Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.
What Are Breast Cancer Subtypes And Why Do They Matter
Your breast cancer subtype is one factor healthcare providers take into account when theyre deciding how to treat your cancer. Thats because not all cancer treatments are successful with all breast cancer subtypes.
Providers look at your cancer cells to identify subtypes. Specifically, they look for molecules on your cells surfaces. These molecules, called receptors, are built to order so only certain substances can climb on and start affecting what your cells do.
Breast cancer cells receptors are open to estrogen and progesterone. Understanding if your breast cancer cells have receptors and if theyre housing hormones helps providers determine how your breast cancer might spread and what treatment might be most effective.
The other type of breast cancer that has another receptor is called her-2 neu. This receptor makes the cells more active, but allows healthcare providers to treat the cancer with specific medicines that target her-2 proteins. If your breast cancer doesnt have her-2 neu and hormone receptors, its called triple negative.
Intake Of Processed Food/diet
According to the WHO, processed foods, such as meat, are confirmed group-1 carcinogen for gastrointestinal cancer and breast malignancy . The excessive use of saturated fats is also considered a carcinogen. The obesity-causing ultra-processed diet plans that are enriched in elements such as sugar, sodium, and fats are thought to be carcinogenic and increase the risk by 11% . Diets that are rich in green vegetables, fresh fruits, protein-enriched grains, and legumes are anti-carcinogenic and therefore reduce the risk of breast cancer . Similarly, diets rich in phyto-estrogen, folate elements, saturated fibers, n-3 PUFA, and vitamin D are regarded as anti-cancer agents . Hence, a low dose consumption of saturated fat and n-6 PUFA has been proposed . The antioxidants found in green tea have also shown anti-carcinogenic properties . Curcuminoids and sulforaphane derived from turmeric are thought to be anti-carcinogens .
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Why Receptor Status Matters
Breast cancer is not a single disease, and researchers now have the ability to break down breast cancer into different subtypes based on the receptor status of the tumors. Among the variations between different types of breast cancers are the proteins found on cell surfaces, which are involved tumor growth. These proteins are related to the genetic material of cancer cells.
For example, with estrogen receptor-positive breast cancer, estrogen binds to specific receptors on breast cancer cells, stimulating proliferation. Similarly, HER2 receptors on the surface of breast cancer cells are stimulated by HER2 protein, promoting the growth and spread of breast cancer.
Its important to note, however, that all breast cellsboth cancerous and noncanceroushave HER2 receptors on their surfaces. The difference is that HER2-positive breast cancer cells have 40 to 100 times more receptors than HER2-negative breast cancer cells or normal breast cells. In positive cases, the abundance of receptors fuels the cancer.
Breast Cancer Discussion Guide
Get our printable guide for your next healthcare providers appointment to help you ask the right questions.
Survival Rates By Stage
Breast cancer survival rates compare the number of women with breast cancer to the number of women in the overall population to estimate the amount of time women with breast cancer are likely to live after theyre diagnosed.
For example, if the survival rate for a stage of breast cancer during a 5-year period is 90 percent, it means that women diagnosed with that cancer are 90 percent as likely to survive for 5 years following their diagnosis as women who do not have the cancer.
As we mentioned earlier, survival rates are based on information from the SEER database, which the NCI maintains.
SEER does not group breast cancers by stages 0 through 4. Instead, it groups them by the following stages:
- localized: when the cancer has not spread outside of the breast
- regional: when its spread outside the breast to nearby structures or lymph nodes
- distant: when its spread to other parts of the body, such as the liver, lungs, or bones
It should be noted that theres a substantial racial disparity gap in survival rates between white women and Women of Color, especially for late-stage breast cancer diagnoses. The chart below, courtesy of the
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Am I Still At Risk Of Breast Cancer Recurrence If I Have Had A Mastectomy
Yes. You are still at risk of breast cancer recurrence if you have had a bilateral mastectomy . Undergoing a bilateral mastectomy drastically reduces your chances of local or contralateral breast cancer recurrence as almost all of the breast tissue has been removed. However, there is still a chance that residual breast tissue or cancer cells could recur on the chest wall.
If you have had a single mastectomy , you are still at risk of developing cancer in the breast that remains.
