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.
What Is The Staging Of Triple
Staging is the process of determining the extent of cancer and its spread in the body. Together with the type of cancer, staging helps determine the appropriate therapy and predict the chances for survival.
To determine if cancer has spread, medical professionals may use several different imaging techniques, including X-ray, CT scans, bone scans, and PET scans. Staging depends upon the size of a tumor and the extent to which it spread to lymph nodes or distant sites and organs in the body. Examination of lymph nodes removed at surgery and the results of ER, PR, and HER2 tests performed on the tumor tissue also help determine the stage of a tumor.
- The American Cancer Society defines 4 stages of breast cancer.
- Stage I is the lowest stage, while stage IV is the highest stage and refers to tumors that have metastasized, or spread to areas distant from the breast.
Most doctors specifically adjust breast cancer treatments to the type of cancer and the staging group.
Surgery
Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer consist of breast-conserving surgery and mastectomy .
Radiation therapy
Radiation therapy destroys cancer cells with high-energy rays. Doctors commonly administer radiation therapy to patients after breast cancer surgery, most commonly after lumpectomy.
Chemotherapy
Types of chemotherapy include the following:
Other therapies for triple-negative breast cancer
Stages Of Breast Cancer
The stage of breast cancer is based on the size and location of the tumor, as well as whether the cancer has spread beyond the part of the breast in which it originated. To determine the stage of breast cancer, healthcare professionals use a scale of stage 0 to stage 4.
Stage 0 breast cancers are isolated in one part of the breast, such as a duct or lobule, and show no sign of spreading into other tissue.
Stage 1 is typically localized, although further local growth or spread may cause the cancer to move into stage 2.
In stage 3, the cancer may be larger and has affected the lymph system. Stage 4 cancer has spread beyond the breast and nearby lymph nodes, and into other organs and tissues of the body.
In addition to stages, breast cancers are given grades based on the size, shape, and activity of the cells in the tumor. A higher-grade cancer means a greater percentage of cells look and act abnormal, or they no longer resemble normal, healthy cells.
On a scale of 1 to 3, with 3 being the most serious, TNBC is often labeled grade 3.
American Cancer Society , the symptoms of TNBC can be the same as those for other types of breast cancer. ACS recommends regular screenings such as mammograms to detect breast cancer before symptoms appear, the time when treatment is most effective.
Other signs of breast cancer include:
Any of these signs can be caused by other conditions. But it is always good to have them checked out by your healthcare professional.
- radiation therapy
- surgery
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What Is Tnbc And Who Is At Higher Risk
Estrogen receptors and progesterone receptors are important proteins that help determine the treatment that may be useful in breast cancer. These proteins are expressed on the surface of cells and are very important for medical oncologists not only for risk stratification but also to determine appropriate therapy. These proteins are absent in TNBC, making chemotherapy the most effective treatment of this subtype of breast cancer. Researchers have noted that younger, premenopausal, or African American women are at increased risk of developing TNBC, but the mechanism that causes this to occur is not yet understood.1 According to Breastcancer.org, TNBC accounts for 10% to 20% of all breast cancers. Risk factors for TNBC include being African American or Hispanic, being younger than 50 years, or harboring the BRCA1 mutation.2
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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What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
Extensive Clinical Research Is Underway For Triple
Because there isnt a set pathway for treatment for triple-negative breast cancer patients, a lot of research is underway to try to find the best treatments for these patients.
Exciting research and clinical research trials are available in the Willamette Valley area in an effort to find new and better ways to care for triple-negative breast cancer patients.
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Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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Can Breast Cancer Recurrence Happen After Mastectomy
Even though the whole breast is removed during a mastectomy, breast cancer can return to the chest region. This is known as local recurrence. It is also important to note that the more lymph nodes that were affected with cancer at the time of mastectomy, the higher the risk for having the cancer return. If the cancer returns, it is common to use radiation therapy to treat the cancer. Our doctors can help you determine the best options.
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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.
A Note About Statistics
Survival rates are statistics. As such, they tend to tell us how the average person will do with an average triple-negative breast cancer. But people and tumors arent statistics. Some people will do better, and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior, and there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
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What Questions Should I Ask My Doctor
You will have lots of questions about your cancer, starting with your diagnosis. Here are some basic questions you might ask:
- What is triple negative breast cancer?
- How do you know my cancer is triple negative breast cancer?
- Why did I get this cancer?
