Probability Of Breast Cancer Recurrence

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Should I Have Scans Or Blood Tests To Check For Breast Cancer

After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated with scans regularly. The frequency is often annually but is best discussed with your specialist.

Current guidelines and evidence recommend against routine CT or bone scans, or blood tests, to look for recurrence of cancer in patients who do not have any symptoms or other concerns that need to be followed up on. These tests have not been shown to improve outcomes and cause unnecessary scanxiety. If you do have concerning symptoms , then you should bring them to the attention of your healthcare team to be checked out.

Identifying First Recurrence Events Of Breast Cancer

The AJCC stages in the SEER data were used to categorize tumor stages in this study. The hormone receptorpositive status was considered as mixed estrogen receptorpositive and/or progesterone receptorpositive , that is, ER+/no PR data, ER+/PR+, ER+/PR, or ER/PR+, or no ER data/PR+. The percentages of available ER, PR, and hormone receptor status among the women were 80.8%, 78.3%, and 81.4%, respectively. Tumor histologic grades were classified as well-differentiated , moderately differentiated , poorly differentiated , and unknown status of grade.

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How Is Breast Cancer Recurrence Managed Or Treated

Your treatment depends on the type of cancer recurrence, as well as past treatments. If cancer develops in a reconstructed breast, your surgeon may want to remove the breast implant or skin flap.

Treatments for local and regional breast cancer recurrence may include:

• Mastectomy: Your surgeon removes the affected breast and sometimes lymph nodes.
• Chemotherapy:Chemotherapy circulates in blood, killing cancer cells.
• Hormone therapy:Tamoxifen and other hormone therapies treat cancers that thrive on estrogen .
• Immunotherapy:Immunotherapy engages your bodys immune system to fight cancer.
• Radiation therapy: High-energy X-ray beams damage and destroy cancer cells.
• Targeted therapy: Treatments target specific cancer cell genes or proteins.

Risk Factors For Distant Recurrence

There are several risk factors that raise the risk of recurrence overall . These include:

• Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
• Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
• Age at diagnosis: Breast cancer recurrence is more common in younger women.
• Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
• Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .

There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.

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Beyond The First 5 Years

The risk of breast cancer recurrence is highest during the first 2 years after the initial diagnosis. As time passes, the risk of recurrence steadily decreases. Many survivors celebrate their 5-year cancer-free date because it is well known that the vast majority of patients who have not had a recurrence by that time have a relatively low risk of recurrence at all.

A late recurrence of breast cancer is one that recurs after the 5-year milestone. Since the likelihood of recurrence is so low at this point, we must ask ourselves:

• Who experiences a late recurrence?

• What factors contribute to their risk?

• Why do seemingly cured patients, like my mother, have to face their cancer again?

Doctors, scientists, and researchers have identified factors that are related to the potential risks for late recurrence of breast cancer. Generally, these factors relate to the patients age, the cancers stage at diagnosis, hormone receptor status, genetic information, and lymph node involvement. Overall, the risk of a recurrence after 5 years is low, but breast cancer survivors with a higher risk of late recurrence are:

• Survivors with the following receptor statuses

• Estrogen receptor-positive tumor

How Does Distant Recurrence Occur

Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?

In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.

While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.

If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.

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Can Breast Cancer Recur

Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at risk of recurrence. The risk of breast cancer recurrence varies greatly from person to person. Talk with your health care provider about your risk of recurrence and things you can do that may lower your risk.

Hr Of The Ajcc Tumor Stage

From the 10 years of follow-up data, the hazard curves for annual HRs for the recurrence of breast cancer stratified by AJCC stage are shown in . The shape of the annual recurrence hazard curve over time reveals the dynamics of recurrence. Upon visual inspection, the HR showed a similar timing of peaks between 1 and 2 years of follow-up, with long-lasting tails manifesting for all stages in the observed women. All peaks started steep and decreased slowly. Women with initially diagnosed stage III disease showed evidence of the highest hazard and largest magnitude during the first 5 years of follow-up than women diagnosed with stage I or stage II . Beyond approximately 5 years, the hazard for all stages gradually decreased until the end of the 10 years of follow-up but never reached zero.

