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Is Breast Cancer Always Fatal

Who Is At Risk Of Breast Cancer Recurrence

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Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.

Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

  • Localized: There is no sign that the cancer has spread outside of the breast.
  • Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
  • Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.

Living With Secondary Breast Cancer

Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.

For many people, uncertainty can be the hardest part of living with secondary breast cancer.

Our information on living with secondary breast cancer addresses the emotional, practical and physical effects of a diagnosis.

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Cure Versus Progression Delay: Models

For the following hypothetical scenarios, we consider the basic model to recapitulate the survival experience of 45,647 ER-positive breast cancer patients diagnosed in the SEER database between 1990 and 1995 and then introduce two theoretical treatments. In this database, the actuarial 20-year breast cancer mortality was 72.4%. By simulation, we can evaluate how the effects of cytotoxic and cytostatic treatments are expected to influence the shape of the mortality curves. To illuminate the two models in terms of expected survival patterns, we have simulated cohorts of 91,294 women under the two scenarios.

Clinical Data Of Patients Who Underwent Early Treatment

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The baseline tumor characteristics are listed and compared between the luminal B group and the non-luminal group .1). The median age at diagnosis of the patients with luminal B breast cancer was 48 years , and the median age at diagnosis of patients with non-luminal breast cancer was 42 . Compared with non-luminal breast cancer patients with postoperative recurrence and metastasis, the average age at diagnosis of patients in the luminal group was greater, and the proportion of patients with postmenopausal status was higher. The difference between the groups was statistically significant . However, in regards to family history of breast cancer, pathological type, clinical stage, and axillary lymph node status, no differences were observed between the groups. An analysis of individuals with luminal B breast cancer showed that patients in this subgroup did not differ in terms of any of the clinical characteristics under investigation .

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What I Wish People Knew About Metastatic Breast Cancer

Women with metastatic breast cancer think about fighting cancer very differently than women who don’t have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.

The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.

While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.

Here are several things you should know about metastatic breast cancer and the women who are living with it.

Local Breast Cancer Recurrence

Local breast cancer recurrence is when the cancer has reoccurred close to or in the same place the first tumor was found within the breast. If you were treated with lumpectomy and radiation for your first occurrence, the breast tissue cannot be treated with radiation again. In that case, the standard of care for surgical treatment is mastectomy.

If radiation was not part of your original treatment when lumpectomy was performed, then another lumpectomy followed by radiation may be recommended. If there is not adequate breast volume remaining for lumpectomy, mastectomy may be recommended. Depending on the medical oncologists evaluation, which is based on the prognostic factors of the tumor, he or she may recommend chemotherapy and/or hormonal therapy.

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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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What Is The Staging For Invasive Ductal Carcinoma

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Staging refers to the extent of a cancer. A cancer is always referred to by the stage it was determined to be at diagnosis, even if it spreads.

Stages of invasive ductal carcinoma include:

  • Stage I: Breast tumor is smaller than 2 centimeters in diameter and the cancer has not spread beyond the breast
  • Stage II: Breast tumor measures 2 to 4 centimeters in diameter or cancerous cells have spread to the lymph nodes in the underarm area
  • Stage III: Cancer is more extensive but it is confined to the breast, surrounding tissues, and lymph nodes
  • Stage IV: Breast cancer has spread to lymph nodes beyond the underarm area or to distant sites, such as the lungs, liver, bones, or brain

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Is Stage 4 Breast Cancer Curable

Theres currently no cure for stage 4 breast cancer, but with treatments it can be kept under control, often for years at a time.

People with metastatic breast cancer need to receive treatments for the rest of their lives. If a certain treatment stops being effective, another treatment regimen may be tried.

Talking To Other People

Talking about how youre feeling can often help you cope in the early days. You may be able to do this with family and friends, but many people find this very difficult.

Talking with a specialist nurse can often help. You can ask to be put in contact with one if you havent already.

Breast Cancer Now is also here to help. Through our services you can:

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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.

What Research Studies Are Under Way On Paget Disease Of The Breast

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Randomized controlled clinical trials, which are considered the gold standard in cancer research, are difficult to perform for Paget disease of the breast because very few people have this disease . However, people who have Paget disease of the breast may be eligible to enroll in clinical trials to evaluate new treatments for breast cancer in general, new ways of using existing breast cancer treatments, or strategies for preventing breast cancer recurrence.

Information about current breast cancer treatment clinical trials is available by searching NCIs list of cancer clinical trials. Alternatively, call the NCI Contact Center at 1-800-4-CANCER for information about clinical trials for individuals with Paget disease of the breast.

Selected References
  • Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 4th ed. Philadelphia: Lippincott Williams & Wilkins 2009.

  • Caliskan M, Gatti G, Sosnovskikh I, et al. Paget’s disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Research and Treatment 2008 112:513521.

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    Who Gets Paget Disease Of The Breast

    Paget disease of the breast occurs in both women and men, but most cases occur in women. Approximately 1 to 4 percent of all cases of breast cancer also involve Paget disease of the breast. The average age at diagnosis is 57 years, but the disease has been found in adolescents and in people in their late 80s .

    A Brief History Of My Stomach

    The bagpipe-like vacuous organ is the repository for so much pleasure. I couldn’t think of a more draconian sentence than losing it especially for me. Some of my first memories are sneaking olives from the fridge and licking egg beaters clean from whipped cream and cake batter.

