Prognosis Of Late Vs Early Cancer Recurrence
Late recurrence is associated with a better prognosis than early recurrence in estrogen receptor-positive breast cancer. A 2018 study in Clinical Breast Cancer found that survival after recurrence was significantly longer in people with a late versus early recurrence . In this study, the lungs were the most common site of late distant recurrence.
Mastectomy And Local Breast Cancer Recurrence
With mastectomy, the best predictor of local breast cancer recurrence is whether the lymph nodes in the underarm area contain cancer.
The risk of local recurrence is usually higher when there are more axillary lymph nodes with cancer than when there are few or no nodes with cancer .
Learn more about breast cancer recurrence.
Prognosis For Stage 1 Breast Cancer
Survival rates for breast cancer are determined based on whether the cancer is localized , regional , or distant .
Stage 1 breast cancer is localized and has a very favorable prognosis . Its five-year survival rate is at least 99 percent. Early diagnosis helps, as well as thorough tumor testing. This helps ensure that each person receives the right therapies for their 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.
When Cancer Recurs After 5 Years
When cancer recurs at a distant site it is no longer early-stage breast cancer. The characteristics of cancer may change as well. Tumors that are initially estrogen receptor-positive may now be negative and vice versa . HER2 status can also change.
For this reason, and because there are now a number of alterations that can be targeted , it’s important for people to have a biopsy and genetic testing of their tumor .
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Study Design And Patient Selection
This study was granted institutional review board approval from the Galway University Hospitals Clinical Research Ethics Committee. A single centre, retrospective observational cohort study was undertaken. Data was obtained from a prospectively maintained institutional database that included patients who were treated for breast cancer between January 2000 and January 2015 at GUH, a tertiary referral centre serving the west of Ireland. Overall, 502 patients were recorded as having metastatic disease during the study period, of which 243 were diagnosed as having metastasis at initial presentation . All of these patients who presented with M1 disease at diagnosis were excluded, leaving only those who were treated originally with curative intent and then suffered a disease recurrence. For the purpose of this study, only patients with complete clinicopathological details including treatment received both at primary diagnosis and subsequent disease recurrence were included. Detailed information regarding patient demographics, clinicopathological data, surgical management, adjuvant treatment regimens, disease recurrence and survival were collected using this database, and all data was cross-referenced with patient electronic and medical records.
Treatment For Locally Advanced Breast Cancer
Treatment for locally advance breast cancer is likely to include a treatment that affects the whole body .
This might be chemotherapy, hormone therapy or targeted therapy.
Chemotherapy
If you have previously had chemotherapy, you may be offered different chemotherapy drugs this time.
Hormone therapy
If the cancer is oestrogen receptor positive you may be offered hormone therapy.
If you were already taking hormone therapy when your cancer returned, your doctor may consider switching you to a different drug.
Targeted therapy
Targeted therapies are a group of drugs that block the growth and spread of cancer.
The most widely used targeted therapies are for HER2 positive breast cancer. However, other targeted therapies are available to treat locally advanced breast cancer that is HER2 negative.
Radiotherapy and surgery
You may be offered radiotherapy if cancer cells are found in the lymph nodes above or below the collarbone, under the breastbone or between the ribs. Its not usually possible to remove the cancer using surgery in this situation.
If the recurrence has affected the muscles on the chest wall, surgery may be offered as well as radiotherapy.
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T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumors size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
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Why Are Cancer Cells Tested
Cells from your cancer, collected during a biopsy procedure or during surgery to remove the cancer, are tested in a laboratory to help determine the aggressiveness of the cells and whether they are sensitive to hormones. Other sophisticated tests can determine what gene mutations are present in the cells.
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Treatments And Recurrence: Early And Late
Treatments also play a role in both early and late recurrences. While chemotherapy can significantly reduce the risk of recurrence in the first five years, it has much less influence on the risk of late recurrence.
Hormonal therapy reduces the risk of recurrence in the first five years , but can also reduce the risk of late recurrences. It is this reduction in risk that has led to recommendations to extend hormonal therapy for people at high risk beyond five years.
Extending hormonal therapy from five years to 10 years has been shown to reduce the risk of late recurrence, but the risk of recurrence needs to be weighed against the side effects of continued therapy.
A 2019 study found that people with luminal A tumors continued to have significant benefit from tamoxifen therapy for 15 years post-diagnosis.
The addition of bisphosphonates to an aromatase inhibitor in post-menopausal women with early-stage breast cancer may improve survival, but it’s too early to determine the effect on late recurrences. Bisphosphonates reduce the risk of bone metastases, but the most common sites of distant late recurrence are the brain, liver, and lungs.
Intrinsic Subtypes And Late Recurrence
A number of different methods have been evaluated for the ability to predict late recurrence. Some of these include:
Higher expression of estrogen-responsive genes: A 2018 study found that people with ER+/HER2 negative breast cancers who had higher expression of estrogen-responsive genes and were not treated with extended hormonal therapy had a high risk of recurrence after five years.
