Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
Moffitt Cancer Center Serves Her2 Positive Breast Cancer Survivors
Moffitt Cancer Centers Don & Erika Wallace Comprehensive Breast Program offers advanced monitoring, preventive treatments and supportive care services to women and men with a history of HER2 positive breast cancer, including those who were treated at other hospitals and cancer centers. We encourage you to consult with one of our oncologists specializing in breast cancer if you have any concerns about your risk of recurrence.
Medically reviewed by Dr. Hatem Soliman
Fill out a new patient registration form online or call to reserve an appointment with a Moffitt physician. We encourage women and men with or without referrals to visit us for regular cancer screening and expert breast health advice.
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Integrative Subtypes And Late Recurrence
Researchers recently developed a model to identify 11 integrative subtypes of breast cancer with different risks and timing of recurrence, according to the findings of a 2019 study published online in Nature.
Four integrative subtypes were identified that were associated with a high risk of late recurrence . Altogether, these four subtypes accounted for roughly 26% of breast cancers that were estrogen receptor-positive and HER2 negative.
These subtypes included tumors that had an enriched copy number alterations in genes that are thought to drive the growth of cancer , including:
They were also able to identify a subgroup of triple-negative tumors that were unlikely to recur after five years as well as a subgroup in which people continue to be at risk of late recurrence. A Breast Cancer Recurrence Calculator including integrative subtypes has been developed but, at the current time, this is meant for research purposes alone.
When Cancer Recurs After 5 Years
When cancer recurs at a distant site it is no longer early-stage breast cancer. The characteristics of cancer may change as well. Tumors that are initially estrogen receptor-positive may now be negative and vice versa . HER2 status can also change.
For this reason, and because there are now a number of alterations that can be targeted , it’s important for people to have a biopsy and genetic testing of their tumor .
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What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
Her2 Breast Cancer Treatment
Targeted therapy is the hallmark of treatment for HER2-positive cancer. The drug used most often is trastuzumab . Trastuzumab interferes with HER2 production and slows or prevents the cancer cells from growing. It is often administered with the chemotherapy agent emtansine in a combined drug called T-DM1.
Another medication, pertuzumab , is sometimes prescribed with trastuzumab when the cancer has spread to other parts of the body or metastasized. Oncologists also may prescribe an aromatase inhibitor, such as lapatinib or neratinib to lower estrogen levels.
If the cancer is also HR-positive, oncologists often prescribe endocrine therapy after the completion of targeted therapy. Endocrine or hormone therapy helps prevent cancer from returning by suppressing estrogen production. Tamoxifen is a common form of endocrine therapy used primarily in premenopausal women. It belongs to a class of drugs called selective estrogen receptor modulators .
Postmenopausal women have the option instead of taking an aromatase inhibitor , such as anastrozole , exemestane , or letrozole to block estrogen production. Postmenopausal women who have completed a tamoxifen regimen may be encouraged to follow up with an AI for added benefit.
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Four Steps To Avoid A Recurrence
Theres nothing you can do to guarantee that your cancer wont come back, but you can make some changes to help you feel your best after cancer treatment and keep your body stay strong.
Eat a balanced diet. Reach for a colorful mix of fruits and vegetables, good sources of fiber like beans and peas, and whole grains like whole wheat bread and brown rice every day. Avoid or limit drinks that are high in sugar and red or processed meat like beef, pork, hot dogs and sausages. You probably dont need to take vitamin or mineral supplements, unless your care team suggests them. In fact, taking more of certain vitamins or minerals than you need can have a negative effect on your cancer recovery, so be sure to discuss any supplements youre considering with your care team before taking them.
Exercise on most days of the week. Being active can improve your mood, boost self-esteem and reduce fatigue. Its even been shown to lower anxiety and depression and relieve nausea, pain and diarrhea.
Lean on a strong support system. Cancer might be all about the cellular changes in your body, but you know it certainly doesnt stop there. Taking care of your emotional health, whether it be cultivating a strong circle of friends and family as support or getting mental health services, can help you manage the stressors that cancer treatment and recovery can bring.
Receptor Status And Recurrence: Early And Late
In discussing receptor status and recurrence rates it’s important to note that no two tumors are the same, and breast cancerseven those with the same receptor statusare a heterogeneous group of tumors. That said, receptor status plays a significant role in when recurrences may occur.
With estrogen receptor-negative tumors , the risk of recurrence peaks at around two years post-diagnosis, and is relatively uncommon after five years.
Estrogen and/or progesterone receptor-positive tumors, in contrast, are more likely to recur more than five years post-diagnosis than in the first five years in people treated with hormonal therapy. That said, some hormone positive tumors are more likely to recur late than others.
With estrogen receptor-positive breast cancer , more than half of recurrences occur after five years.
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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.
