When Can Metastatic Breast Cancer Occur
Most often, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer. This is sometimes called a distant recurrence.
Some people have metastatic breast cancer when they are first diagnosed . This is called de novo metastatic breast cancer.
Komen Perspectives
Is Tumour Dormancy The Sole Explanation For Recurrence
In pondering the mechanisms of metastatic relapse among breast cancer patients, one obvious question is whether early recurrence is simply the consequence of direct metastatic outgrowth, whereas late relapses reflect a period of tumour dormancy. To address this query, it is imperative to consider how long it takes for a single cancer cell to grow into a clinically detectable metastasis. Pioneering measurements of breast tumour volume doubling time carried out by radiographic analysis on more than 800 women concluded that it takes ~12 years on average for a single cell with a 10-µm diameter to reach a clinically detectable mass of 1cm,, and that metastases can have a TVDT up to twofold higher than their matched primary tumours. However, these initial analyses focused on a small number of samples, without taking into account the vast heterogeneity among breast tumours or the effect that adjuvant therapies might have on their growth rate, as the subjects in this study were untreated.
Fig. 3: The puzzling timing of metastatic relapse in breast cancer patients.
Examples Of Rates Versus Numbers
Say, town A has a population of 100,000 and town B has a population of 1,000. Over a year, say there are 100 breast cancer deaths in town A and 100 breast cancer deaths in town B.
The number of breast cancer deaths in each town is the same. However, many more people live in town A than live in town B. So, the mortality rates are quite different.
In town A, there were 10 breast cancer deaths among 100,000 people. This means the mortality rate was less than 1 percent .
In town B, the mortality rate was 10 percent .
Although the number of deaths was the same in town A and town B, the mortality rate was much higher in town B than in town A .
Lets look at another example. In 2021, its estimated among women there will be :
- 100 breast cancer deaths in Washington, D.C.
- 720 breast cancer deaths in Alabama
- 4,730 breast cancer deaths in California
Of the 3, California has the highest number of breast cancers. However, that doesnt mean it has the highest breast cancer rate. These numbers dont take into account the number of women who live in each state. Fewer women live in Alabama and Washington, D.C. than live in California.
Other factors may vary by state as well, such as the age and race/ethnicity of women. So, to compare breast cancer mortality rates, we need to look at mortality rates.
In 2021, the estimated mortality rates are :
- 26 per 100,000 women in Washington, D.C.
- 22 per 100,000 women in Alabama 22
- 19 per 100,000 women in California 20
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Can Exercise Help Reduce My Risk Of Developing Breast Cancer
Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.
The type of exercise you do can vary the main goal is get your heart rate up as you exercise. Its recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.
Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:
- Walking.
- Dancing.
- Hiking.
Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:
Will I Die Of Breast Cancer
This is a difficult question to answer early in your cancer care but it is still worth asking. Many people just diagnosed with cancer have no idea how much of a risk to their life their unique situation poses. Most breast cancers carry a low risk of recurrence, especially early-stage cancers. The answer is usually reassuring.
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Interactive Statistics With Seer*explorer
With SEER*Explorer, you can…
- Create custom graphs and tables
SEER*Explorer is an interactive website that provides easy access to a wide range of SEER cancer statistics. It provides detailed statistics for a cancer site by gender, race, calendar year, age, and for a selected number of cancer sites, by stage and histology.
Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
Metabolic markers
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Encouraging Statistics On Prognosis Of Metastatic Breast Cancer
In recent years, there have been some encouraging new statistics on the prognosis of metastatic breast cancer, these include:
- The statistics on survival rates show that women with breast cancer live longer today than ever before.
- In the past decade, the survival rate has substantially increased, due to an improvement in early diagnosis and screening, as well as improved targeted treatment.
- Survival rates are higher for women in higher economic groups
- The stage of cancer at the time of diagnosis plays an impactful role in prognosis, the highest survival rate begins for those who are five years post-treatment.
Breast Cancer Gene Mutation
Mutations in two separate genes for breast cancer have been identified. Fewer than 1% of women have these gene mutations. About 5 to 10% of women with breast cancer have one of these gene mutations. If a woman has one of these mutations, her lifetime risk of developing breast cancer is about 50 to 85%. The risk of developiing breast cancer by age 80 is about 72% with a BRCA1 mutation and about 69% with a BRCA2 mutation. However, if such a woman develops breast cancer, her chances of dying of breast cancer are not necessarily greater than those of any other woman with breast cancer.
