Genetic Mutations Gene Microarrays
Another reason for young patients presenting with more aggressive tumors is the higher proportion of BRCA1 and BRCA2 mutations , which are known to be associated with higher histological grade, higher proliferation rate and ER negativity . Other genetic variances have also been studied. According to Dubsky et al. , p53 mutation, c-erbB-2 over expression and tumor proliferation markers are associated with a young age and an increase in local recurrence probability, and thus more aggressive tumors. In 2008, Andres et al. identified 367 gene sets that may make a distinction between breast tumors in young women from those in older women, which may have an impact on prognosis. Moreover, a recent study by Azim et al. assessed the differential role of proliferation, stroma, and immune-related gene signatures in providing prognostic information in different breast cancer subtypes. They further confirmed the age-dependent differential expression of genes associated with immature mammary cell populations , and growth factor signaling .
Based on the aforementioned adverse pathological and possible genetic characteristics present in young breast cancer patients, one could explain the poor outcome in this patient population. However, many studies showed that even after accounting for these factors, young age per se seems to act independently in affecting prognosis.
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.
Wise Regression For Variable Selection
The selected prognostic factors were also combined in a multivariate analysis to determine odds ratios and to quantify the contribution of LRR risk to the total 5-year follow-up period. The same analysis was performed to quantify the contribution of individual factors to each consecutive 6-month time interval during the 5-year period. This time interval corresponds to the follow-up intervals described in multiple guidelines .
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Abstract: Backgroundlimited Evidence Mostly From Studies In Western Populations Suggests That The Prognostic Effects Of Lifestyle
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What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
What Causes Breast Cancer Recurrence
The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.
Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.
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Local Breast Cancer Recurrence
Breast cancer can return to the same area where it first appeared, Lange says. In this case, your doctor will base a treatment approach on how the first cancer was addressed.
If the original tumor was treated with lumpectomy and radiation, many patients may then need a bigger surgery, such as mastectomy, for the purpose of local control, she explains. If the original tumor was treated with mastectomy, then local resection of the recurrence should be considered. This is often followed by radiation therapy to the resection site.
Lange says an oncologist will evaluate a patient with recurrent breast cancer. Based on characteristics of the cancer cells and how they are behaving, the oncologist might recommend chemotherapy, hormonal therapy or a combination of treatments. For some patients, clinical trials of new therapies may be available.
Having Certain Benign Breast Conditions
Women diagnosed with certain types of benign breast conditions may have a higher risk of breast cancer. Some of these conditions are more closely linked to breast cancer risk than others. Doctors often divide benign breast conditions into different groups, depending on how they affect this risk.
Non-proliferative lesions: These conditions dont seem to affect breast cancer risk, or if they do, the increase in risk is very small. They include:
- Fibrosis and/or simple cysts
- Mild hyperplasia
- Epithelial-related calcifications
Mastitis is not a tumor and does not increase the risk of breast cancer.
Proliferative lesions without atypia : In these conditions theres excessive growth of cells in the ducts or lobules of the breast, but the cells don’t look very abnormal. These conditions seem to raise a womans risk of breast cancer slightly. They include:
- Usual ductal hyperplasia
- Several papillomas
Proliferative lesions with atypia: In these conditions, the cells in the ducts or lobules of the breast tissue grow excessively, and some of them no longer look normal. These types of lesions include:
Breast cancer risk is about 4 to 5 times higher than normal in women with these changes. If a woman also has a family history of breast cancer and either hyperplasia or atypical hyperplasia, she has an even higher risk of breast cancer.
Lobular carcinoma in situ
For more on these conditions, see Non-cancerous Breast Conditions.
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Having Dense Breast Tissue
Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Breasts appear denser on a mammogram when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts on mammogram have a higher risk of breast cancer than women with average breast density. Unfortunately, dense breast tissue can also make it harder to see cancers on mammograms.
A number of factors can affect breast density, such as age, menopausal status, the use of certain drugs , pregnancy, and genetics.
To learn more, see our information on breast density and mammograms.
Inheriting Certain Gene Changes
About 5% to 10% of breast cancer cases are thought to be hereditary, meaning that they result directly from gene changes passed on from a parent.
BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer.
- If you have inherited a mutated copy of either gene from a parent, you have a higher risk of breast cancer.
- On average, a woman with a BRCA1 or BRCA2 gene mutation has up to a 7 in 10 chance of getting breast cancer by age 80. This risk is also affected by how many other family members have had breast cancer.
- Women with one of these mutations are more likely to be diagnosed with breast cancer at a younger age, as well as to have cancer in both breasts.
- Women with one of these gene changes also have a higher risk of developing ovarian cancer and some other cancers.
- In the United States, BRCA mutations are more common in Jewish people of Ashkenazi origin than in other racial and ethnic groups, but anyone can have them.
Other genes: Other gene mutations can also lead to inherited breast cancers. These gene mutations are much less common, and most of them do not increase the risk of breast cancer as much as the BRCA genes.