Multigene assays: Several multigene assays may help predict late recurrence, but using this information to figure out when to extend hormonal therapy requires more research. A 2018 evaluation of an 18-gene, 10-year signature found that the information regarding prognosis was similar to other tests including Oncotype DX Recurrence Score, Prosigna PAM50 risk of recurrence score, Breast Cancer Index and IHC4.
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What Is The Grade Of Invasive Breast Cancer
Three features of the invasive breast cancer cell are studied and each is given a score. The scores are then added to get a number between 3 and 9 that is used to get a grade of 1, 2, or 3, which is noted on your pathology report. Sometimes the terms well differentiated, moderately differentiated, and poorly differentiated are used to describe the grade instead of numbers:
Does Having Breast Cancer Shorten Life Expectancy
Women with breast cancer whose tumour is detected early can survive as long as those without the disease. Analysis of the latest figures shows that if a cancer was small, low grade and had not spread to the lymph nodes, women were given a normal life expectancy if they remained clear for five years after treatment.
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Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.
Recurrence Can Mean Different Things
For some women, a recurrence can be metastatic â the cancer has come back not in the breast , but elsewhere in the body as well. Thatâs a much more serious situation . Or, it may have come back much as the first time you were diagnosed, as a ânewâ cancer, and is treated as such.
Be aware that many people talk about recurrence and metastasis in the same breath. But they are not the same thing. If you have had a local recurrence, when the cancer remains confined to your breast, the good news is that your prognosis is not necessarily any worse than it was the first time.
âWhether itâs a recurrence of the original cancer or a new primary cancer in the other breast, in both cases we assume weâre dealing with a curable situation, and we attempt to think about those patients as we would anyone with a new presentation,â says Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York.
If, for example, you finished treatment for breast cancer seven or eight years ago, any recurrence or new cancer would be treated largely as an entirely new problem.
âThat woman will not only undergo surgery, but may well receive additional therapy that doesnât ignore the fact that she had a previous cancer, but recognizes that seven years out, her prognosis from the first cancer is excellent,â says Eric Winer, MD, director of the Breast Program at the Dana-Farber Cancer Institute in Boston.
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Is Grade 1 Ductal Carcinoma Invasive
Histologic Grade I Invasive Ductal Carcinoma. This invasive ductal carcinoma consists of small angulated glands with fairly uniform nuclei. Grade I carcinomas tend to have be less aggressive and have a better prognosis than higher grade carcinomas. They are also more often ER positive, which is another feature associated with a more favorable prognosis.
Risk Factors For Overall Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumor size: Larger tumors are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumors 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 people.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence in the first five years.
- Tumor grade: More aggressive tumors are more likely to recur than less aggressive tumors , especially in the first five years
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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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.
Locally Advanced Breast Cancer
If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer. Sometimes breast cancer is locally advanced when it is first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
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Can A Blood Test Tell You If You Have Cancer
Blood tests. No blood test can tell you your cancer stage, but blood tests may give your doctor an idea of your overall health and clues about which other staging tests may be useful. Blood tests might include a complete blood count and a blood chemistry test, which assess your kidney and liver function. Breast-imaging tests.
What Is A Breast Cancer Recurrence
Breast cancer recurrence means that the cancer was diagnosed when limited to the breast and/or armpit lymph nodes, then treated, and at some time later has come back.
This can occur in several ways:
- Local and/or regional recurrence: the breast cancer that was previously treated returns within the breast, chest wall or regional lymph nodes.
- New primary breast cancer: an unrelated new breast cancer occurs in one or the other breast. This actually isnt a local recurrence at allits a new cancer in the breast . This typically occurs many years after the original cancer and in an entirely different area of the breast. Its pathology is often different lobular instead of ductal, for example. Though they are often counted as recurrences in the statistics for breast conservation, they should be treated as completely new cancers, much as with new cancers in the opposite breast.
- Distant or systemic recurrence or metastasis is much more serious than local recurrence and is synonymous with stage 4 disease. For breast cancer patients, the most common areas of spread are the bone, liver, lungs and brain
Breast cancer recurrence occurs if:
- Cells from the original breast cancer diagnosis break away and hide nearby in the breast or spread elsewhere in the body
- Treatment, including surgery, chemotherapy, radiotherapy and/or hormone therapy have not gotten rid of all these cancer cells from the body.
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What Are Breast Cancer Stages
The stage of a cancer describes the size of the cancer and how far it has spread.
Your breast cancer may be described as stage 1, stage 2, stage 3 or stage 4.
An early form of breast cancer called DCIS is sometimes referred to as stage 0 breast cancer.
The stage takes into account:
- The size of the cancer
- Whether the lymph nodes are affected
- If the cancer has spread to other parts of the body
The stage of your cancer may not be fully known until after you have had surgery.
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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