These mutations are most common among Ashkenazi Jews.
Women likely to have one of these mutations are those who have at least two close, usually first-degree relatives who have had breast or ovarian cancer. For this reason, routine screening for these mutations does not appear necessary, except in women who have such a family history.
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Basic Information About Breast Cancer
Cancer is a disease in which cells in the body grow out of control. Except for skin cancer, breast cancer is the most common cancer in women in the United States. Deaths from breast cancer have declined over time, but breast cancer remains the second leading cause of cancer death among women overall and the leading cause of cancer death among Hispanic women.
Each year in the United States, about 255,000 cases of breast cancer are diagnosed in women and about 2,300 in men. About 42,000 women and 500 men in the U.S. die each year from breast cancer. Black women have a higher rate of death from breast cancer than White women.
How To Treat Breast Cancer
In early breast cancer, i.e. stage 1 and stage 2 the treatment is breast conservation surgery, i.e. removing the lump in the breast with little margin of normal tissue around it and removing the nodes in the axilla. The patient, however, needs to compulsorily take radiation after breast conservation surgery in addition to chemotherapy and/ or hormonal treatment if required. It is also possible to do oncoplastic breast reconstruction in breast conservation surgery. In stage 3 breast cancer, chemotherapy is given to shrink the disease to make it operable, and this is followed by adjuvant treatment. In stage 4, the aim of the treatment is usually palliation, i.e. to improve the quality of life of the patient and this can be achieved by chemotherapy and/ or hormonal treatment and /or radiation.
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Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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Differences By Race And Ethnicity
Some variations in breast cancer can be seen between racial and ethnic groups. For example,
- The median age of diagnosis is slightly younger for Black women compared to White women 63 years old).
- Black women have the highest death rate from breast cancer. This is thought to be partially because about 1 in 5 Black women with breast cancer have triple-negative breast cancer – more than any other racial/ethnic group.
- Black women have a higher chance of developing breast cancer before the age of 40 than White women.
- At every age, Black women are more likely to die from breast cancer than any other race or ethnic group.
- White and Asian/Pacific Islander women are more likely to be diagnosed with localized breast cancer than Black, Hispanic, and American Indian/Alaska Native women.
- Asian/Pacific Islanders have the lowest death rate from breast cancer.
- American Indian/Alaska Natives have the lowest rates of developing breast cancer.
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How Much Do Anastrozole And Exemestane Lower The Risk Of Breast Cancer
Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.
In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.
The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause .
Last reviewed by a Cleveland Clinic medical professional on 12/31/2018.
References
New Marker Could Detect Fatal Breast Cancer Up To One Year Earlier Than Current Methods
A new marker that could be used to diagnose fatal breast cancer up to one year ahead of current methods has been described in a study published in the open access journal Genome Medicine this week
A team of researchers led by University College London, UK found that a region of DNA called EFC#93 showed abnormal patterns of DNA methylation in breast cancer samples.
Importantly, these patterns are present in blood serum before the cancer becomes detectable in the breast.
Professor Martin Widschwendter, corresponding author of the study, said: “For the first time, our study provides evidence that serum DNA methylation markers such as EFC#93 provide a highly specific indicator that could diagnose fatal breast cancers up to one year in advance of current diagnosis. This may enable individualised treatment, which could even begin in the absence of radiological evidence in the breast.”
Professor Widschwendter added: “We found that the presence of EFC#93 DNA methylation in blood serum correctly identified 43% of women who went on to be diagnosed with fatal breast cancer within three to six months of giving serum samples, as well as 25% of women who went on to be diagnosed within six to twelve months of giving samples.”
DNA methylation is the addition of a methyl group to DNA, which often affects gene expression.
Aberrant DNA methylation is common in human tumours and methylation changes occur very early in breast cancer development.
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What Is Stage 1 Breast Cancer
This breast cancer is the earliest stage of invasive breast cancer. In stage 1, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.
Because a stage 1 tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.Stage 1 breast cancer is divided into two categories:
Stage 1A: The tumor measures 2 cm or smaller and has not spread outside the breast.
Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
At stage 1, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N0: Usually, cancer has not spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
Stage 1 breast cancer survival rate
The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.
Symptoms Of Metastatic Cancer
Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
- pain and fractures, when cancer has spread to the bone
- headache, seizures, or dizziness, when cancer has spread to the brain
- shortness of breath, when cancer has spread to the lung
- jaundice or swelling in the belly, when cancer has spread to the liver
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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.