How To Reduce Your Risk Of Breast Cancer Recurrence: An Experts Guide
- How to Reduce Your Risk of Breast Cancer Recurrence: An Experts Guide
Most women treated for breast cancer have something else in common: they worry about the cancer coming back.
Michelle Shayne, M.D., a breast cancer specialist and genetics expert at the Wilmot Cancer Institute, recently spoke to a packed house at the Breast Cancer Coalition of Rochester on reducing the risk of recurrence. She covered a range of topics from exercise and diet to plastics and hair dyes and suggested that all survivors should read, ask questions and stay up to date on prevention strategies, even when the data is inconclusive.
We never want this to happen to us again, she told the audience.
Here are Shaynes key messages on each topic:
- THE ENVIRONMENT Studies show that 90 percent of breast cancers are environmental in origin, but the main environmental cause is unknown. The environment includes lifestyle , indoor and outdoor toxins, and consumer products and packaging. The good news: most people have some control over their environment and can learn how exposures might contribute to risk, Shayne says.
- AGE Risk of recurrence is more a function of tumor biology than age. By and large, younger patients tend to have more aggressive tumor types, Shayne says. And cancers in older patients tend to be more slow-growing. But there are many exceptions, she adds, and each patient must be treated according to her own risk factors, genetic profile and tumor characteristics.
What Factors Contribute To The Risk Of Breast Cancer Recurrence
Whilst it is never completely certain that breast cancer has been cured, there are many treatments available that reduce the risk of recurrence. There are a number of risk factors that can contribute to a breast cancer recurrence.
Your age at first diagnosis Younger women, particularly those who had their first diagnosis under the age of 35, have a greater risk of recurrence. This is because those diagnosed at a young age are more likely to have aggressive features in their breast cancer. Additionally women diagnosed with breast cancer before menopause have a greater risk of recurrence.
Tumour size Women who have a larger breast tumour have a greater risk of recurrence.
Lifestyle factors Lifestyle factors can influence the risk of recurrence. Excess weight is associated with a higher risk of postmenopausal breast cancer and is also associated with a higher risk of breast cancer recurrence and death. Smoking has also been shown to increase the risk of recurrence. Women who exercise regularly appear to have a lower rate of breast cancer recurrence.
Lymph node involvement If cancer is found in lymph nodes at the time of the original breast cancer diagnosis, there is an increased risk of breast cancer recurrence. This is the strongest prognostic factor, and the more nodes involved, the higher the risk of recurrence.
Cancer Beyond The Breast Area
A locally advanced recurrence means that the breast cancer has spread beyond the breast and the lymph nodes under the arm . This includes areas near to or around the breast but has not spread to other parts of the body.
A locally advanced cancer might come back in one or more of the following:
- the chest wall
- lymph nodes under the breastbone or between the ribs
- the nodes above the collarbone
- lymph nodes around the neck
Symptoms can include, changes in the breast, and swelling in the lymph nodes above and below the collarbone, the neck, and around the breast bone.
The tests you might have are usually the same as for checking for a local recurrence.
Do speak to your nurse or doctor if you notice any of these changes.
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Supplements That Help Prevent Cancer Recurrence
Lise N. Alschuler, ND, board-certified naturopathic oncologist in practice at Naturopathic Specialists in Scottsdale, Arizona. A breast cancer survivor, she is coauthor of The Definitive Guide to Thriving After Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health and cocreator of FiveToThrivePlan.com, a Web site about integrative cancer care. Dr. Alschuler also is a past president of the American Association of Naturopathic Physicians, a founding board member of the Oncology Association of Naturopathic Physicians, and former medical director of the Bastyr University Natural Health Clinic. DrLise.net
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- Boosting immune system function.
- Supporting digestion and detoxification.
- Reducing stress-induced hormone imbalances.