It must be noted that having a mastectomy or bi-lateral mastectomy does not reduce your risk of developing cancer in other parts of your body .
Risk Of Recurrence: Early And Late
Research has shown the HER2-positive early breast cancers are two to five times more likely to recur than HER2-negative tumors. Even very small HER2-positive tumors with negative lymph nodes have a much higher risk of recurrence relative to tumors that are HER2-negative. Treatment with Herceptin can cut this risk by half.
The pattern of breast cancer recurrence may also differ. Small tumors are also more likely to have a metastatic recurrence if they are HER2-positive.
Despite the fact that HER2-positive and estrogen receptor-negative tuors are more likely to recur early on than estrogen receptor-positive and HER2-negative cancers, late recurrences are much less common.
With estrogen receptor positive breast cancers, the cancer is more likely to recur after five years than in the first five years, and the risk of recurrence remains steady each year for at least 20 years following the diagnosis. In contrast, those who have HER2 positive tumors and reach their five-year mark are much more likely to be âin the clearâ and remain recurrence free.
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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 Stages Of Breast Cancer
Breast cancer is staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade cancer and three is high grade cancer that grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site, with possible spread to the sentinel lymph nodes, which are the first lymph nodes the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
- Stage IV: The cancer has spread to distant parts of the body.
Another highly detailed classification system is the TNM classification system based on tumor size, lymph node involvement and metastatic spread.
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Relative Survival Rates For Breast Cancer
The National Cancer Institute gives 5-year relative survival rates for breast cancer based on how far the disease had spread before a doctor found it.
- Localized : 99%
- Unknown stage: 55%
- All stages: 90%
While these numbers can give you a general idea, they are an average for women with any type of breast cancer. They arenât specific to the HER2+ type. They also come from data that researchers collected from 2010 to 2016, so they donât reflect more recent treatment advances.
Immunohistochemical Evaluation Of Er Pgr And Her2 Status
Tumors were tested for estrogen receptor and progesterone receptor by enzyme immunoassay before 2001, by either EIA or immunohistochemistry in 200203, and by IHC from 2004 onwards. ER and PgR positivity was defined as a value greater than 10 fmol/mg protein before the autumn of 2009, and a value greater than 1 fmol/mg protein from then on. The subtype of HR positivity was defined as ER-positive and/or PgR-positive. HER2-positive status was defined as IHC staining for HER2 protein of 3+ intensity, or 2+ with the presence of amplification of the HER2 gene by fluorescence in situ hybridization . HER2-negative status was defined as IHC staining for HER2 protein of 01+ intensity, or 2+ with absence of amplification of the HER2 gene by FISH. The data of HER2 status before 2002 were not available for patients. It is because HER2 testing was approved in Japan in 2002, and this test was not performed routinely in clinical practice. We evaluated samples based on the guidelines for HER2 testing produced by the Pathological Committee for Optimal use of trastuzumab since 2001 , and the American Society of Clinical Oncology/College of American Pathologists guideline . Patients with a prior-history of trastuzumab therapy without histologically-proven HER2-positive status, were also defined as a clinically HER2-enriched subtype.
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Availability Of Data And Materials
The dataset analysed in the current study is not publicly available, but was obtained from the Cancer Registry of Norway under a specific ethical approval by the Regional Committee for Medical and Health Research Ethics in the South East Health Region of Norway. Researchers with appropriate approvals can apply for Norwegian health registry data from .
Recurrence Of Metastatic Breast Cancer
Metastatic breast cancer is considered a chronic disease, so it doesnt go away and recur.
But in recent years, people under age 50 have seen a particularly strong decline in death rates due to breast cancer, according to the Centers for Disease Control and Prevention .
These declines are due in part to improved screening and treatment for the disease.