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How Does The Brca1 Or Brca2 Gene Mutation Affect My Risk Of Breast Cancer Recurrence

Women with a BRCA1 or BRCA2 gene mutation and who have already been diagnosed with breast cancer, have a higher-than-average chance of new primary breast cancers than those without this genetic mutation. The chance of local or distant recurrence depends on the type and stage of the original breast cancer, and is no different from a non-BRCA-mutated breast cancer.

For women with a BRCA1 or BRCA2 gene mutation, the chance of a contralateral breast cancer, or cancer in the opposite breast to the original cancer, 10 years after diagnosis of the first cancer is about 10-30 percent compared to about 5-10 percent for women diagnosed with breast cancer who do not have a BRCA1 or BRCA2 gene mutation.

Women who have a BRCA1 or BRCA2 gene mutation and have received a breast cancer diagnosis, should talk to their treatment team about their options to reduce the risk of breast cancer recurrence.

Eating A Healthy Diet

Most research on possible links between diet and the risk of breast cancer coming back has looked at broad dietary patterns, rather than specific foods. In general, its not clear if eating any specific type of diet can help lower your risk of breast cancer coming back.

Studies have found that breast cancer survivors whose eating patterns include more vegetables, fruits, whole grains, chicken, and fish tend to live longer than those who eat more refined sugars, fats, red meats , and processed meats . But its not clear if this is due to effects on breast cancer or possibly to other health benefits of eating a healthy diet.

Two large studies have looked at the effects of lowering fat intake after being diagnosed with early-stage breast cancer. One study found that women on a low-fat diet had a small reduction in the risk of cancer coming back, but these women also lost weight as a result of their diet, which might have affected the results. The other study did not find a link between a diet low in fat and the risk of cancer coming back.

The links between specific types of diets and breast cancer coming back are not certain, but there are clearly health benefits to eating well. For example, diets that are rich in plant sources are often an important part of getting to and staying at a healthy weight. Eating a healthy diet can also help lower your risk for some other common health problems, such as heart disease and diabetes.

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The Importance Of Age And The Lifetime Risks For Breast Cancer

In 1989, a womans lifetime risks for breast cancer was about 1 in 10. That risk increased to about 1 in 7 by 2003 and is currently 1 in 8 in the US over an 80-year lifespan.

Even though it may seem that breast cancer risk has increased in recent years, the actual risk of dying from breast cancer has decreased significantly.

As we can see from the graph above, the likelihood of being diagnosed with breast cancer increases as a woman ages.

The percentages on the graph can also be translated to the following risks for breast cancer listed below:-

• Age 30: 1 in 227
• At age 40: 1 in 68
• Age 50: 1 in 42
• Age 60: 1 in 28
• At Age 70: 1 in 26

What jumps out at you from the above table is the exponential increase in probability between age 30 and 40 years.

A woman is around 3.5 times more likely to get breast cancer at age 40 than she was aged 30. In addition, between the ages of 40 and 50, there is another increase in probability.

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How Can I Prevent Breast Cancer Recurrence

There is no definitive way to prevent breast cancer or breast cancer recurrence. However, treatments such as surgery, chemotherapy, radiotherapy, targeted therapy and/or hormone therapy do reduce the risk of recurrence, depending on the type and stage of the cancer. These can be discussed with your treatment team.

Understanding breast cancer risk factors and participating in regular breast screening through BreastScreen in Australia and BreastScreen Aotearoa in New Zealand can help to pick up any breast changes. Discussion with your healthcare team can help to catch any changes or abnormalities early and act on them.

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Limit Or Avoid Alcohol

Studies show that there is a link between moderate and heavy alcohol use and breast cancer. Alcohol is known to raise estrogen levels in your blood. This makes it more likely for you to get cancer again. If youâre a cancer survivor, itâs best to avoid alcohol altogether.

