What Factors Contribute To The Risk Of Breast Cancer Recurrence
Whilst it is never completely certain that breast cancer has been cured, there are many treatments available that reduce the risk of recurrence. There are a number of risk factors that can contribute to a breast cancer recurrence.
Your age at first diagnosis Younger women, particularly those who had their first diagnosis under the age of 35, have a greater risk of recurrence. This is because those diagnosed at a young age are more likely to have aggressive features in their breast cancer. Additionally women diagnosed with breast cancer before menopause have a greater risk of recurrence.
Tumour size Women who have a larger breast tumour have a greater risk of recurrence.
Lifestyle factors Lifestyle factors can influence the risk of recurrence. Excess weight is associated with a higher risk of postmenopausal breast cancer and is also associated with a higher risk of breast cancer recurrence and death. Smoking has also been shown to increase the risk of recurrence. Women who exercise regularly appear to have a lower rate of breast cancer recurrence.
Lymph node involvement If cancer is found in lymph nodes at the time of the original breast cancer diagnosis, there is an increased risk of breast cancer recurrence. This is the strongest prognostic factor, and the more nodes involved, the higher the risk of recurrence.
Treating Cancer When It Returns
For as long as she can remember, Eileen Kaplan has infused humor into every chapter of her life. It made her fellow Girl Scouts laugh at camp. It caused little pieces of trouble throughout high school. It put her patients at ease when she worked as an X-ray technologist. It built rapport with her business clients.
So naturally, when Eileen faced breast cancer twice in a matter of months, laughter carried her through treatment and recoverya journey with an unexpected but fulfilling destination.
While performing a monthly breast self-exam in the shower in June 2005, Eileen felt a lump on her right breast. I knew it was a tumor, she recalls. Since my gynecologist was at Brigham and Womens Hospital, I called her office, and they helped me arrange an oncology appointment for the next day. Lo and behold, there it was: the uninvited guest. A wild adventure began.
Brigham and Womens Hospital surgeons performed a lumpectomy to remove the cancerous tumor from Eileens breast. She then endured infusions of chemotherapy and rounds of radiation therapyboth designed to kill any lingering cancer cells.
Recovery was a toughie, and in the end, I decided not to go through with reconstruction surgery, Eileen says. But I never asked, Why me? I said, Lets get the cancer out and let me get on with my life.
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
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Survival Rates By Stage
Breast cancer survival rates compare the number of women with breast cancer to the number of women in the overall population to estimate the amount of time women with breast cancer are likely to live after theyre diagnosed.
For example, if the survival rate for a stage of breast cancer during a 5-year period is 90 percent, it means that women diagnosed with that cancer are 90 percent as likely to survive for 5 years following their diagnosis as women who do not have the cancer.
As we mentioned earlier, survival rates are based on information from the SEER database, which the NCI maintains.
SEER does not group breast cancers by stages 0 through 4. Instead, it groups them by the following stages:
- localized: when the cancer has not spread outside of the breast
- regional: when its spread outside the breast to nearby structures or lymph nodes
- distant: when its spread to other parts of the body, such as the liver, lungs, or bones
It should be noted that theres a substantial racial disparity gap in survival rates between white women and Women of Color, especially for late-stage breast cancer diagnoses. The chart below, courtesy of the
Mastectomy And Local Breast Cancer Recurrence
With mastectomy, the best predictor of local breast cancer recurrence is whether the lymph nodes in the underarm area contain cancer.
The risk of local recurrence is usually higher when there are more axillary lymph nodes with cancer than when there are few or no nodes with cancer .
Learn more about breast cancer recurrence.
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How Will My Prognosis Affect My Treatment
Following surgery or radiation, your treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with your surgeon, may advise the use of tamoxifen or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
Will I Die Of Breast Cancer
This is a difficult question to answer early in your cancer care but it is still worth asking. Many people just diagnosed with cancer have no idea how much of a risk to their life their unique situation poses. Most breast cancers carry a low risk of recurrence, especially early-stage cancers. The answer is usually reassuring.
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Should I Have Scans Or Blood Tests To Check For Breast Cancer
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated with scans regularly. The frequency is often annually but is best discussed with your specialist.
Current guidelines and evidence 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. These tests have not been shown to improve outcomes and cause unnecessary scanxiety. If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.
How Serious Is Your Recurrence
The more your cancer spreads from the original tumor, the more serious it is likely to be. Your cancer may be local, regional, or distant:
Local: The cancer comes back in the same breast as the original tumor.
Regional: Here, the cancer returns to the same area as the original tumor, but in a more expanded sense that includes the armpit or collarbone lymph nodes.