Although dietary supplements are available over-the-counter, before you start taking them, it is essential to check with a naturopathic doctor or an integrative medical doctor with specific expertise in integrative cancer care. These providers have training in nutritional biochemistry as it relates to cancer. They can confirm that the following supplements are appropriate for you and determine the dosages and the specific brands that will best suit your needs.
The top five cancer fighters include
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.
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Find Out Your Family History
Women with a strong family history of cancer can take special steps to protect themselves, so its important for women to know their family history. You may be at high risk of breast cancer if you have a mother or sister who developed breast or ovarian cancer or if you have multiplefamily members who developed breast, ovarian or prostate cancer. A doctor or genetic counselor can help you understand your family history of the disease.
Breast Cancer Recurrence Risk Lingers Years After Treatment Ends
Steady rates of recurrence in women with estrogen receptor-positive disease could influence decisions about long-term therapy.
Even 20 years after a diagnosis, women with a type of breast cancer fueled by estrogen still face a substantial risk of cancer returning or spreading, according to a new analysis from an international team of investigators published in the New England Journal of Medicine.
Standard treatment for estrogen receptor-positive, or ER-positive, breast cancer includes five years of the endocrine-based treatments tamoxifen or aromatase inhibitors, both of which are taken daily as a pill.
Researchers from the Early Breast Cancer Trialists Collaborative Group analyzed data from 88 clinical trials involving 62,923 women with ER-positive breast cancer. The patients all received endocrine therapy for five years and were free of cancer when they stopped therapy.
Over the next 15 years, however, a steady number of these women saw their cancer spread throughout the body, as late as 20 years after the initial diagnosis.
Even though these women remained free of recurrence in the first five years, the risk of having their cancer recur elsewhere from years five to 20 remained constant, says senior study author Daniel F. Hayes, M.D., Stuart B. Padnos Professor of Breast Cancer Research at the University of Michigan Rogel Cancer Center.
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Types Of Recurrent Cancer
There are three types of recurrent breast cancer:
Local recurrence: When cancer returns to the same part of the breast as the initial diagnosis, the disease is classified as a local recurrence.
Regional recurrence: This type is diagnosed when the breast cancer is found in nearby lymph nodes and/or the chest wall.
Distant recurrence: Also called metastatic breast cancer, this occurs when cancer cells travel away from the original tumor in the breast to other parts of the body through the lymphatic system or bloodstream. Common metastatic areas include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast.
Smoking And Breast Cancer Recurrence
There is emerging evidence that smoking may affect the risk of breast cancer recurrence but further research is needed to find out more.
We know smoking causes a range of health conditions. If you want to stop smoking there are a range of programmes to help. Speak to your pharmacist, GP or practice nurse for advice.
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How Long After Breast Cancer Treatment Do Recurrences Occur
The risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.
The late recurrence or relapse of breast cancer refers to cancers that come back after five years, but may not return for 10 years, 20 years, or even more. For people who have estrogen receptor-positive tumours, the cancer is actually more likely to recur after five years than in the first five years.
In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumours there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumours.
An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who dont understand this risk are often less likely to be supportive as you cope with the fear of recurrence.
- The long bones of the arms and legs
Symptoms and Detection
Getting Help And Support
You may find it helpful to talk to other people in the same situation if you are finding it hard to cope with the fact that you have had cancer. Or you could talk to a trained counsellor. This can help you to find ways of dealing with the fear and worry.
You can get in touch with a counsellor by contacting one of the counselling organisations.
You can phone the Cancer Research UK nurses if you would like to talk to someone outside your own friends and family. Talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
You can also look at our section about coping emotionally with cancer.
Or you can share your experiences with other people and find out how they coped by using our online forum, Cancer Chat.
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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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What This Means For You
If youve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.
If you were diagnosed with hormone receptor-positive, early-stage breast cancer, its likely that your doctor will recommend you take some type of hormonal therapy medicine either tamoxifen or an aromatase inhibitor depending on your menopausal status for five to 10 years after surgery.
