Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
Breast Cancer Surgery Options
Knowing your surgical options can help you face breast cancer head on
From the awkward excitement of putting on your first training bra to the profound tenderness of nursing your first baby, you have a deeply personal relationship with your breasts. But when women are diagnosed with breast cancer, that relationship is forever changed.
“Decisions about breast surgery can be very complicated and very emotional,” says Claudia Perez, DO, a breast surgeon at Rush. “It’s not just about cosmetics, it’s about your femininity and your sense of self.”
Surgery is considered the primary treatment for breast cancer the only women who may not typically have surgery are those who have metastatic breast cancer that has spread to places like the liver or bones.
However, breast cancer is unique compared to other cancers that are treated surgically because there are more surgical options for breast cancer. Your doctors will educate you about your options, and you will work together to make a shared decision about the best surgical option for you.
Making that decision with confidence starts with knowing what you’re up against and using that knowledge to make the best choice for yourself. These seven steps can help you get started.
Prompt Surgery Is Better
Because Im a surgeon Ill take a look at Bleicher et al first. This study looks at two large cancer databases, the Surveillance, Epidemiology, and End Results -Medicarelinked database and the National Cancer Database . The SEER-Medicare cohort included Medicare patients older than 65 years, and the NCDB cohort included patients cared for at Commission on Canceraccredited facilities throughout the United States. Analyses performed assessed overall survival as a function of time between diagnosis and surgery and evaluated five intervals . It also looked at disease-specific survival at 60 day intervals. The patient cohort included women diagnosed with invasive breast cancer that had not metastasized beyond axillary lymph nodes who were treated with surgery first. Patients with inflammatory breast cancer were excluded, which makes sense because inflammatory cancer is generally treated first with chemotherapy. The SEER-Medicare cohort included 94,544 patients 66 years or older diagnosed between 1992 and 2009, while the NCDB cohort included 115,970 patients 18 years or older diagnosed between 2003 and 2005.
The tale is told by this graph, from the SEER-Medicare cohort and the NCDB cohort :
You might wonder why there is less of an effect of treatment delay in stage III disease. So did the authors:
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A Vaccine May Be Helpful
Patients diagnosed with DCIS may one day get a vaccine to help reduce their risk of developing an invasive breast cancer in the future, according to a 2016 study published in Clinical Cancer Research.
More clinical trials are underway, but researchers hope that a vaccine may be able to stimulate the immune system and keep early DCIS from progressing beyond the milk duct. If trials are successful, experts say it could eventually be an alternative to surgery and radiation for some patients.
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Surgery For Breast Cancer Treatment
Surgery is the first treatment for most people with breast cancer.
The two main types of breast surgery are:
- breast-conserving surgery: the cancer is removed along with a margin of normal breast tissue
- mastectomy: removal of all the breast tissue including the nipple area
You can find out more about going into hospital for surgery in our booklet Your operation and recovery.
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Study Looks At How Many Women Die From Breast Cancer After A Dcis Diagnosis
DCIS is the most common form of non-invasive breast cancer and is considered stage 0 cancer. While DCIS isnt considered life threatening, it does increase the risk of developing invasive breast cancer later in life.
DCIS usually is found when a biopsy is done on a suspicious area found by a mammogram. As old cancer cells die off and pile up, tiny specks of calcium form within the broken-down cells. The mammogram will show the cancer cells inside the ducts as a cluster of these microcalcifications, which appear either as white specks or as a shadow. Most of the time, you dont feel DCIS as a lump. If the biopsy results find DCIS, doctors want to remove the whole area of concern to make sure the DCIS has been removed completely. Its most important to know if theres any evidence of invasive cancer.
DCIS usually is treated with surgery to remove the cancer in most cases a lumpectomy even though DCIS doesnt usually form a lump. After lumpectomy, many women have radiation therapy to the rest of the breast. Radiation reduces the risk of an invasive cancer and also helps reduce the risk of DCIS coming back . If the DCIS is hormone-receptor-positive , hormonal therapy also may be recommended after lumpectomy.
The study was published online on Aug. 20, 2015 by JAMA Oncology. Read Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ.
The researchers noted:
How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
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Lifestyle Also Plays A Role
Some risk factors for DCIS are modifiable. Eating lots of fruits and vegetables, maintaining a healthy weight, and limiting alcohol intake have all been linked to lower breast cancer rates, says Dr. Meyers, and they are smart habits to develop no matter what type of breast cancer you’re trying to avoid.
For women who have already had DCIS, cutting back on drinking may reduce their risk of a recurrence, according to a 2014 study in the journal Cancer, Epidemiology, Biomarkers & Prevention. “It is possible that alcohol consumption may increase risk of second breast cancer incidence,” the authors wrote in their paper, “but may not substantially increase the likelihood of aggressive second diagnoses that result in death, particularly among DCIS survivors.”
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.
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What Happens After The Local Breast Cancer Treatment
Following local breast cancer treatment, the 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 the surgeon, may advise the use of the drugs like tamoxifen or anastrozole 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.
After treatment for breast cancer, it is especially important for a woman to continue to do a monthly breast examination. Regular examinations will help you detect local recurrences. Early signs of recurrence can be noted in the incision area itself, the opposite breast, the axilla , or supraclavicular region .
Maintaining your follow-up schedule with your physician is also necessary so problems can be detected when treatment can be most effective. Your health care provider will also be able to answer any questions you may have about breast self-examination after the following procedures.
