Can Stage 0 Breast Cancer Come Back

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• GregP_WN

  Look at the search tool on the left side of the questions page, click on cancer, then patient, then breast cancer and click the search button, there are 236 people, on the site with stage 0, breast cancer. I tried to paste the URL here but it’s too long, the site won’t let me. Give it a try, you will see them.

What Is Stage 0 Dcis

Stage 0 breast cancer, ductal carcinoma in situ is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if its left untreated or undetected, it can spread into the surrounding breast tissue.

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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The Tnm System For Staging Breast Cancer

The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:

• T : The tumor grade shows a higher number for a larger size or density.
• N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
• M : This refers to how the cancer has spread beyond the breast and lymph nodes.

The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.

Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.

No matter the stage, the best source of information about your individual outlook is your own oncology team.

Make sure you understand your breast cancer stage and subtype so that you can better understand treatment options and individual outlook.

Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.

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Can I Lower My Risk Of Getting A Second Cancer

There’s no sure way to prevent all cancers, but there are steps you can take to lower your risk and stay as healthy as possible. Getting the recommended early detection tests, as mentioned above, is one way to do this.

Its also important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen after breast cancer.

To help maintain good health, breast cancer survivors should also:

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How Is Ductal Carcinoma In Situ Diagnosed

The sooner this type of cancer is found, the sooner it can be treated. The following tests or procedures are usually used to diagnose DCIS:

• Breast examination: A routine breast exam is usually part of a regular physical. It is the first step in detecting breast cancer. Although DCIS does not usually come with a noticeable lump, the doctor may be able to feel an abnormal growth in the breast, such as a small, hardened spot, during a physical examination. The doctor will also look for any skin changes, nipple changes or nipple discharge. Most times, though, the abnormal growth will show up on a mammogram.
• Mammogram: DCIS is usually found during a mammogram. As old cells die off and pile up within the milk duct, they leave tiny, hardened calcium spots which show up as a shadow or white spot on a mammogram.
• Biopsy: If a spot or a shadow is found on the mammogram, the doctor will recommend a biopsy.
• Core needle biopsy: With this procedure, the doctor inserts a large needle into the breast to get a big sample of the breast tissue that looked abnormal on the mammogram. The doctor will first numb the skin at the site of the biopsy and then make a small incision in the skin to help get the needle into the breast. Because the skin has been cut, there will be a tiny scar which will fade over time.

Biopsies are only used to diagnose that there is cancer within the breast. If cancer is found, surgery will be recommended to remove the abnormal cells.

What Type Of Follow

Each patient is different, and the doctor will work with each individual on a follow-up plan after surgery and radiation therapy. Typically, a patient can expect to see the doctor for a physical exam every six to 12 months for five years after treatment, then annually after that. An annual mammogram will also be recommended.

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What Every Physician Needs To Know:

Stage 0 breast cancer includes non-invasive breast cancer ductal carcinoma in situ , and lobular carcinoma in situ . Physicians should understand the following:

• Incidence and clinical significance of DCIS and LCIS.

• Pathologic findings of both DCIS and LCIS.

• Differences in management of DCIS versus LCIS.

Incidence of in situ cancer

In 2012, 63,300 new cases of in situ cancer will be diagnosed in the United States compared to the 229,060 cases of invasive cancer. Often when breast cancer statistics are quoted, these in situ cases are not included, despite the fact that they represent an increasing proportion of breast cancer cases. In the early 1980s, in situ cancer accounted for 3-4% of all breast cancers compared to 22% currently.

Most in situ cancers are DCIS. DCIS accounted for 83% of in situ cancers diagnosed between 2004-2008. The incidence of DCIS has been increasing over time. The DCIS rate increased about 2% per year between 1973 and 1982. From 1982 to 1988, the DCIS rate increased dramatically, about 28% per year, at the same time mammography screening was increasing. After this, the DCIS rate increased more slowly at about 6% per year.

Since 1999, incidence rates of in situ breast cancer stabilized among women over 50, but continue to increase in younger women. The stabilization in incidence among women over 50 years of age may correlate with trends in mammography screening, which peaked in 2000.

Difficult Decisions For Patients

Toro de Stefani is one of 60,000 U.S. women diagnosed with DCIS each year. Each must decide on a treatment option.

Current guidelines that recommend lumpectomy and radiation are causing concerns that the condition may be overtreated, since most cases never become invasive.

This gives medical professionals enormous uncertainty about how to advise women on an individual basis, says Thompson, professor of Surgery at MD Anderson. And therefore, historically the treatments have ranged from active surveillance on one end of the pectrum all the way to mastectomies on the other.

Thompson says DCIS diagnoses have increased as breast imaging has become more accurate and frequent. The National Institutes of Health estimates that by 2020, more than 1 million women in the U.S. will be living with a DCIS diagnosis, compared to 500,000 in 2005.

Before mammograms became common, many women had the condition for years without being aware of it, because it grows so slowly and causes no symptoms.

Perhaps, surprisingly, given that breast screening has been around for three or four decades, were only now really coming to grips with the fact that we often diagnose some conditions like DCIS as breast cancer even though theyre not conventional, invasive breast cancers, Thompson says.

Hes participating in three DCIS research studies that he hopes will make treatment decisions easier.

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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.

I Was Diagnosed With Dcis Stage 0 Breast Cancer

Im religious about getting my annual mammogram. Thats because I have a history of fibrocystic disease and in my 20s had a fibroadenoma removed from my right breast. Every year, I worry that something not so benign will show up and every year I sigh with relief when I get a letter saying everything is normal. Not this year. Instead, I got a phone call from the Mammography Department at Mercy Hospital. The radiologist wanted me to come back for additional views. My heart sank.

