Treatment Starts With Hope
Sofia Merajver, M.D., Ph.D., medical oncologist and scientific director of the Rogel Cancer Centers breast oncology program, approaches each patients cancer individually and does not think predictions make sense until treatment begins.
Joses treatment plan included four rounds of chemotherapy, which reduced her 5-centimeter tumor to undetectable.
I wanted to immediately convey to Heather that wed have a long road together, including the medical center helping her family get through this challenge. Thats why I wanted to know about her husband and family members, says Merajver. In addition to giving her confidence that weve seen her disease before, a first step is to begin to recruit the social support the patient needs.
Because Joses cancer had spread, she knew not to expect to be cured. She had a double mastectomy, received radiation therapy and joined a clinical trial to receive two stem cell transplants. There have been several recurrences over the years, but each has been managed as treatment progresses for metastatic breast cancer.
The goal for me is to hear that my scans are stable. Stable means good, Jose says.
How Is Stage 4 Breast Cancer Treatedand Whats The Survival Rate
While every stage 4 breast cancer diagnosis is differentwhich means the methods used to treat it will also differthis stage of breast cancer is usually treated systemically , since the cancer has already spread to other areas of the body. Systemic treatments usually include options like hormone therapy, chemotherapy, targeted therapy, and immunotherapy, according to the NCI.
Still, those treatments vary depending on a variety of factors, including where the cancer is located, as well as the patientâs symptoms, overall health, and previous cancer treatmentsand patients are closely monitored throughout treatment for the best outcome. Patients are generally started on the treatment of best reflex or biology and followed closely using scans, with change in treatments as needed if the current treatment is not resulting and either shrinkage or stability of the breast cancer, Dr. Tripathy explains.
In addition to more standard systemic treatment options, Dr. Tripathy explains that there are newer technologies being increasingly usedlike ones that sequence the DNA of cancerous tumor cells for more specified treatmentsas well as various clinical trials designed to offer more options and possibly better outcomes to those dealing with the disease.
What Is Stage Ii Breast Cancer
Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.
Stage IIA is based on one of the following:
- Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
- A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.
Stage IIB is based on one of these criteria:
- A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
- A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.
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Mortality Rates Versus Number Of Breast Cancer Deaths
Sometimes its useful to have an estimate of the number of people expected to die from breast cancer in a year. This numbers helps show the burden of breast cancer in a group of people.
Numbers, however, can be hard to compare to each other. To compare mortality in different populations, we need to look at mortality rates rather than the number of breast cancer deaths.
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Myth #: If An Earlier
Ninety percent of MBC diagnoses occur in people who have already been treated for an earlier-stage breast cancer. Many people are under the impression that remaining cancer-free for five years means that a metastatic recurrence cant happen. However, distant recurrences can occur several years or even decades after initial diagnosis. Factors such as original tumor size and the number of lymph nodes involved can help predict the risk of recurrence.
For example, a 2017 survey of 88 studies involving nearly 63,000 women diagnosed with early-stage, hormone-receptor-positive breast cancer found that the risk of distant recurrence within 20 years ranged from 13% to 41%, depending on tumor size and lymph node involvement.
As KatyK of Idaho comments: that you are cured if you are cancer-free five years after initial diagnosis. I fell for that one myself. When I was diagnosed with MBC 12 years after initial diagnosis I was shocked. I thought I was cured, which to me means all better. Nope! Not even sure medically what cured means.
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Why People Are Getting Covid
Were seeing more reinfections now than during the first year of the pandemic, which is not necessarily surprising, Dr. Esper says.
The CDC says cases of COVID-19 reinfection remain rare but possible. And with statistics and recommendations changing so quickly and so frequently, that rare status could always change, as well.
Dr. Esper breaks down the reasons behind reinfection.
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How Quickly Do Breast Cancer Tumors Grow From Stage To Stage
Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.
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Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor, who is familiar with your situation, about how these numbers may apply to you.
Breast Cancer Subtypes Hormonal And Her2 Status And Survival Rates
Many research studies over the years have shown that Estrogen-positive breast cancers have better survival rates than all of the Estrogen-negative subtypes.
Progesterone-positive breast cancer also appears to have improved survival rates in comparison to progesterone-negative cases.
For ER+ sub-types survival rates were significantly better than all other subtypes. For example, at stage 1b,
ER+ PR+ HER2- 5-year survival rates were 98.6%ER+ PR- HER2+ 5-year survival rates were 97.3%
The subtype triple negative breast cancer had the worst survival rates over all three stages. At stage I the 5-year survival rate was 92.9% and at stage III 48.9%.
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How Is Stage 4 Breast Cancer Treated
The aim of treatment is to improve the quality and length of life of people with stage 4 breast cancer. Each person will be treated differently based on the disease characteristics and the intended goals of treatment.
Most treatments aim at decreasing the tumor burden and stabilizing the disease. In general, stage 4 cancer treatmentsalthough they may extend life in a significant number of peopleare considered palliative . This is because only a handful of people treated at this stage are cured of their disease.
Breast Cancer Survival By Age
Five-year survival for female breast cancer shows an unusual pattern with age: survival gradually increases from 85% in women aged 15-39 and peaks at 92% in 60-69 year olds survival falls thereafter, reaching its lowest point of 70% in 80-99 year-olds for patients diagnosed with breast cancer in England during 2009-2013.