Vaccine Derived From Her2 Protein May Help Prevent Breast Cancer Recurrence
A new breast cancer vaccine that is derived from the HER2 protein may help prevent recurrence in patients with HER2-positive disease and appears safe. Phase II study results of the vaccine were released at the 2014 Breast Cancer Symposium, September 46, in San Francisco.
The HER2 protein, also known as human epidermal growth factor receptor 2, is found on the surface of certain cancer cells, including breast cancer. In normal cells HER2 helps control cell growth. Cancer cells, however, can make too much of the protein, which can cause cells to grow more quickly and be more likely to spread to other parts of the body.
The HER2-derived vaccine, known as GP2, is designed to provoke the bodys immune system to fight cancer by recognizing tumor cells that express HER2. It is administered in addition to standard breast cancer treatment, such as Hercpetin® , with the goal of preventing recurrence.
Based on these findings, the GP2 vaccine appears promising in addition to standard therapy in women with HER2-positive breast cancer, as it might have the potential to safely and effectively prevent recurrences. The researchers also speculate that GP2 works with Herceptin in a specific way to stimulate immune response and that further research into this interaction is warranted.
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Modified Vaccination Measles Virus
A phase I trial is currently investigating the safety profile and optimal dose of the oncolytic virus MV-s-NAP in metastatic BC patients, irrespective of the biological subtype . MV-s-NAP has been engineered to have an extra gene that allows the virus to produce the Helicobacter pylori neutrophil-activating protein , which is normally expressed in inflammatory reactions. The expected enrolment of 33 participants, and the estimated completion date in August 2022.
How Is Breast Cancer Recurrence Managed Or Treated
Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.
Treatments for local and regional breast cancer recurrence may include:
- Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
- Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
- Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
- Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
- Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
- Targeted therapy: Treatments target specific cancer cell genes or proteins.
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Stage The Stage Is The Main Prognostic Factor For Breast Cancer There Is Less Risk That Early Stage Breast Cancer Will Come Back So It Has A More Favourable Prognosis Breast Cancer Diagnosed At A Later Stage Has A Greater Risk Of Recurrence So It Has A Less Favourable Prognosis Doctors Will Consider If Cancer Has Spread To Lymph Nodes And The Size Of The Tumour When They Predict A Prognosis
If cancer has spread to lymph nodes
Whether or not cancer has spread to lymph nodes is the most important prognostic factor for breast cancer. Breast cancer that has spread to lymph nodes has a higher risk of coming back and a less favourable prognosis than breast cancer that has not spread to the lymph nodes.
The number of lymph nodes that contain cancer is also important. The more positive lymph nodes there are, the higher the risk that breast cancer will come back. Breast cancer that has spread to 4 or more lymph nodes has the highest risk for recurrence.
The size of the tumour
The size of the tumour is the 2nd most important prognostic factor for breast cancer. The tumour size will affect prognosis no matter how many lymph nodes have cancer in them.
Breast tumours that are 5 cm or larger are more likely to come back after treatment than smaller tumours. Breast tumours that are smaller than 1 cm and have not spread to the lymph nodes have a very favourable prognosis.
What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0 or 1+, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
Triple-positive breast tumorsare HER2-, ER-, and PR-positive. These cancers are treated with hormone drugs as well as drugs that target HER2.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Revised: November 8, 2021
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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 For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .
This might be chemotherapy, hormone therapy or targeted therapy.
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.
Radiotherapy and surgery
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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Staging And Grading Of Breast Cancer
Knowing the stage and grade of the cancer helps your doctors plan the best treatment for you.
On this page
Your specialist doctor needs certain information about the cancer to advise you on the best treatment for you. This includes:
- the stage of the cancer
- the grade of the cancer
- whether the cancer has receptors for hormones or a protein called HER2.
This information comes from the results of all the tests you have had, including:
- the biopsy, when the tissue was examined
- other tests that were done on the cells.
Your specialist doctor and nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. Were here if you need someone to talk to. You can:
Metastatic Or Distant Recurrence
When breast cancer comes back in other areas of the body, it is called “metastatic.” Metastatic breast cancer is stage IV breast cancer.
The most common breast cancer metastasis sites are the bones, the lungs, the brain, and the liver. Symptoms can vary depending on the location, and can include bone pain, numbness or weakness anywhere in the body, constant dry cough, loss of appetite, severe headaches, vision problems, constant nausea, weight loss, seizures, loss of balance, or confusion.
Tests to diagnose a metastatic breast cancer recurrence include blood tests, X-ray, MRIs, CT scans, PET scans, bone scans, and biopsy.
For more detailed information about symptoms and treatment of metastatic breast cancer, whether the metastasis is a recurrence or a first-time diagnosis of breast cancer , visit Metastatic Breast Cancer Symptoms and Diagnosis.
The medical experts for Recurrent Breast Cancer are:
- Brian S. Wojciechowski, M.D., medical oncologist, Crozer-Keystone Health System, Philadelphia area, PA Breastcancer.org medical adviser
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What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
- the skin
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