- Do I need genetic testing?
- Has my breast cancer spread, and if so, how far has it spread?
- What is the stage of my cancer?
- What is my prognosis or expected outcome?
- What treatments do you recommend?
- Why do you recommend those treatments?
- What are those treatment side effects?
- Will I need surgery? If so, what surgery do you recommend and why?
- Im interested in participating in clinical trials. Are you able to help me find one?
- Do you know if there are any local support groups?
A note from Cleveland Clinic
Triple negative breast cancer is one of the more challenging breast cancers to treat. You might be discouraged by what you have read about triple negative breast cancer. But there are a number of very effective treatments for triple negative breast cancer, including immunotherapy, chemotherapy, surgery and radiation. And every day researchers learn more about this rare cancer. Their knowledge is your power. If youre concerned you arent getting the straight story about your cancer, ask your healthcare provider to walk you through your diagnosis and treatment options.
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.
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I Wish I Had Treated My Feelings As Valid
I remember being so frustrated, sad, and angry after my surgery. My mom brought up the possibility of a revision surgery, and at the time, I told her no, I didnt want more surgeries. I hadnt even begun chemotherapy, and I was sick of cancer. I felt like I was supposed to feel lucky that the surgery was deemed successful, and that the cancer didnt seem to have spread to my lymph nodes.
I told myself now was not the time for vanity. What I couldnt quite understand was that mixed emotions were normal and okay. I could feel both happy and dissatisfied at the same time. Similar dichotomous emotions came up when I froze my eggs. I felt lucky to be given the opportunity to freeze them, but also so mad that I was forced to make a decision about the chance of future children.
The truth is, there is no right way to feel, and I wish I had stopped fighting how I felt. Everyone has different experiences, desires, and feelings. Each experience is unique, and each experience is valid.
I Wish I Had Taken Time To Understand What Mastectomy And Recovery Would Be Like
I went into my double-mastectomy with no idea what it was, what it would feel like post-surgery, or how long it would take to recover. Doctors said full recovery was six weeks, but I had told myself Id be back to work in four. Four weeks after surgery, I found myself still sleeping uncomfortably on the couch, lacking arm mobility, and not yet recovered from a surgery that was far more intricate than I had expected.
Had I chosen to allow myself to give cancer the air that was warranted, I would have asked questions and prepared myself to undergo such a major surgery. After my mastectomy, I learned that there are pillows that could have helped me sleep more comfortably, and that physical therapy could have eased my pain and increased my mobility.
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Treating Triple Negative Breast Cancer
Triple negative breast cancer can be treated with a combination of
Research has shown chemotherapy generally has a larger benefit for triple negative breast cancer compared to oestrogen receptor positive breast cancer. Chemotherapy for triple negative breast cancer is often given before surgery. The drugs used are likely to include carboplatin or cisplatin.
Some breast cancer treatments, such as hormone therapy and HER2 targeted therapies are of no benefit to people with triple negative breast cancer.
After 10 Years I Went Back To Where I Started
I was first diagnosed with breast cancer in 1999. I had a lumpectomy, followed by radiotherapy.
In 2009, I was told that I had a recurrence, and that the cancer had returned. It wasn’t a complete shock I always had a fear and a feeling that the cancer could come back.
Despite this, it still felt surreal that after 10 years I would be going back to where I had started.
I dealt with it by being as practical as possible. I’d learnt through my previous diagnosis how to process things logically, rather than emotionally. I wanted to know my treatment options, when we would start, what my prognosis was and how we were going to deal with it this time around.
Thinking practically about my recurrence made it so much easier to accept my diagnosis, not just for myself, but for those around me.
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Now Is The Time To Do Things I Love
Today I feel very lucky to have more time with my family and friends. I take every opportunity I can to go on holidays, to visit relatives and to travel to new places. Now is the time to do things I love, to learn a new skill and to travel the world. I am so thankful to have the chance to do everything I want to do.
From my experience and hearing the stories of others, I know that Breast Cancer Now makes an enormous difference to the lives of people affected by breast cancer. It’s so important that they continue to offer their life-changing services for a long time.
Because of this, I’ve left a legacy in my will for Breast Cancer Now. I hope that it will help give them the resources to help more people in the future, and provide the vital support for families, friends and individuals going through the difficulties of breast cancer.
To request a free guide to gifts in wills, please email , call us on 0333 20 70 300 or download a copy here.