Check On Whether You Need Medications
After you complete your cancer treatment, if you have a high chance of your cancer returning, your doctor may prescribe you certain drugs to reduce your risk.
Tamoxifen and raloxifene are two such drugs. These drugs are approved for use in the U.S. and doctors usually prescribe them to lower the chances of estrogen-related breast cancer. Both drugs block estrogen hormone in breast cells. Studies show that they reduce your chances of getting breast cancer again by about 40%.
Tamoxifen. You take this once a day by mouth as a pill or liquid. It may make it less likely for you to get cancer in parts of your breast that werenât affected earlier. You may have side effects like hot flashes, vaginal discharge, irregular periods, loss of sexual interest, memory loss, fatigue, and joint pain.
Raloxifene. Itâs a pill you take once a day. Itâs usually given to women who are post-menopausal — those who stopped having their periods. It may also help you avoid or treat osteoporosis, when your bone density thins, putting you at risk of fractures.
While rare, these drugs can also cause blood clots in your leg veins or lungs. This can be a serious side effect that may need immediate medical attention. Contact your doctor as soon as possible if you think you have a blood clot.
Side effects can include vaginal discharge, muscle and joint pain, hot flashes, and night sweats. These drugs may also speed up osteoporosis and may raise your cholesterol.
Beyond The First 5 Years
The risk of breast cancer recurrence is highest during the first 2 years after the initial diagnosis. As time passes, the risk of recurrence steadily decreases. Many survivors celebrate their 5-year cancer-free date because it is well known that the vast majority of patients who have not had a recurrence by that time have a relatively low risk of recurrence at all.
A late recurrence of breast cancer is one that recurs after the 5-year milestone. Since the likelihood of recurrence is so low at this point, we must ask ourselves:
Who experiences a late recurrence?
What factors contribute to their risk?
Why do seemingly cured patients, like my mother, have to face their cancer again?
Doctors, scientists, and researchers have identified factors that are related to the potential risks for late recurrence of breast cancer. Generally, these factors relate to the patients age, the cancers stage at diagnosis, hormone receptor status, genetic information, and lymph node involvement. Overall, the risk of a recurrence after 5 years is low, but breast cancer survivors with a higher risk of late recurrence are:
Survivors with the following receptor statuses
Estrogen receptor-positive tumor
Tumor larger than 2 centimeters
High number of involved lymph nodes
Postmenopausal survivors who are younger than 60 and had
Tumor larger than 2 cm
High number of involved lymph nodes
Postmenopausal women who are older than 60 and had
High number of involved lymph nodes
Stage 3 Breast Cancer
What is Stage 3 breast cancer?
Stage 3 breast cancer is when tumors are larger than earlier stages or are growing into nearby tissues, and the cancer has spread to nearby lymph nodes. There are three categories of Stage 3 breast cancer:
- Stage 3A In some cases, Stage 3A breast cancer indicates that the cancer spread to four to nine area lymph nodes, and there may or may not be a tumor in the breast. In other cases, it can describe a cancer that has spread less but the tumor is larger than 5 centimeters.
- Stage 3B Stage 3B breast cancer can mean that the cancer has spread to the chest wall or to the breasts skin, causing swelling or an ulcer. It may also mean that cancer has spread to up to nine axillary lymph nodes or lymph nodes near the breast bone.
- Stage 3C Stage 3C breast cancer means the cancer may have spread to the chest wall or breasts skin, or it has spread to 10 or more nearby lymph nodes. It can also mean the cancer has also spread to lymph nodes above or below the collarbone.
What are the treatment options for Stage 3 breast cancer?
Stage 3 breast cancer treatment timeline
The treatment timeline for Stage 3 breast cancer depends greatly on the severity, extent of spreading, the type of treatment youre undergoing and how youre responding to those treatments. For most Stage 3 cases, treatment can last anywhere from six to 12 months with hormone therapy lasting many years after.
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Who Is At Risk Of Breast Cancer Recurrence
Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.
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.
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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.
Treatment Type And Breast Cancer Survival
One major decision you may face with early breast cancer is whether to have lumpectomy plus radiation therapy or mastectomy. They are equally effective in treating early breast cancer.
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.
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What Does Cancer Grade Mean
Breast cancers are given a grade according to:
- How different the cancer cells are to normal breast cells
- How quickly they are growing
The grade of a cancer is different to the cancer stage.
A cancers grade is determined when a doctor looks at the cancer cells under a microscope, using tissue from a biopsy or after breast cancer surgery.
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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Take Care Of Your Emotional Needs
A breast cancer diagnosis can take quite a toll on your body, both physically and mentally. The treatments can affect each person differently. And the uncertainty that comes along with breast cancer may also affect your self-worth, identity, and your confidence.
After treatment, managing your new normal and coming to terms with all that has happened may feel challenging. Itâs important to take the time to heal and prioritize your overall emotional and mental health, in addition to your physical health.
- Make some time for self-care and put your needs first.
- Talk to a professional counselor or therapist if fears of breast cancer coming back start to interfere with your daily life.
- Connect with other people whoâve had breast cancer to gain a sense of community.
- Follow news on new treatments or findings.
- Practice mindfulness to reduce stress. Yoga, meditation, and other relaxation techniques can help you center yourself.
- Pick up a hobby that youâve enjoyed before, or explore new ones.
- Journal your feelings.