There are a few general facts that are helpful to know about breast cancer outlook:
- Breast cancer is the most common cancer diagnosis in the United States, according to the
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What About Breast Cancer In Men
The stages of breast cancer relate to how much the cancer has grown and how far its spread. Generally, the earlier breast cancer is diagnosed and treated, the higher the chances for long-term survival.
|Stage 0||This is a precancerous stage with no invasive cancer cells.|
|Stage 1||The tumor is small and localized to the breast. There may be a small amount of cancer in nearby lymph nodes.|
|Stage 2||The tumor is still localized to the breast but is larger and may have spread to several nearby lymph nodes.|
|Stage 3||This stage includes cancers that have spread to the skin, chest wall, or multiple lymph nodes in or near the breast.|
|Stage 4||This is metastatic breast cancer, meaning its spread to one or more distant parts of the body, most commonly to the bones, lungs, or liver.|
The stages of breast cancer are based on the following factors:
- whether the lymph nodes contain cancer cells
- whether the cancer has metastasized, meaning its spread to other, more distant parts of the body
Since 2018, the following factors have also been used to determine breast cancer stage:
- whether the cancer cells have hormone receptors and need estrogen or progesterone to grow
- whether the cancer cells have the HER2 protein that helps them grow
- tumor grade, meaning how aggressive the cells look under the microscope
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.
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Trastuzumab Provides A Comparable Prognosis In Patients With Her2
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Background and Purpose: We investigated the locoregional effect of trastuzumab, and determined whether patients with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab could achieve comparable efficacy to that of patients with HER2-negative BC.
Materials and Methods: This was post hoc analyses of data of 793 BC patients from a randomized controlled trial comparing post-mastectomy hypofractionated radiotherapy with conventional fractionated radiotherapy. Survival rates were analyzed by the KaplanMeier method and compared by the log-rank test.
Results: Patients were classified into three groups: HER2-negative , HER2-positve with trastuzumab , and HER2-positive without trastuzumab . The HER2+ + T group had significantly lower locoregional recurrence , distant metastasis and higher disease-free survival at 5 years than that of the HER2+ T group . The HER2 group had significantly lower LRR , DM and higher DFS at 5 years than that of the HER2+ T group . The difference in LRR, DM and DFS at 5 years was not significant between the HER2+ + T group and HER2 group . Different annual LRR patterns was found among groups according to HR status.
Can Tnbc Be Prevented
Researchers dont know all the factors that cause triple negative breast cancer. They have identified the BRAC1 gene mutation as one potential cause for triple negative breast cancer. Unfortunately, you cant prevent BRAC1 because you inherit this gene mutation from your parents.
But there are steps that help prevent breast cancers, including TNBC:
- Maintain a healthy weight.
- Exercise on a regular basis.
- Know your family medical history.
- Monitor your breast health. Studies show 95% of women whose breast cancer was treated before it could spread were alive four years after diagnosis.
- Talk to your healthcare provider about genetic testing for the BRCA gene if you have a family history of breast cancer, ovarian cancer, pancreatic or prostate cancer. If you have the BRCA gene, there are steps you can take to prevent breast cancer.
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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.
Why Women May Choose Double Mastectomy
While a double mastectomy does not affect survival rates for most women with early stage breast cancer, some women are choosing to have the operation for peace of mind or because they feel they may have more symmetrical results from breast reconstruction surgery. However, a double mastectomy is a bigger procedure than a lumpectomy. It comes with a longer recovery and more chance of complications, though the complication rate is still low. Sometimes you can have breast reconstruction during the same operation as that to remove your breasts, but make sure you understand what is involved in breast reconstruction and how doctors can match a reconstructed breast to a natural breast.
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Treatment For Triple Negative Early Breast Cancer
Treatment for triple negative early breast cancer may involve:
- Immunotherapy provided through a clinical trial.
As triple negative breast cancer is usually very responsive to chemotherapy, your medical oncologist will most likely develop a chemotherapy treatment plan for you. This will take into account your own individual needs and preferences.
Chemotherapy for triple negative breast cancer is often given before surgery. This is called neoadjuvant chemotherapy. There are a number of benefits in having chemotherapy before surgery.
- You can see if the chemotherapy is working .
- You may be able to have breast conserving surgery instead of mastectomy if the tumour shrinks enough.
- It gives you time to have genetic testing done to determine if you have an inherited gene mutation if the test comes back positive it may affect your decision around what type of surgery to have.
Treatment for triple negative breast cancer may also include radiotherapy after surgery, especially if you have breast conserving surgery.
You may be offered immunotherapy treatment through a clinical trial, although there are strict eligibility criteria. You can talk to your medical oncologist about any clinical trials that may be suitable for you.