If you do choose to drink, make sure to limit it to only one drink a day to lower your chances of your cancer coming back.

Eat A Wide Variety Of Healthy Foods

According to a 2017 review of studies to date, people with breast cancer who eat a diet rich in vegetables, fruits, whole grains, fish, and poultry have better survival rates. There are many phytonutrients in the foods we eat, several of which have anti-cancer properties. That said, it’s likely that the combination of nutrients found in these foods that’s key, rather than any particular food.

To understand this, it helps to realize that cancer cells are “smart.” Unlike the popular conception of cancer, tumors are not unchanging clones of cells, but continually develop new mutations. Some of these mutations help a tumor grow. Some help a tumor avoid death . Others help a tumor spread, or suppress the body’s attempt to eliminate the cells . Just as tumor cells have many ways to continue their growth , a combination of healthy nutrients gives us the best opportunity to stay as healthy as possible.

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What Questions Should I Ask My Healthcare Provider

You may want to ask your provider:

• What type of breast cancer recurrence do I have?
• Has the cancer spread outside the breast?
• What stage is the breast cancer?
• What is the best treatment for this type of breast cancer?
• What are the treatment risks and side effects?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.

Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.

References

Local And Regional Recurrence

Breast cancer that comes back in the treated breast, chest or scar is called a local recurrence. Having a local recurrence does not mean the cancer has spread.

Breast cancer that comes back in the lymph nodes in the armpit, close to the breast bone, or lower neck, is called a regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm and cause lymphoedema.

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Cumulative Incidence From Competing Analysis

When treating breast cancerspecific death before evidence of recurrence as a competing risk, the 10-year estimated cumulative incidence of recurrence is 35% , 44% , and 56% for the stage I, II, and III, respectively. On the other hand, when treating recurrence as a competing risk, the 10-year estimated cumulative incidence of death before recurrence is 0.9% , 4.7% , and 14% for the stage I, II, and III, respectively.

The results of cumulative incidence from 2 competing events, that is, recurrence and cancer-specific death before evidence of recurrence show that the hazard of competing risks of death was comparatively low, suggesting a relatively small competing risk. With a low competing risk of death, for the purpose of simplicity, the KaplanMeier analysis is sufficient.

When To Contact A Doctor

A person may wish to contact a doctor if they notice signs that their cancer has returned.

Since the cancer may have spread, a person should contact a doctor about any unusual symptoms throughout their body, not just their breasts.

When making an appointment, a person should be prepared to talk about any new symptoms they are experiencing. They may also want to be ready to discuss their history with cancer.

A doctor may want to ask questions, order tests, and perform a physical examination.

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Risk Of Breast Cancer Recurrence Persists Up To 32 Years After Diagnosis

The risk of breast cancer recurrence persists up to 32 years after a patients primary diagnosis, according to a study published in the Journal of the National Cancer Institute.

The results showed that patients with high lymph node burden, larger tumors, or estrogen receptor -positive disease had an increased risk of late recurrence.

For this study, researchers used Danish population-based and medical registries to investigate the incidence of breast cancer recurrence up to 32 years after primary diagnosis. The researchers also evaluated the association between tumor and patient characteristics at primary diagnosis and the risk of recurrence.

The study included 20,315 women diagnosed with early breast cancer between January 1, 1987, and December 31, 2004, who did not have a recurrence or second cancer at 10 years after diagnosis.

From year 10 to 32 , 2595 patients experienced breast cancer recurrence. The incidence rate was 15.53 per 1000 person-years.

The cumulative incidence of breast cancer recurrence was 8.5% at 15 years, 12.5% at 20 years, 15.2% at 25 years, and 16.6% at 32 years.

The cumulative incidence of recurrence 10 to 25 years after diagnosis increased with increasing lymph node involvement at baseline, ranging from 12.7% for patients with T1N0 disease to 24.6% for patients with T2N4-9 disease.

The cumulative incidence of recurrence at 10 to 25 years was 14.4% in patients with tumors measuring 20 mm or less and 15.5% in patients with larger tumors.

Reference