Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
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
How Does Breast Cancer Spread
Breast cancer can spread through the lymphatic system, the bloodstream, or uncommonly, by local invasionwhich is when cancer cells actually invade nearby tissues, such as the chest wall or ribs.
When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage. The spread of breast cancer to lymph nodes does not necessarily mean that its metastatic, even though pathology reports often somewhat confusingly state breast cancer metastatic to lymph nodes.
A growing cancer may shed a cell or a clump of cells, and It can use your blood or lymph system as a network of highways for traveling. So, if a loose cancer cell makes it via the lymphatic system to your lymph nodes, its also possible that it may spread via the bloodstream to other parts of your body.
When cancer recurs in a lymph node near the breast, it is considered a regional recurrence and not a distant recurrence.
When breast cancer spreads to lymph nodes it has essentially declared its intent to metastasize. Breast cancer reaching the lymph nodes is in effect a declaration that its working to spread further.
In women with negative nodes, its trickier. What we want is a way to identify the 20 to 30 percent who have microscopic cells elsewhere and not over-treat the other 70 percent. At present we dont have a perfect way to do this.
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When Do Second Cancers Occur
A second cancer can appear at any time during survivorship. Some studies show that a common time for cancers to develop is from five to nine years after completion of treatment.
For childhood cancer survivors, secondary leukemia is most likely to occur less than ten years after treatment of the original cancer. Solid tumors related to radiation may occur more than ten years afterward. However, because the exact causes of second cancers are not yet known, it is difficult to predict when they might appear. Lifetime monitoring by health care providers who are knowledgeable about survivorship care is recommendedâeven years after completing treatment for the original cancer.
Breast Cancer Stats In Australia
Breast cancer is the second most commonly diagnosed cancer in Australia. Approximately 57 Australians are diagnosed each and every day. That equates to over 20,000 Australians diagnosed with breast cancer each year.
1 in 7 women are diagnosed with breast cancer in their lifetime.
About 1 in 600 men are diagnosed in their lifetime.
Around 1000 young women are diagnosed with breast cancer each year, equivalent to about 3 young women each day.
In 2022, over 3,200 Australian will pass away from breast cancer . Approximately one woman under the age of 40 is expected to die each week from breast cancer.
Thats 9 Australians a day dying from the disease.
In the last 10 years, breast cancer diagnosis have increased by 33%.
Since the National Breast Cancer Foundation started funding in 1994, the five-year survival rates have improved from 76% to 92%.
Weve come a long way. But theres still progress to be made.
Thats why were committed to funding a broad spectrum of research to help understand risk factors, develop new ways to detect and treat breast cancer, improve quality of life for breast cancer patients, improve treatment outcomes and ultimately save lives.
Our mission: Zero Deaths from breast cancer.
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What Is The Recurrence Rate Of Triple
A 2019 study found that roughly 40% of people with stage 1 to stage 3 TNBC will see their cancer return after standard treatment. The remaining 60% will have long-term survival without recurrence.
The outcomes of treatment vary. About 42% of those with this form of cancer will have a rapid relapse after standard treatment. This recurrence typically occurs within the first 23 years following the initial diagnosis.
It is not currently possible to predict who will experience a relapse in their cancer, even if they have had intensive chemotherapy.
Triple-negative breast cancer can recur in various areas of the body and at local, regional, and distant levels:
- Local means that the cancer remains in the breast and has not spread.
- Regional is when the cancer spreads from the breast to lymph nodes and other structures located nearby.
- Distant refers to cancer that has spread far from the breast to other organs, such as the liver or lungs.
A 2017 study examined the patterns of recurrence among 1,930 people with TNBC. The researchers divided the patients into two age groups: 15% were younger than 40 years at the time of their diagnosis, and 85% were 40 years or older.
The researchers found only a small difference between the two groups in terms of recurrence of the cancer on the local level: 6% of those under 40 versus 5% of those aged 40 or above.
The same study found that the rate of regional recurrence was 2% for both groups.
What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer
In women who have breast-conserving treatment, the chance of recurrence is about 3%-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.
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Understanding Her2+ Status And Survival
Doctors use three markers to help define breast cancers and guide treatment. One of those is the HER2 protein. The other two are hormone receptors . When a cancer has none of these, doctors call it triple negative. Until recently, there wasnât much information about how these markers changed survival rates for breast cancer.
A recent study looked at the National Cancer Institute data to see if there were differences in survival for women based on these markers. The study shows there are. Overall, women who have HR+ and HER2- breast cancer do best. But in the later stages, those who have the HER2+ type have better survival rates than those with HER2-. Breast cancers that are triple negative have the lowest survival rates. The 4-year survival rates are as follows:
- HR+/HER2-: 92.5%
- HR-/HER2-: 77.0%
Supporting Someone With Breast Cancer
If youre reading this because theres a breast cancer survivor in your life, youre already being supportive.
Maybe you dont know what to say or fear saying the wrong thing. Say something anyway. Dont let breast cancer go unmentioned. The best thing you can do now is to be there and let them lead the way.
People with breast cancer may feel obligated to act with confidence and have a positive attitude. That may mask whats really going on. Let them know they can be real with you, then listen without judgment.
Offer to help in a concrete way. Can you prepare a meal? Do some chores? Share a movie night? Let them know what youre willing to do. But take them at their word. If they dont want help, dont push it. Just making the offer lets them know you care.
The end of treatment is not the end of the experience. There are many adjustments ahead. Some things may never return to the way they were, but change isnt always a bad thing.
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How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
Do I Need Cancer Screenings More Often Than Other People
You are probably having screenings to check for a recurrence of the first cancer. Your doctor can also tell you if you need to be screened for other cancers. You should get these on the schedule your doctor recommends. If you have a high risk of cancer, you might have screenings more often than other people. Tell your doctor as much as possible about your family history and past cancer treatment.
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Relative Survival Rates For Breast Cancer
The National Cancer Institute gives 5-year relative survival rates for breast cancer based on how far the disease had spread before a doctor found it.
- Localized : 99%
- Regional : 86%
- Distant : 28%
- Unknown stage: 55%
- All stages: 90%
While these numbers can give you a general idea, they are an average for women with any type of breast cancer. They arenât specific to the HER2+ type. They also come from data that researchers collected from 2010 to 2016, so they donât reflect more recent treatment advances.
Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
The following are the common treatment options for different types of stage 4 breast cancer.
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Receptors For Secondary Breast Cancer
Breast cancer cells may have receptors . Hormones, or a protein called HER2, can attach to the receptors and encourage the cells to grow. A doctor called a pathologist tests cancer cells taken during a biopsy or surgery for these receptors. Your doctor uses the results of these tests to help plan your treatment.
If you have had primary breast cancer before, the receptors may not be the same as when you were first diagnosed. This may mean different treatments are useful. Your doctor may be able to diagnose a secondary cancer from your scan results. But they may still recommend a biopsy to find out more about the cancer cell receptors.Cancer that does not have receptors for either hormones or HER2 is called triple negative breast cancer.
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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Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
Understanding Breast Cancer Survival Rates
Prognosis varies by stage of breast cancer.
Non-invasive and early-stage invasive breast cancers have a better prognosis than later stage cancers .
Breast cancer thats only in the breast and has not spread to the lymph nodes has a better prognosis than breast cancer thats spread to the lymph nodes.
The poorest prognosis is for metastatic breast cancer . This is when the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
Learn more about breast cancer treatment.
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Type Of Breast Cancer
The type of breast cancer can affect the recurrence rate.
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.