Coping With Worries About Recurrence
Nearly everyone who has been treated for cancer worries about it coming back.
At first, every ache or pain can frighten you. But, as time passes, you may come to accept minor symptoms for what they are in most cases warning signs of a cold or flu or the result of over-exerting yourself.
Some events may be particularly stressful the days or weeks leading up to your check-ups, the discovery that a friend or relative has been diagnosed with cancer or the news that someone you met while having treatment is ill again or has died.
We all cope with such anxieties in our own way and there are no easy answers. But keeping quiet about them and not wanting to bother anyone is probably not the best approach.
Just as talking about your diagnosis and treatment may have helped you through the early days, talking about your fears relating to recurrence may help you later on.
Breast Cancer Nows Forum lets you share your worries with other people in a similar situation to you.
Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
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Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
Metastatic Breast Cancer Genetic Testing To Guide Treatment
The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . People who have an inherited mutation in one of these genes may have a PARP inhibitor drug included in their treatment plan .
As more is learned and breast cancer treatment becomes more personalized, inherited gene mutations may help guide other parts of breast cancer treatment, such as the use of other drug therapies.
Learn more about treatments for metastatic breast cancer.
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Genetics And Family History
Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.
Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.
Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.
Emerging treatments for breast cancer being studied in clinical trials include:
- PARP inhibitors that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
- Drugs that or prevent androgen production are being used and tested for TNBC.
If youre interested, ask your oncologist for information about available trials.
Breast Cancer Treatment: Beyond Surgery
Many women might undergo additional treatments before or after their breast surgery. Chemotherapy and radiation therapy are the most familiar to most patients, but another common treatment option is anti-hormone therapy.
This treatment targets the estrogen receptors commonly found in breast cancers. Anti-hormone drugs block these receptors to prevent the cancer cells from reproducing. Patients typically remain on the anti-hormone drugs for five years, but women with a higher risk of recurrence may take the medications for 10 years.
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Delay Between Breast Cancer Diagnosis & Surgery
The average interval from diagnosis to treatment in the study was 43 days. Ann Surg Onc, 2010. The impact of delays shorter than 90 days is questionable and there is no general consensus on what constitutes an acceptable delay after a diagnosis of breast cancer. There is a reported trend in the literature for an increasing time interval between …
The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
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Cost Of Genetic Testing To Learn About Inherited Gene Mutations Related To Breast Cancer Risk
If you are getting genetic testing to learn whether your breast cancer is related to an inherited gene mutation that increases breast cancer risk, check with your health insurance company to find out whether the costs of genetic counseling and genetic testing are covered in your plan.
Most insurance plans cover the cost of BRCA1, BRCA2 and other genetic testing if you meet the criteria for testing. Coverage of expanded panel testing varies from plan to plan.
The Affordable Care Act requires insurance plans that began on or after August 1, 2012 to cover genetic testing costs .
Genetic counseling is usually covered if you meet the criteria for testing or have a personal or family history of cancer.
Your health care provider or a genetic counselor can help you determine if your insurance will cover BRCA1/2 or panel testing.
Common Questions About What To Expect After Breast
Surgery is usually the first step in treating breast cancer in order to remove the tumor and any surrounding tissue that may be cancerous. Understandably, its a daunting situation for any woman to have to face, and one that brings up a lot of questions even after your care team has determined the kind of surgery thats most appropriate for you based on the
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Surgery For Early Breast Cancer
Some inherited gene mutations put you at a high risk of getting breast cancer in the opposite breast. This may affect your breast cancer surgery decisions. A health care provider may recommend a mastectomy instead of a lumpectomy. You may also consider a contralateral prophylactic mastectomy.
Contralateral prophylactic mastectomy is the removal of the opposite healthy breast in a woman diagnosed with breast cancer in one breast. Its usually done at the same time as breast cancer surgery.
Women with a high-risk mutation in one of these genes may consider contralateral prophylactic mastectomy to lower their risk of breast cancer in the opposite breast :
Learn more about inherited gene mutations.
Timely Breast Cancer Treatment Improves Survival
- Tags:Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Early-stage: Stage IIIA, Planning/Considering Chemotherapy, and Planning/Considering Surgery
Doctors recommend starting treatment as soon as possible after breast cancer is diagnosed. Timely treatment reduces the risk that the cancer will spread and increases the chances for survival. Still, sometimes women delay treatment for a number of reasons, including cost and scheduling. But if treatment is delayed too long it can affect survival.
Echoing results from earlier research, two studies have found that delaying surgery by 30 days and chemotherapy by 90 days can lead to worse survival.
The studies were published online on Dec. 10, 2015 by JAMA Oncology. Read the abstracts of:
Doctors call treatments given after surgery adjuvant treatments.
In the study looking at when women started chemotherapy, the researchers looked at the records of 24,843 women diagnosed with stage I to stage III breast cancer between 2005 and 2010 who were prescribed chemotherapy after surgery:
- 21% started chemotherapy 30 or fewer days after surgery
- 50% started chemotherapy 31 to 60 days after surgery
- 19.2% started chemotherapy 61 to 90 days after surgery
- 9.8% started chemotherapy 91 or more days after surgery
The researchers considered chemotherapy that started 91 or more days after surgery to be delayed treatment.
