How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Recurrences Can Occur Far Beyond The 5
Unlike the common perception that people who have survived for five years are “cured,” we know that some breast cancers, particularly hormone receptor positive breast cancers, can recur many years and even decades later. In fact, estrogen receptor positive early breast cancers are more likely to recur five years to 10 years after diagnosis than in the first five years.
A 2017 study in JAMA looked at over 62,000 cisgender women with estrogen receptor positive breast cancer over a period of 20 years. The women all received endocrine therapy for five years and were free of cancer when they stopped their medication. Over the next 15 years a steady number of these women developed distant recurrences of their cancer.
There are algorithms that can be used to estimate the risk of recurrence of a breast cancer, but none of these take into account all of the nuances of an individual person.
Recurrences sometimes occur locally in the breast, or regionally in nearby lymph nodes, but far too often are distant recurrences recurrences that show up in distant regions of the body such as the bones, lungs, liver, brain, or other areas. Once a distant recurrence occurs, breast cancer is no longer considered “curable” and the median survival rate of stage 4 breast cancer is only three years with treatment.
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.
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Types Of Recurrent Cancer
There are three types of recurrent breast cancer:
Local recurrence: When cancer returns to the same part of the breast as the initial diagnosis, the disease is classified as a local recurrence.
Regional recurrence: This type is diagnosed when the breast cancer is found in nearby lymph nodes and/or the chest wall.
Distant recurrence: Also called metastatic breast cancer, this occurs when cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common metastatic areas include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast.
What Is Hormone Therapy
Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
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Be Mindful Of Your Environment Including Household Chemicals
It’s long been suspected that environmental exposures, including the chemicals we are exposed to in everything from household cleaners to cosmetics, may play a role both in breast cancer risk and recurrence. While it’s difficult to study , we are learning that practicing caution is wise.
A 2017 review looked at the evidence to date connecting breast cancer and the environment. Some compounds, such as PCBs , may raise the risk of recurrence. Others may alter the regulation of genes involved in cell growth, apoptosis , and much more. Endocrine disrupting chemicals can mimic the function of hormones in our bodies, and it’s well known that the hormone estrogen should be avoided to reduce breast cancer recurrence, at least for people with hormone positive tumors.
There is a great amount of information out there of varying degrees of concern, but the important thing to note is that it’s relatively easy to avoid concerning chemicals . Most household cleaners can easily be replaced with baking soda, lemon juice, and vinegar .
The environmental working group has a website where you can search on thousands of personal care products . And adding a few houseplants to your home can help to absorb many indoor air carcinogens with indoor air thought to be more of a concern that outdoor air pollution.
The Emerald Phase 3 Trial
The results from the international Phase III EMERALD clinical trial were released at the 2021 San Antonio Breast Cancer Symposium by Dr. Aditya Bardia and colleagues.8 The trial included participants with ER+/HER2- MBC who had experienced progression on 1 or 2 prior lines of endocrine therapy for metastatic disease. All patients had received a prior CDK 4/6 inhibitor with endocrine therapy. Only 22% had received prior chemotherapy . Patients were treated with Elecestrant 400mg daily or standard of care and directly compared
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When To Contact A Doctor
A person may wish to contact a doctor if they notice signs that their cancer has returned.
Since the cancer may have spread, a person should contact a doctor about any unusual symptoms throughout their body, not just their breasts.
When making an appointment, a person should be prepared to talk about any new symptoms they are experiencing. They may also want to be ready to discuss their history with cancer.
A doctor may want to ask questions, order tests, and perform a physical examination.
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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How Does The Brca1 Or Brca2 Gene Mutation Affect My Risk Of Breast Cancer Recurrence
Women with a BRCA1 or BRCA2 gene mutation and who have already been diagnosed with breast cancer, have a higher-than-average chance of new primary breast cancers than those without this genetic mutation. The chance of local or distant recurrence depends on the type and stage of the original breast cancer, and is no different from a non-BRCA-mutated breast cancer.
For women with a BRCA1 or BRCA2 gene mutation, the chance of a contralateral breast cancer, or cancer in the opposite breast to the original cancer, 10 years after diagnosis of the first cancer is about 10-30 percent compared to about 5-10 percent for women diagnosed with breast cancer who do not have a BRCA1 or BRCA2 gene mutation.
Women who have a BRCA1 or BRCA2 gene mutation and have received a breast cancer diagnosis, should talk to their treatment team about their options to reduce the risk of breast cancer recurrence.
Lumpectomy Plus Radiation Therapy And Local Breast Cancer Recurrence
For women who have lumpectomy plus radiation therapy, the chance of a local breast cancer recurrence in 10 years is about 3-15 percent .
The risk of local recurrence depends on tumor characteristics, including biomarkers .
It also depends on whether or not the tumor margins and the lymph nodes in the underarm area contain cancer cells. The chance of local recurrence is lower when :
- Tumor margins do not contain cancer
- Lymph nodes do not contain cancer
Chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies can lower the risk of breast cancer recurrence for people treated with lumpectomy plus radiation therapy .
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What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.
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.
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Lying In Wait: Dealing With Lingering Cancer Cells After Treatment
After treatment, remaining breast cancer cells can lie dormant for years before causing a recurrence. Researchers are investigating how to stop them.
