need to do is indicate:
- Grade of tumor
- Lymph node status and
- Whether lymphatic or vascular invasion is present or not.
After inputting all your data, the breast cancer recurrence rate calculator will tell you the chances of breast cancer returning, specifically, the local recurrence.
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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.
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’s The Risk Of Recurrence
Everyone who has had breast cancer has some risk of recurrence, but its typically low.
In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, its considered to be a significant milestone to be celebrated. Recurrence after that five year markrare, but possibleis called late recurrence.
Theres still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence:
- Having high blood sugar
- Not eating enough fruits and vegetables
- Having had a surgical site infection after your surgery
Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:
- A tumor of more than five centimeters across
- Cancer cells that are HER2-positive
- Cancer cells that are triple negative
- Cancer cells in four or more axillary lymph nodes at the time of surgery
- Cancer cells in the chest muscles or breast skin
You might be at higher risk for late recurrence if you had:
- A tumor of more than two centimeters
- A high number of affected lymph nodes
- A hormone receptor-positive cancer
- A HER2-negative cancer
- Hormone therapy for only a short time after surgery
Breast cancer treatment: The care you need is one call away
Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
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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.
Clear Benefit For Patient Subgroup
The clear-cut findings are noteworthy because of the controversy surrounding indications for PMRT in this stage of patients. Data from older randomized trials suggested that PMRT significantly reduces risk of LRR in women with one to three positive lymph nodes. But more recent studies have reported five-year recurrence rates ranging from 4% to 11% post-mastectomy in the absence of radiation therapy, suggesting that PMRT may not be needed in many of these patients.
This study underscores the factors that are associated with higher risks of recurrence and identifies a subgroup of patients who might have a benefit that goes well beyond local control, says Dr. Sittenfeld. Most of the available studies to date have been small, single-institution studies, which individually lacked the statistical power and ability to give personalized risk estimates.
Competing risk regression models for each primary endpoint included predictors defined a priori, including age, tumor size, grade, number of positive lymph nodes, ratio of positive lymph nodes to sampled lymph nodes, pathologic N stage, LVI, nodal extracapsular extension, estrogen receptor and progesterone receptor status, HER2/neu gene amplification and use of adjuvant contemporary chemotherapy and/or trastuzumab.
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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.
Study Design And Participants
Our analyses are based on data from the placebo arm of the adjuvant Tykerb evaluation after chemotherapy trial , the design and main outcomes of which have been previously published . Briefly, between August 2006 and May 2008, the study recruited 3,161 women with stage I to IIIC HER2+ invasive BC who were disease-free at any time in follow-up after completion of prior adjuvant chemotherapy, but who had not received adjuvant trastuzumab. By randomizing patients at any time after diagnosis, the design of this trial and the resulting cohort of patients included are unique, as patients as late as 179 months from diagnosis were randomized , resulting in a very long follow-up period from diagnosis.
The study was approved by ethics review boards at all participating centers . Patients gave written, informed consent. The study complied with the Declaration of Helsinki and Good Clinical Practice. Only patients assigned to the placebo group and with centrally confirmed HER2+ disease are included in this analysis.
Patients were randomized to oral lapatinib or placebo, daily for 12 months or until disease recurrence, development of a second primary cancer, or unacceptable toxicity. Details of randomization and stratification have been previously published .
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Circulating Tumor Cells At 5 Years Post
In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.
In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.
Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.
That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.
Type Of Breast Cancer
The type of breast cancer can affect the recurrence rate.
In a 2017 study, researchers found that people with estrogen-receptor positive breast cancer had a persistent risk of recurrence for at least 20 years after their original diagnosis.
According to Susan G. Komen, factors that influence recurrence can include:
- biology of the tumor
- treatment of the original tumor
- stage of the cancer at diagnosis
, treatment for recurrent local breast cancer depends on what treatment the person originally had.
If a person originally had a lumpectomy, a doctor may recommend a mastectomy.
If a person originally had a mastectomy, a doctor may try to remove the tumor and recommend radiation.
For either scenario, a doctor may also suggest hormone therapy, chemotherapy, or targeted therapy in addition to removing the tumor and using radiation therapy.
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