    The dinner table in our home growing up was always laid with a tablecloth and matching china sets for plates of lightly crisped wienerschnitzel or tomato and pepper layered goula or bryndzové haluky, a potato dumpling and sheep cheese dish, all in heavy rotation in my Slovak mom’s kitchen.

    My childhood love of eating slowly evolved into a love of gardening, cooking and baking. I regularly buy 50-pound bags of flour, spending hours creating rum and red currant-soaked, checkered cake and berry tarts with pastry cream. I brew hachiya persimmon vinegar or jalapeño soda. I have been accused of having a cookbook buying addiction.

    Spending a day dirtying dishes with friends and sitting down to share our spoils al fresco is my favorite pastime. Giving up my stomach would mean severing me from so much joy.

    Yet the thought of facing a cancer diagnosis was shatteringly tangible for me. For seven years, I’d watched my sister, a physician, try to hold the threads of her professional and family life together as she struggled with terminal neuroendocrine pancreatic cancer.

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    How Fatal Is Stage 3 Breast Cancer

    Ask U.S. doctors your own question and get educational, text answers â it’s anonymous and free!

    Ask U.S. doctors your own question and get educational, text answers â it’s anonymous and free!

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    Symptoms Of Metastatic Breast Cancer

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    The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.

    • If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
    • If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
    • Breast cancer that has spread to your lungs or liver usually causes no symptoms.

    The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.

    These treatments may include:

    • hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
    • chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
    • immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
    • a combination of these therapies

    In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.

    The following are the common treatment options for different types of stage 4 breast cancer.

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    If All The Cancer Was Removed With Surgery Why Do I Need Any Additional Treatment

    It has long been recognized that breast cancer is not always cured by locoregional treatment alone.

    The goal of treating early breast cancer is to remove the cancer and keep it from coming back . Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at potential risk of recurrence, and that is why in most cases, there is a recommendation for treatment in addition to surgery, which is known as adjuvant therapy. The risk of recurrence can never be entirely eliminated, but the aim of adjuvant therapy is to reduce recurrence risk to the absolute minimum.

    Scenario : The Cure Model

    We consider a cohort of 45,647 women with a survival of 72.4% at 20 years. Assume that a new treatment prevents 30% of all deaths . In this simulation, we randomly removed 30% of deaths from the cohort and assumed that these women were alive at 20 years. We assume further that the time to death of women who are not cured is the same as in the absence of treatments. The three curves representing the survival experience of the untreated and treated women are presented in Fig. ac.

    a Impact of 30% reduction in deaths on annual mortality rates, ER-positive patients in SEER. b Impact of 30% reduction in deaths on actuarial survival, ER-positive patients in SEER. c Impact of 30% reduction in deaths on time to death, ER-positive patients in SEER

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    What Is Stage 4 Breast Cancer

    Stage 4 breast cancer is also called metastatic breast cancer or advanced breast cancer. In this stage, cancer that developed in your breast has spread to other areas of your body.

    Cancer cells might have traveled through your lymphatic system to your lungs, bones, liver, brain, or other organs.

    Stage 4 is the most serious and life threatening stage of breast cancer. Most often, stage 4 breast cancer develops long after a person has first been diagnosed with cancer. In rare cases, the cancer may have progressed to stage 4 at the time a person is first diagnosed.

    Facing stage 4 breast cancer can be challenging. But following your doctors recommended treatment plan and practicing healthy lifestyle habits can help to improve your outcome. It may significantly increase your lifespan and improve your quality of life.

    Breast Cancer Healthline is a free app for people who have faced a breast cancer diagnosis. The app is available on the App Store and . Download here.

    Box 1 How Rapid Autopsy Studies Can Inform On Metastatic Dissemination And Relapse

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    Definitions

    • Rapid autopsy: rapid post-mortem collection, examination and biobanking of tissuesfresh, snap-frozen and fixedfrom deceased patients shortly after death.

    • Rapid autopsy cancer programme: coordinated effort among oncologists, pathologists and scientists aimed at collecting specimens from cancer patients within a post-mortem interval of 68h before key biological information within the tissues of interest is lost.

    Advantages

    • Multiregional biopsies: to conduct extensive, spatial sampling of tissuesprimary and metastatic, cancerous and normalfor in-depth, high-resolution multi-omics analysis.

    • Physiological model: to analyse DTCs in their natural metastatic niche.

    • to generate novel, ex vivo living patient-derived modelsautopsy-derived xenografts and organoids of metastatic tumours from sites that would otherwise be difficult to sample for functional evaluation .

    • Cancer evolution: to study the phylogenetic relationship of each sampled site to each other and infer the complete clonal evolution of a neoplasm.

    • Dormancy: to examine why some DTCs lodged in certain organs of the human body become dormant for years to decades.

    • Drug resistance: to study why DTC spread across different sites responds differently to therapy, with some developing resistance and others remaining sensitive to treatment.

    • Recurrence: to understand why only some DTCs residing in certain sites of the human body give rise to active metastases, ultimately responsible for patients relapse.

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    What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer

    In women who have breast-conserving treatment, the chance of recurrence is about 3-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.

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