Inherited mutations in several other genes have also been linked to breast cancer, but these account for only a small number of cases.
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Having Radiation To Your Chest
Women who were treated with radiation therapy to the chest for another cancer when they were younger have a significantly higher risk for breast cancer. This risk depends on their age when they got radiation. The risk is highest for women who had radiation as a teen or young adult, when the breasts were still developing. Radiation treatment in older women does not seem to increase breast cancer risk.
Tips For Coping With Breast Cancer Recurrence
Fear of recurrence after cancer is totally normal. Rest assured that youre not alone and that the feeling may fade over time. In the meantime:
- Be vigilant about regular checkups and follow-up testing. It may help to know that youre doing everything within your control.
- Be mindful about your overall health. Follow your doctors recommendations for diet, exercise, and medications.
- Have fun. Dive into things that bring you joy or contentment.
Its also important to know that recurrence is not your fault guilt should never be part of the picture. Here are some constructive ways to deal with recurrence:
- Dont go it alone. Lean on your family, friends, and social network for support.
- Join an in-person or online support group. Theres nothing quite like sharing with others who totally get it. You might also find it beneficial to speak with a therapist.
- Speak openly with your oncologist. Ask questions, discuss your concerns, and seek another opinion.
If someone you care about has a breast cancer recurrence, your support can make all the difference. You can lend a ton of support, even if youre unsure what to say or do:
- Be there. Just showing up can be a major boost.
- Listen. Let them talk about fears and frustrations without fear of judgement.
- Ask how you can help. Their needs may not be obvious, so ask for specifics.
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What’s The Risk Of Recurrence
Everyone who has had breast cancer has some risk of recurrence, but its typically low.
In general, the more time that goes by, the lower the risk of recurrence. Cancer is most likely to recur in the first two years after treatment, and once people get to five years of living cancer-free after treatment, its considered to be a significant milestone to be celebrated. Recurrence after that five year markrare, but possibleis called late recurrence.
Theres still so much that is unknown about cancer recurrence, but researchers have found some patterns in recent years that point to clues about why it happens. These factors might be linked to a higher risk of breast cancer recurrence:
- Having high blood sugar
- Not eating enough fruits and vegetables
- Having had a surgical site infection after your surgery
Certain characteristics of your original cancer also might mean a higher risk of recurrence, such as:
- A tumor of more than five centimeters across
- Cancer cells that are HER2-positive
- Cancer cells that are triple negative
- Cancer cells in four or more axillary lymph nodes at the time of surgery
- Cancer cells in the chest muscles or breast skin
You might be at higher risk for late recurrence if you had:
- A tumor of more than two centimeters
- A high number of affected lymph nodes
- A hormone receptor-positive cancer
- A HER2-negative cancer
- Hormone therapy for only a short time after surgery
Breast cancer treatment: The care you need is one call away
How The Study Was Done
This study was a meta-analysis. A meta-analysis combines and analyzes the results of a number of earlier studies. In this case, the researchers analyzed the results of 17 studies published between 1970 and 2018 looking at the risk of invasive breast cancer coming back in the same breast after a diagnosis of DCIS.
The number of women in each study ranged from 52 to 37,692, and average follow-up time ranged from 3.2 years to 15.8 years.
The researchers found 26 factors that could be linked to invasive breast cancer recurrence after DCIS. Their analysis found that six of those factors were statistically significant, which means the factors were likely linked to a higher risk of invasive breast cancer recurrence rather than it being due to chance.
The researchers said that the reason each of the six factors was linked to a higher risk of invasive breast cancer recurrence could be biologically explained.
The researchers recommended that these six factors be validated in other studies. They also recommended that the type of recurrence after a DCIS diagnosis and treatment be specified in new studies on DCIS.
“New studies need to capture information about whether the cancer recurrence was DCIS or a subsequent invasive cancer and whether these are true recurrences or new, primary lesions,” Wesseling said.
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What Are The Types Of Breast Cancer Recurrence
If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
Advanced Stage At Presentation
Several studies raised the notion that young breast cancer patients tend to present with more advanced stages than older women . A retrospective cohort from Denmark of 10,356 women diagnosed before 50 years reported that patients aged â¤35 years at diagnosis were at higher risk of being node positive compared with patients between 35 and 50 years . A study of 732 non-metastatic breast cancer patients from Mount Sinai Medical Center, New York showed that patients younger than 36 years had larger tumors , and were more likely to be diagnosed with stage II or III cancer .
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Treatment For Breast Cancer Recurrence
If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.
Treatment options depend on where the cancer has recurred and what breast cancer treatment youve had before:
- Local recurrence is likely to be treated surgically first with a mastectomy if you didnt have one already or a surgical removal of the tumor if you did. After surgery, breast cancer chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
- Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
- Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy for breast cancer or a combination of these. Breast cancer surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.
Expert cancer care
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