Breast Cancer , Five-Year Net Survival by Age, Women, England, 2009-2013
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
What Are The Symptoms Of Breast Cancer Recurrence
You may experience different signs of breast cancer recurrence depending on where the cancer forms.
Local breast cancer recurrence may cause:
- Breast lump or bumps on or under the chest.
- Nipple changes, such as flattening or nipple discharge.
- Swollen skin or skin that pulls near the lumpectomy site.
- Thickening on or near the surgical scar.
- Unusually firm breast tissue.
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Age And Stage For Breast Cancer Prognosis
Stage 1 Breast Cancer: The highest survival rates for stage I breast cancer tends to be for women aged 50 to 69 years. Women under 39 have the poorest overall survival rates for stages I and II breast cancers.
Stage II, III and IV Breast Cancers: Women between the ages of 40 and 49 showed the highest survival rates for more advanced breast cancers. Conversely, as we have seen, women over 70 years showed the lowest survival rates for Stages III and IV breast cancer.
What Does It Mean To Have Stage 4 Breast Cancer
Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver.
Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.
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Myth #: Metastatic Breast Cancer Requires More Aggressive Treatment Than Earlier
Related to myth #3 is the notion that because MBC is advanced cancer, doctors have to pull out all the stops to fight it. But thats actually not the case, says Breastcancer.org professional advisory board member Sameer Gupta, MD, a medical oncologist at Bryn Mawr Hospital in Bryn Mawr, Pa., and a clinical assistant professor of medicine at Jefferson Medical College in Philadelphia. The goal is control rather than cure. Think of it as a marathon vs. a 50-yard dash.
Doctors treat earlier-stage breast cancer more aggressively because the goal is to cure it: destroy all of the cancer cells and leave none behind, reducing the risk of recurrence as much as possible. With MBC, the goal is control so that patients can live well for as long as possible. And chemotherapy isnt necessarily the mainstay of treatment.
DivineMrsM of Ohio shares her experience: eople in general think we should be hooked up to a chemo IV and looking sickly. When I told one woman I took a daily anti-estrogen pill to combat MBC, she looked at me with pity and sadness like I had no clue what I was talking about. Or that I was making up that I had advanced breast cancer, perhaps as a sympathy ploy or for attention. She even asked, Arent you on chemo? And I worked with this woman for a number of years, she was not a stranger!
Discussion On The Figures And Bar Graphs
As we can see outlook for breast cancer according to stage has improved immensely since these statistics first started appearing on the internet.
The estimated 5 year survival rates from Dr. Halls early data for Stage I was only 85%. By 2002 this figure has risen to 88% and for 2012 almost a 100% survival rate.
For Stage II the outlook is also much improved. From the 2002 data the survival rate was between 74% and 81%. Again by the latest data the relative percentage survival rate is 93%.
Furthermore Stage III in 2002 had a percentage survival rate of 41% to 49%. However, the 2012 data shows that this percentage has risen to 72%
Sadly, the survival percentage for stage IV breast cancer remains fairly low. 15% 5-year survival rate in 2002 to 22% 5-year relative survival rate in 2012.
NOTE: Just a word of caution on statistics. The first two graphs are percentage survival rates. So, if the figure is, for example, 93% for Stage II breast cancer, this means that 93 out of 100 patients with a Stage II diagnosis will be alive 5 years later.
On the other hand, relative survival rates in the lower table, compares breast cancer sufferers with the general population. So, if the relative survival rate for Stage II breast cancer is 93% this means that people with that diagnosis are 93% as likely to be alive 5 years later as the general population with similar life factors.
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Coping With Advanced Breast Cancer
Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.
There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:
Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.
When Is Radiation Usually Used To Treat Stage 2 Breast Cancer
According to the American Cancer Society, radiation therapy may be used after lumpectomy to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.
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What Are Cancer Survival Statistics
A key part of making a prognosis is looking at survival rates. These are numbers researchers collect over many years in people with the same type of cancer. These numbers are based on large groups of people. For breast cancer, there are two main measurements:
Breast cancer survivalrates reflect the percentage of women who are alive 5 years or longer after their diagnosis. This means the numbers are based on women who were found to have breast cancer at least 5 years ago. Advances in diagnosing and treating cancer have led to steadily improving survival rates, so the outlook for women diagnosed today is likely better.
Relative survival rates dont take into account the cause of death. Theyre a measure of the percentage of people with cancer who have lived for a certain time after diagnosis, compared with people who did not have cancer.
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Should I Have Scans Or Blood Tests To Check For Breast Cancer
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated with scans regularly. The frequency is often annually but is best discussed with your specialist.
Current guidelines and evidence 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. These tests have not been shown to improve outcomes and cause unnecessary scanxiety. 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 Affects Survival
Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.
The type of cancer and grade of the cancer cells can also affect your survival. Grade means how abnormal the cells look under the microscope.
Your general health and fitness also affect survival, the fitter you are, the better you may be able to cope with your cancer and treatment.
Another factor that can affect survival is whether the cancer cells have receptors for particular cancer drugs.