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Breast Cancer: Lymphedema After Treatment
Lymphedema is a problem that may occur after cancer surgery when lymph nodes are removed. Lymphedema can occur months or years after treatment. Its a chronic condition that has no cure. But steps can be taken to help keep it from starting, and to reduce or relieve symptoms. If left untreated, lymphedema can get worse.
You Have Plenty Of Time To Make Decisions
Making good decisions is the most difficult part of having breast cancer. You will feel pressed for time to learn everything and start your treatment as soon as possible. Time is usually on your side. You must work with your team to learn everything about your cancer and treatment options. We created the Breast Cancer School for Patients to quickly teach you to be your own expert in breast cancer. You will make better decisions being your own best advocate.
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Factors That Help Doctors Determine Optimal Treatment
After completing a breast biopsy and receiving your diagnosis, your doctor will order additional imaging and pathology tests to determine the size and characteristics of the cancer. These tests will establish the stage of your cancer and help guide treatment recommendations.
Breast cancer stages range from 0 to IV:
- Stage 0 Abnormal cells are located in the duct lining or sections of the breast. This is non-invasive cancer.
- Stage I Tumor is less than one inch in diameter.
- Stage II Tumor is between and 1 and 2 inches in diameter and may have spread to nearby lymph nodes.
- Stage III Tumor is larger than 2 inches and has spread to the auxiliary lymph node. You may experience dimpling, inflammation or color changes in the skin.
- Stage IV Cancerous cells have spread to other organs in the body.
Your physician will assign a cancer stage in combination with the Tumor, Node, Metastasis Classifications. In addition, as prognostic factor such as ER, PR and HER2 status will be included. These factors help to determine what is driving the cancer and play a large role in determining treatment recommendations.
The TNM staging system for breast cancer is an internationally accepted system used to determine the disease stage and is attached to the stage numbers.
- T The size and extent of invasion to nearby tissue
- N Whether the cancerous cells have spread to the surrounding lymph nodes
- M If it has spread to other organs in the body
Time To Treatment With Metastatic Breast Cancer
There is little research looking at the optimal time until treatment for metastatic breast cancer, though it appears that waiting more than 12 weeks has been linked with lower survival. In general, however, the goal of treatment with MBC is different than early stage disease. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. With MBC, the goal is often to use the least amount of treatment necessary to control the disease.
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Summary Of Surgery Timing
Though we don’t have a solid answer on how soon surgery should be done after a diagnosis of breast cancer , it would seem earlier surgery is ideal .
Delaying for a lengthy period of time can be dangerous, with studies finding that those who delay over six months are twice as likely to die from the disease. This is important to keep in mind for those who have breast lumps they are “observing” without a clear diagnosis. Any breast lump needs to be explained.
How Long You Can Wait To Be Treated For Breast Cancer
Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity. JAMA Surgery. 2013. 148:516-523. doi: 10.1001/jamasurg.2013.1680. Lee, S., Kim, Y., Han, W. et al. Tumor Growth of Invasive Breast Cancer During Wait Times for Surgery Assessed by Ultrasonography.
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Treatment For Stage 2 Breast Cancer
The most common for stage 2 breast cancer is surgery.
In most cases, treatment involves removing the cancer. The person may undergo a lumpectomy or mastectomy. The doctors and the individual can decide based on the size and location of the tumor. The surgeon may also remove one or more lymph nodes.
A doctor may recommend a combination of radiation therapy, chemotherapy, and hormone therapy to people with stage 2A or 2B breast cancer.
In some cases, a doctor may recommend neoadjuvant therapy, which is chemotherapy before surgery to reduce the size of a tumor.
are 3A, 3B, and 3C.
3A breast cancer is an invasive breast cancer where:
- There is no tumor in the breast, or a tumor of any size is growing alongside cancer found in four to nine axillary lymph nodes or the lymph nodes by the breastbone.
- A person has a tumor greater than 5 cm. They also have clusters of breast cancer cells in the lymph nodes that are between 0.22 mm in diameter.
- The tumor is larger than 5 cm. The cancer has also spread to one to three axillary lymph nodes or the lymph nodes near the breastbone.
Stage 3B breast cancer is invasive breast cancer where:
- A tumor of any size has spread into the chest wall or skin of the breast, causing swelling or an ulcer to develop.
- Cancer cells may also be present in to up to nine axillary lymph nodes.
- They may be present in lymph nodes by the breastbone.
About Breast Cancer Recurrence
During surgery to remove early-stage breast cancer, surgeons remove all the cancer they can see. In some cases, there may be individual cells circulating in the bloodstream or hiding in the bones or other places in the body. These cells may be inactive and not growing, or what doctors call dormant. But at some point in the future, the cells may start growing and cause a recurrence.
Doctors prescribe treatments after surgery such as hormonal therapy, chemotherapy, and targeted therapies to destroy any cancer cells left behind and reduce the risk of recurrence.
The risk of recurrence is unique to each person diagnosed with early-stage breast cancer and depends on a number of factors, including:
- cancer stage
- number of positive lymph nodes
- hormone receptor status
- HER2 status
- age at diagnosis
Doctors work very hard to estimate the risk of recurrence for each person. They use that estimate to tailor a treatment plan you can start after surgery to keep the risk of recurrence as low as it can be.
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Breast Cancer In Women
Breast Cancer Now: secondary breast cancer Surgery. There are 2 main types of breast cancer surgery: breast-conserving surgery, where the cancerous lump is removed mastectomy, where the whole breast is removed In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a breast.