My husband Barry took time off from work so he could go with me. If there was any bad news to be delivered, I didnt want to hear it alone. Renee, the kind and wonderful mammography tech who had done my screening mammogram told me she was going to take some magnification views so they could look at an area in my right breast more closely.

After she was done, Barry and I were ushered into the viewing room to talk with the radiologist, who pointed out a sprinkling of tiny white dots near the middle of my mammogram and explained that they were microcalcifications. Some of them looked normal, but others could go either way. Either way? I tried to remain calm and stared at the image intently. You can look too. The picture at the beginning of this post is a copy of the magnified view.

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Signs That Dcis Is Likely To Become Invasive Breast Cancer

Bottom Line: New research shows when it may be safe to watch and wait.

Source:

Study titled Predictors of an Invasive Breast Cancer Recurrence after DCIS: A Systematic Review and Meta-Analyses by researchers at the Netherlands Cancer Institute, Amsterdam, published in Cancer Epidemiology, Biomarkers & Prevention.

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Mostductal carcinoma in situ breastcancer will never become life-threatening, even if left untreated. However,there hasnt been a good way to tell when DCIS should be treated and when treatment can be safely skippeduntilnow. A new study has identified six factors that determine when DCIS is mostlikely to become invasive breast cancer.

DCISis cancer that starts in a milk duct and has not spread outside the duct. Oftencalled stage 0, its such an early stage of cancer that some experts believeits actually a precancerous condition rather than actual cancer. DCIS has becomeincreasingly commonpossibly because women are living longer, more women aregetting screening mammograms, and mammograms have become better at findingthese small breast cancers. About 20% of all breast cancers are DCIS.

Mostwomen with DCIS have a lumpectomy, and some also have radiation. The risk forDCIS recurrence after lumpectomy alone is about 25% to 30%adding radiation therapydrops the risk to about 15%. Only half of recurrences are invasive cancertherest are DCIS again.

Date

Stage Iii Breast Cancer

In stage III, the cancer has spread farther in the breast, or the tumor is larger. This stage includes three subcategories:

Stage IIIA involves one of the following:

• Cancer is found in four to nine nearby lymph nodes, with or without a tumor in the breast.
• A breast tumor is larger than 50 mm, and the cancer has spread to between one and three nearby lymph nodes.

In stage IIIB, the tumor has spread to the chest wall behind the breast, and:

• Cancer may have spread to the skin, causing swelling or inflammation.
• Cancer may have broken through the skin, causing a wound.
• Cancer may have spread to as many as nine lymph nodes under the arm or nodes near the breastbone.

In stage IIIC, with or without a tumor in the breast, the cancer has spread to one of the following places:

• Ten or more underarm lymph nodes
• Lymph nodes near the collarbone
• Some underarm lymph nodes and lymph nodes near the breastbone
• The skin of the breast

In stage III, the patient may experience similar symptoms as stage II, listed earlier. The five-year survival rate for stage III breast cancer is 66% to 98%.

Note:

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Is Surgery The Right Decision For Women With Dcis

Women with ductal carcinoma in situ face the difficult decision of howto treat the condition. Researchers at MD Anderson are studying ways tomake this tough choice easier.

Ligia Toro de Stefani, Ph.D., had just retired from a busy academic medical research career when a mammogram revealed a suspicious mass in her right breast. Her doctors in Brownsville, Texas, referred her to MD Anderson, where she was diagnosed with ductal carcinoma in situ, or DCIS, often called stage 0 breast cancer the very earliest stage.

Toro and her husband, Enrico Stefani, M.D., Ph.D., researched everything they could about the condition before meeting with MD Anderson surgeon Alastair Thompson, M.D., to discuss treatment options.

Investigating came naturally to the scientific couple. Toro is an emeritus professor of anesthesiology and molecular and medical pharmacology at the University of California, Los Angeles. Her husband is a former director of UCLAs anesthesiology division of molecular medicine.

We started reading a lot of papers, not just Googling the disease, but doing a serious literature search, Toro de Stefani says.

DCIS is a cluster of cancer cells inside a milk duct. The cells are held in place by the ducts wall, but they have the ability to break through the wall. Thats when they become invasive.

That wont happen to everyone, Toro de Stefani says, but theres no predicting when cells will break through the duct and spread, and when they wont.

How Common Is Ductal Carcinoma In Situ

The American Cancer Society expects that 63,960 new cases of DCIS will be found in 2018. Today more and more women are aware of the importance of early detection and are getting mammograms each year. Because of this, the number of cases of DCIS has increased. In addition, mammography technology has greatly improved as well and is better able to detect problems at an earlier stage. An estimated 12.4% of women in the U.S. will develop invasive breast cancer at some time in their lives.

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Living With Stage : The Breast Cancer No One Understands

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Editors note: Were bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.

A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.

âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â

An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.

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How Treatment Can Impact Survival Of Early Stage Breast Cancer

In most cases, the earlier breast cancer is first diagnosed and treated, the better the chance of survival. Cancer cells often become more difficult to treat and may develop drug resistance once they spread. The aim of treatment for Stage 1 and 2 breast cancer is to remove the breast cancer, and any other cancer cells that remain in the breast, armpit or other parts of the body but cannot be detected. Having treatment at this stage can also reduce the risk of the cancer coming back.

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