VICKI SINGER WOLF hopes her diet and exercise will help prevent a cancer recurrence. – PHOTO BY KONNOR J. DURANTE
Thirteen years after undergoing a double mastectomy to treat a recurrence of breast cancer, Patti Aluise felt numbness in her lower right jaw. Figuring it was a tooth problem, she went to her dentist, who couldnt find anything wrong. Then, in March 2014, the numbness came back, and Aluise had shoulder pain, too. Visits to an oral surgeon and a neurologist yielded no answers aside from probably arthritis. That October, as the pain grew worse, Aluise made an appointment with a neurologist at Johns Hopkins Medicine in Baltimore, an easy drive from her home.
Im very pleased, Aluise says, adding that when its time to undergo scans to look for any recurrences, I still get scanxiety, but Ive been very lucky.
Even when breast cancer is caught early and successfully treated, all patients face some risk that their disease will return. Particularly in women with estrogen receptor -positive disease, a recurrence can happen even after two or three decades, and by then, the cancer has metastasized beyond its original site.
Oral Selective Estrogen Receptor Degrader
Elacestrant demonstrated a 30% improvement in survival duration without cancer progression and a 45% improvement in patients with mESR1 mutations. Overall, 22% of Elacestrant treated patients survived beyond 12 months after starting treatment compared to 9% of those treated with SOC. This was further improved in patients with the mESR1 mutation. Elacestrant was fairly well-tolerated with only 6% of patients discontinuing due to side effects. Gastrointestinal side effects including nausea, vomiting, decreased appetite, and constipation with the main concerns.
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Are There Reasons Not To Take One Of These Drugs To Help Reduce Breast Cancer Risk
All drugs have risks and side effects that must be discussed when making the decision about chemoprevention.
Most experts agree that tamoxifen and raloxifene should not be used to reduce breast cancer risk in women who:
- Have a higher risk of serious blood clots*
- Are pregnant or planning to become pregnant
- Are breastfeeding
- Are taking estrogen
- Are taking an aromatase inhibitor
- Are younger than 35 years old
*Women who have a higher risk of serious blood clots include those who have ever had serious blood clots . Many doctors also feel that if youve had a stroke or heart attack, or if you smoke, are obese, or have high blood pressure or diabetes, you also have a higher risk of serious blood clots. Women with any of these conditions should ask their doctors if the benefits of taking one of these drugs would outweigh the risks.
A woman who has been diagnosed with any type of uterine cancer or atypical hyperplasia of the uterus should not take tamoxifen to help lower breast cancer risk.
Raloxifene has not been tested in pre-menopausal women, so it should only be used if you have gone through menopause.
Aromatase inhibitors are not useful for pre-menopausal women, so they should only be used if you have gone through menopause. These drugs can cause bone thinning , so theyre not likely to be a good option in women who already have thin or weakened bones.
Talk with your doctor about your total health picture to make the best possible choice for you.
Breast Cancer Recurrence Risk Lingers Years After Treatment Ends
Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy.
Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.
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Standard treatment for estrogen receptor-positive, or ER-positive, breast cancer includes five years of the endocrine-based treatments tamoxifen or aromatase inhibitors, both of which are taken daily as a pill.
Researchers from the Early Breast Cancer Trialists Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.
Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.
Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere from years five to 20 remained constant, says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center.
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Libtayo Approved By The European Commission As The First Immunotherapy In Second Line Recurrent Or Metastatic Cervical Cancer Irrespective Of Pd
Approval based on a Phase 3 trial that demonstrated significant survival benefit in patients with recurrent or metastatic cervical cancer, with Libtayo reducing the risk of death by 31% compared to chemotherapy during the study
Libtayo now approved to treat four cancer types in the European Union
TARRYTOWN, N.Y., Nov. 22, 2022 /PRNewswire/ — Regeneron Pharmaceuticals, Inc. today announced that the European Commission approved Libtayo® as monotherapy for the treatment of adult patients with recurrent or metastatic cervical cancer and disease progression on or after platinum-based chemotherapy.
“Despite recent advancements in the prevention and treatment of cervical cancer, there remain limited options for people with recurrent or metastatic cases,” said Israel Lowy, M.D., Ph.D., Senior Vice President, Translational and Clinical Sciences, Oncology at Regeneron. “Libtayo was the first PD-1 inhibitor to demonstrate significant improvements in survival compared to chemotherapy in a Phase 3 trial. With this fourth approval from the European Commission, Libtayo can now be extended to appropriate patients in the European Union with advanced cervical cancer, irrespective of their PD-L1 status or histology.”
In addition to today’s approval, Libtayo is approved in the European Union for the treatment of certain patients with advanced basal cell carcinoma , advanced cutaneous squamous cell carcinoma and advanced non-small cell lung cancer .
Females who are able to become pregnant:
What’s The Risk Of Recurrence
Everyone who has had breast cancer has some risk of recurrence, but its typically low.
In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, its considered to be a significant milestone to be celebrated. Recurrence after that five year markrare, but possibleis called late recurrence.
Theres still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence:
- Having high blood sugar
- Not eating enough fruits and vegetables
- Having had a surgical site infection after your surgery
Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:
- A tumor of more than five centimeters across
- Cancer cells that are HER2-positive
- Cancer cells that are triple negative
- Cancer cells in four or more axillary lymph nodes at the time of surgery
- Cancer cells in the chest muscles or breast skin
You might be at higher risk for late recurrence if you had:
- A tumor of more than two centimeters
- A high number of affected lymph nodes
- A hormone receptor-positive cancer
- A HER2-negative cancer
- Hormone therapy for only a short time after surgery
Breast cancer treatment: The care you need is one call away
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