Chemotherapy after surgery is usually completed in three to six months. If youre also receiving a targeted therapy, such as Herceptin , with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.
Radiation therapy after surgery can be completed in one to seven weeks.
So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either dont start taking the medicine or stop taking it early, in many cases because of side effects.
Learn more about Staying on Track With Treatment. You can read about why its so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.
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Combined Diet And Pa And Risk Of Breast Cancer Recurrence: Evidence From Clinical Trials
As obesity is a major risk factor breast cancer recurrence and morbidity in pre- and post-menopausal women , targeting reductions in body weight through combined diet and exercise interventions have been conducted. Three RCTs will be discussed, including the Exercise and Nutrition to Enhance Recovery and Good Health for You trial , a smaller yet pertinent RCT from Scott and colleagues , and an ongoing RCTthe Diet and Androgens -5 study .
The ENERGY trial is the largest weight loss intervention trial among breast cancer survivors to date . This multicenter trial included 692 overweight/obese women who were approximately 2 years from primary treatment for early-stage breast cancer. Women were randomized to either a group-based behavioral intervention with telephone counseling and newsletters to support weight loss or a less intensive control intervention including weight management resources and materials. The goal of the intervention was a 7 % weight loss in 2 years and included weekly 1-h group sessions for the first 4 months tapering to every other week for 2 months followed by monthly from month 6 onward. Dietary guidance promoted a reduction in energy intake of 5001000 kcal/day and a PA goal of an average of 60 min/day at a moderate intensity. Body weight was measured at 6, 12, 18, and 24 months.
Keep Up With Exercise
A recent study shows that if you regularly exercise even for at least 2.5 hours per week, you can improve your overall health. It may also lower the risk of your cancer coming back. Research also shows that if youâre overweight, cancer is more likely to come back. Physical activity can help you reduce or maintain your weight at a healthy range for your body type.
Exercise can include waking, running, cardio activities, strength training, and flexibility. Guidelines recommend:
- At least 150 minutes of moderate aerobic exercise per week or 75 minutes per week of harder physical activity like running.
- 2 days of muscle training with weights per week.
Thatâs a lot to do if youâre not active now. Take it one step at a time, starting with even a few minutes. Gradually, youâll be able to do more.
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Surviving Breast Cancer: 7 Ways To Keep It From Coming Back
Breast cancer is a terrible affliction that affects millions of Americans every year. When youre in recovery, it is important to take control of the variables and factors that lead to tumors and remission you are in control of the risks in your life. You CAN make a difference and prevent the return of further complications, if you live well and prioritize your health and wellbeing.
This article will provide you with seven changes you can make to your lifestyle that will protect you from cancer, repair cellular damage, and put you in the best position to remain as healthy as possible for as long as possible. Try these seven methods for improving your cancer recovery and preventing future episodes.
Breast Cancer May Return Even 20 Years Later Researchers Find
This means women with the most common type of breast cancer, called estrogen-positive or hormone-positive breast cancer, need to think carefully about whether they want to stop taking the pills, even if they cause side-effects, doctors said.
These breast cancers have a lingering smoldering quality and carry substantial risk of late recurrence after five years of therapy, said Dr. Harold Burstein of the Dana Farber Cancer Institute, who was not involved in the study.
Many patients think. OK, I made it to five years. I know Im safe, said Dr. Jennifer Litton, an oncologist at the MD Anderson Cancer Center. But for estrogen-receptor positive breast cancer, its a continued lifelong risk.
Breast cancer is the second-biggest cancer killer of American women, after lung cancer. The American Cancer Society says every year, it’s diagnosed in 200,000 women and a few men, and kills around 40,000.
Most breast cancers are fueled by estrogen, and drugs called hormone blockers are known to cut the risk of recurrence in such cases.
Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors sold as Arimidex, Femara, Aromasin and in generic form do the job with less risk of causing uterine cancer and other problems. The longer women take them, the lower their risk of having the cancer come back.
However, they do cause side-effects.