Can Cancer Form In Other Parts Of The Breast
Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:
- Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
- Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
- Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
- Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.
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Including The Study Results In Patient Counseling
Results from the new study should be incorporated into patient counseling, wrote Monica Morrow, M.D., a breast surgeon at Memorial Sloan Kettering Cancer Center, in an accompanying editorial.
The lower quality-of-life scores after mastectomy compared with breast-conserving therapy should be included in discussions about the merits of mastectomy versus breast-conserving therapy, Dr. Morrow added.
She pointed out that women with early-stage breast cancer have a low risk of developing cancer in the other breast. This information should be conveyed to patients along with the lack of survival benefit and higher risk of surgical complications with mastectomy, she wrote.
A surgeons recommendation against contralateral prophylactic mastectomy is a powerful deterrent against the use of the procedure, she wrote.
How To Prepare For A Breast Lump Removal
Prior to surgery, youll have several appointments with your doctor. These will include physical examinations and imaging with X-rays or mammography. The goal is to determine the size and shape of the tumor.
A few days before the surgery, youll meet with your surgeon. During this meeting, tell your surgeon about any allergies and medications you take, including over-the-counter drugs and supplements. You should also mention if youre pregnant or you think you may be pregnant.
Your doctor may advise you to stop taking any blood thinners up to a week before your surgery. This cuts down your risk of bleeding. Youll also need to fast and avoid drinking liquids for up to 8 to 12 hours before surgery.
Bring a list of questions you for your doctor. You may want to bring a friend or family member with you to take notes. It can also be helpful to bring someone with you on the day of your surgery. A companion can provide support, listen to any instructions after surgery, and give you a ride home. If no one is available to stay with you, talk to your doctor about alternative ways to get help.
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History Of Breast Cancer Or Breast Lumps
A person who has had breast cancer is more likely to develop it again than a person with no history of the disease.
Having some types of noncancerous breast lumps increases the risk of developing the cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.
People with a history of breast, ovarian, fallopian tube, or peritoneal cancer should ask their doctors about genetic testing.
How And When Should I Tell My Children
This is one of those answers that is tricky, depending on the ages of your children, but Newman offered this advice:
“In general it is best to be as honest with them as possible, because they are likely to sense and/or see that something major is happening, and it is important to provide them with reassurance that you are taking care of yourself,” she said. “Very young children may need to also be reassured that cancer is not contagious like the flu, and older children may actually feel empowered if they are allowed to help out and provide support during your treatment. All children need to understand that the cancer diagnosis was not anyones fault.”
Do you have a question about breast cancer? Contact the Susan G. Komen organization, which is the largest breast cancer organization in the world. Theyre trained to help you. Call 1-877-GO-KOMEN or 1-877-465-6636. Or email them at email@example.com. We’ll be covering breast cancer awareness all month long, check out this page for more stories.
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What Will The Doctor Do
Sometimes a doctor will discover a lump in a woman’s breast during a routine examination or a patient might come to the doctor with questions about a lump she found.
In other cases, a mammogram may find a lump in the breast that can’t be felt. A mammogram is a special kind of X-ray of the breast that helps doctors see what’s going on inside. Sometimes, other kinds of pictures, like an MRI, also can be taken.
When a lump is found, the doctor will want to test it. The best way to do this is usually with a biopsy. In a biopsy, a small amount of breast tissue is removed with a needle or during a small operation. Then, the tissue is examined under a microscope to look for cancer cells.
The biopsy may be benign , which means the lump is not cancer. If the biopsy shows cancer cells, the lump is malignant . If a breast lump does contains cancer cells, the woman, along with her doctor and family, will decide what to do next.
Getting Your Incision Wet
Keep your incision clean and dry for 1 week after surgery. You may need to take sponge baths rather than showers. Bathing in a bathtub is OK if you keep the incision area dry.
Small pieces of tape will remain over the incision. They usually fall off by themselves.
Donât go swimming until your doctor and surgeon say itâs OK.
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Breast Examination After Treatment For Breast Cancer
The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .
At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.
After breast reconstruction
Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.
After radiation therapy
After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.
What to do
What Tumor Factors Threaten My Life More
There are important tumor biology factors not well reflected in survival statistics by breast cancer stage. Below we list a few important factors that carry a higher risk to life beyond just the stage of cancer. You must ask your surgeon or medical oncologist to explain your receptor status and give you a copy of your biopsy pathology report.
Triple Negative Receptor breast cancer
Triple negative breast cancer is considered a more aggressive breast cancer. Invariably it does require chemotherapy. If you have triple negative breast cancer the risk of dying is higher than the standard statistics usually quoted for a particular stage of breast cancer . Learn more about Triple Negative Breast Cancer with our video lesson
HER2-Positive breast cancer
HER2-positive breast cancers are also more aggressive tumors. But the good news is that we now have incredibly effective, targeted chemotherapy and immunotherapy for HER2-positive cancers. Our video lesson covers HER2-Positive Breast Cancer in more detail .
Breast Cancer at a Young Age
Women younger than 40 have a higher chance of being diagnosed with a more advanced stage breast cancer. Also, the specific cancer type younger women develop has a higher chance of being more aggressive . As a result, age is a relative risk factor for survival.
Untreated breast cancer
Teaching everyone to be an expert in their own breast cancer care.
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