Keep in mind that if breast cancer does come back, it is not your fault and it can often be treated.
Johns Hopkins Medicine: âReducing Risk of Recurrence,â âEndocrine Therapy for Premenopausal Women,â âEndocrine Therapy for Postmenopausal Women,â âBreast Cancer Recurrence.â
Cleveland Clinic: â3 Reasons to Quit Smoking After a Cancer Diagnosis.â
American Lung Association: âTop Tips for Quitting Smoking.â
Breast Cancer May Return Even 20 Years Later Researchers Find
This means women with the most common type of breast cancer, called estrogen-positive or hormone-positive breast cancer, need to think carefully about whether they want to stop taking the pills, even if they cause side-effects, doctors said.
These breast cancers have a lingering smoldering quality and carry substantial risk of late recurrence after five years of therapy, said Dr. Harold Burstein of the Dana Farber Cancer Institute, who was not involved in the study.
Many patients think. OK, I made it to five years. I know Im safe, said Dr. Jennifer Litton, an oncologist at the MD Anderson Cancer Center. But for estrogen-receptor positive breast cancer, its a continued lifelong risk.
Related: Breast Cancer Drug Can Also Prevent Cancer
Breast cancer is the second-biggest cancer killer of American women, after lung cancer. The American Cancer Society says every year, it’s diagnosed in 200,000 women and a few men, and kills around 40,000.
Most breast cancers are fueled by estrogen, and drugs called hormone blockers are known to cut the risk of recurrence in such cases.
Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors sold as Arimidex, Femara, Aromasin and in generic form do the job with less risk of causing uterine cancer and other problems. The longer women take them, the lower their risk of having the cancer come back.
However, they do cause side-effects.
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The Extrinsic Effect Of Targeted Therapy
Fig. 4: The effects of cell-extrinsic and cell-intrinsic determinants in dictating breast cancer outcomes.
Part I The journey of a breast cancer patient from the development of undetectable disease and its clinical discovery , through its surgical removal and adjuvant ET , to metastatic relapse and death . The presence of tumour lesions across the body is indicated by starsthe smaller referring to the clinically undetectable ones , the bigger ones to the clinically detectable ones . Part II The development of an HR+ breast tumour lesion in the breast , comprising a mixture of ER+/PR+ and ER/PR cells . DTC escape from the primary site can occur early and/or late during tumorigenesis , although the HR phenotype of DTCs at these stages is often unclear. Bones, lungs and liver are represented as common secondary sites for breast cancer metastases, albeit the sequential patterns of DTC spread among these organs are still elusive . Targeted treatment for HR+ breast cancer patients relies on adjuvant ET. Several mechanisms of ET resistance cytostasis, ESR1 mutations and HR function regulationcontribute to DTC outgrowth. DTC disseminated tumour cell, ER oestrogen receptor, ET endocrine therapy, HR hormone receptor, PR progesterone receptor. Figure created with BioRender.com.
How To Lower Your Risk Of Recurrence
There are things you can do to make it less likely that your breast cancer comes back. Some treatments and lifestyle choices have been shown to lower the risk.
Here are treatments that may lower your risk of recurrence:
- Bone-building drugs may cut your risk of cancer coming back in your bones.
- Chemotherapy. Research suggests people who have chemotherapy have a lower risk of recurrence.
- Hormone therapy. If you have receptor-positive breast cancer, hormone therapy after your first treatment may lower your risk of it coming back.
- Radiation therapy. Research suggests people who have radiation to treat inflammatory breast cancer or a large tumor have a lower risk of it returning.
- Targeted therapy. Drug treatments that target the protein HER2 may lower your risk if your cancer makes extra HER2 protein.
Lifestyle choices that help prevent a recurrence include:
- Eating healthy food like vegetables, fruits, and whole grains. Try to limit alcohol to no more than one drink a day.
- Getting regular exercise. Be active.
- Staying at a healthy weight
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How Is A Local Recurrence Or Metastasis Found
Breast cancer can recur at the original site . It can also return and spread to other parts of the body .
Local recurrence is usually found on a mammogram, during a physical exam by a health care provider or when you notice a change in or around the breast or underarm.
Metastasis is usually found when symptoms are reported to a provider.
If you have a local recurrence or metastasis, its not your fault. You did nothing to cause it.
Learn about follow-up care after breast cancer treatment.
Why Do Recurrences Happen And What Can Trigger Them
Sometimes cancer cells can survive treatment. These cells may eventually reproduce enough to form a new tumor. If they manage to reach the blood stream or lymph system, they can spread to distant organs and tissues.
There are so many factors involved that its not possible to pinpoint exactly why an individual has a recurrence. We do know that the majority of recurrences happen within the first . The risk never completely goes away, but it does steadily decline over time.
The main factors that can influence your chance of recurrence are:
- tumor size
Its likely that youll need a combination of therapies to treat a breast cancer recurrence. Treatment depends on many factors such as:
- breast cancer type
- how far and to where it has spread
- your earlier treatments
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How Often Does Stage 1 Breast Cancer Come Back After Treatment
If stage 1 cancer is treated comprehensively, it rarely comes back. A new, unrelated breast cancer is more likely to emerge after stage 1 breast cancer is treated than a recurrence. Your healthcare provider will recommend a surveillance schedule for you so that new breast cancer or a recurrence can be identified and treated as quickly as possible.
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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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.