Distant: This is what doctors call metastatic cancer or stage IV breast cancer. Here, the cancer shows up far away from the original tumor in places like the bones, lungs, brain, or other areas.
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What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
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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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
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Cancers with thehighestrecurrencerates include: Glioblastoma, the most common type of brain cancer, has a near 100 percent recurrencerate, according to a study published in the Journal of Neuro-Oncology . Epithelial ovarian cancerhas an 85 percent recurrencerate, according to a study published in Expert Review of Anticancer Therapy.
A 2013 study found that exercising, even at a moderate level following a breastcancer diagnosis, led to a 40 to 50 percent lower risk of recurrence when comparing the risk in women who sweat less. The results were particularly apparent in women with hormone-responsive.
Thetype of breastcancer can affect the recurrencerate. In a 2017 study, researchers found that people with estrogen-receptor -positive breastcancer had a persistent risk of recurrence for.
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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.
New Medications For Metastatic Breast Cancer
Immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma.
In 2019, Tecentriq became the first immunotherapy drug to be approved for triple-negative breast cancer that is metastatic or locally advanced but unresectable . However, in August 2021, Tecentriq’s manufacturer voluntarily withdrew that indication in the United States.
However, also in 2021, the Food and Drug Administration approved Keytruda for high-risk, early-stage, triple-negative breast cancer. It is used in combination with chemotherapy as a neoadjuvant treatment , and then continued as a single agent as adjuvant treatment .
PARP inhibitors are another class of medication that may alter survival rates in the future, particularly among women who have hereditary breast cancer .
For bone metastases, bone-modifying drugs may be effective in both treating metastases and possibly reducing the development of further metastases in bone.
Finally, for people who have only a single or a few metastases , treating these metastases locally may be an option. While studies are young, treating oligometastases may improve survival or even lead to long-term survival for a minority of people.
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What Are The Treatment Options For Invasive Lobular Carcinoma
ILC can be more difficult to diagnose than other forms of breast cancer because it spreads in a unique pattern thats not always noticeable in imaging tests. The good news is that its a relatively slow-growing cancer, which gives you time to form a treatment plan with your cancer team.
There are several treatment options that can help increase your chances of a full recovery.
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 .
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Treatment Type And Breast Cancer Survival
Overall survival is the same for lumpectomy plus radiation therapy and mastectomy. This means both treatments lower the risk of dying by the same amount.
For a summary of research studies on lumpectomy plus radiation therapy and mastectomy in the treatment of early breast cancer, visit the Breast Cancer Research Studies section.
Identifying First Recurrence Events Of Breast Cancer
The AJCC stages in the SEER data were used to categorize tumor stages in this study. The hormone receptorpositive status was considered as mixed estrogen receptorpositive and/or progesterone receptorpositive , that is, ER+/no PR data, ER+/PR+, ER+/PR, or ER/PR+, or no ER data/PR+. The percentages of available ER, PR, and hormone receptor status among the women were 80.8%, 78.3%, and 81.4%, respectively. Tumor histologic grades were classified as well-differentiated , moderately differentiated , poorly differentiated , and unknown status of grade.
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Risk Of Late Recurrence Is Underestimated
A survey led by the Canadian Breast Cancer Network found that women often underestimate their risk of late recurrence. In the survey, only 10% were aware of the risk of recurrence after five years of tamoxifen therapy, and 40% felt that they were cured after hitting the five-year mark.
Many breast cancer survivors underestimate their risk of late recurrence.
Tumor Size And Lymph Node Status
The risk of recurrence is linked to the size of the original tumor as well as the number of positive lymph nodes, although these factors alone can’t explain all recurrences. In the 2017 study noted earlier, for women who were cancer-free after five years of hormonal therapy, the risk of recurrence was highest for those who had large tumors that had spread to four or more lymph nodes , and lowest with small, node-negative tumors.
The risk of recurrence of these small, node-negative tumors, however, remains significant at roughly 1% per year until at least 20 years post-diagnosis. Due to the life expectancy of metastatic breast cancer , the risk of death lags somewhat behind recurrence.
|Late Recurrence Rate and Lymph Node Status|
|Years After Diagnosis|
Within these ranges, the risk of recurrence was greater in women who had larger tumors than smaller tumors . Tumor grade and Ki-67 had only moderate predictive value, and progesterone receptor status and HER2 status had no predictive value in this study.
It’s noteworthy that women who had one to three positive lymph nodes were twice as likely to have their cancer recur at distant locations between five years and 20 years post-diagnosis than in the first five years, and those who have node-negative tumors were roughly four times more likely to have a late than an early recurrence.
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