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Stage 4 Triple Positive Breast Cancer Prognosis

Cancer Alters Your Life And It Never Really Leaves You

Ask the expert: Early-stage hormone receptor-positive, HER2-positive & triple-positive breast cancer

For those beginning their cancer journey, Carol has two bits of advice. Definitely dont put off getting anything suspicious checked. She doubts she would have found the cancer early if she werent seeing Dr. Khoo regularly. Lastly, know that cancer never leaves you. Post-cancer PTSD and anxiety is real, even after treatment ends, and thats OK.

Because El Camino Health knows that the emotional toll may continue long after cancer treatment ends, theyve developed the Survivorship Program to support patients like Carol who may have questions or fears about whats happening with their mind, body or emotions.

Now at age 33, Carols life is basically back to normal, although she still struggles with the possibility that she may not be able to have more children through natural means.

As much as cancer sucked, states Carol, I truly appreciate the many new perspectives it gave me: A glimpse of the lives of the doctors and nurses providing care. The depths of empathy of everyone on a cancer journey. And it forced me to jump off the never-ending achievement treadmill with no regrets. Life is such a gift!

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Coping With Stage 4 Breast Cancer

It is natural to feel depressed, anxious, or even angry when you have been diagnosed with stage 4 breast cancer. It can leave you feeling as if you have no control over your health or future. Moreover, you may find that certain people will withdraw from you or suggest that you have metastatic cancer because you “left it too long.”

It is important to shield yourself from these negative emotions and embrace people who can provide you with genuine support. These include loved ones, support groups, and your oncology team. If you are unable to cope, ask for a referral to a therapist who can provide you counseling or a psychiatrist able to dispense treatment.

With that being said, there are women who experience positive emotional growth after being diagnosed with stage 4 breast cancer. It is not uncommon to hear someone say that cancer helped prioritize their life, allowing them to pursue what is truly important and connect with people on a deeper, more profound level.

Whatever your experience, don’t go it alone. Seek support and work with your medical team as a full partner in your care.

Facing Triple Positive Breast Cancer

My life changed forever once I received the phone call no one wants to get early one morning in March 2015. My surgeon was on the other line with the results from my recent biopsy. The lump that was supposed to be only a pesky cyst was indeed cancerous. The surgeon further explained my diagnosis. But the only thing I heard was that I had cancer.

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Coping With Advanced Breast Cancer

Being told that you have advanced or metastatic breast cancer may be very confronting or overwhelming. Some women also find the news that their cancer has spread or come back is more devastating than their original diagnosis.

There are many resources available online to help you further understand the meaning of your diagnosis and how to manage the emotional, physical and practical issues arising from metastatic breast cancer. Below are some links where these resources can be accessed:

Although support groups can provide a safe place for people to express their feelings amongst others who share a similar experience, some people are more comfortable talking one-on-one, such as with a counsellor, therapist or trained volunteer . Your GP can also refer you to a psychologist, social worker or other trained therapist. Every person is different and it is important to find a healthy support system that works for you.

Inoperable Breast Cancer Is Often Still Treatable

Triple Negative Breast Cancer

Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.

If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.

Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.

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Diagnosis Of Stage 4 Breast Cancer

If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.

In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.

Surviving Stage 4 Breast Cancer: Is It Possible

Understanding survival rates of stage 4 breast cancer

According to the National Cancer Institute , an estimated 27 percent of people in the United States live at least 5 years after being diagnosed with stage 4 breast cancer.

Many factors can affect your longevity and quality of life. Different subtypes of breast cancer behave differently. Some are more aggressive than others, and some have far fewer treatment options than others. For this reason, your subtype may affect your outlook.

Higher survival rates are also associated with the extent and location of metastasis. In other words, your long-term outlook may be better if your cancer has only spread to your bones than if its found in your bones and lungs.

Immediately seeking treatment, like chemotherapy, surgery, or hormone therapy, can help improve your outlook. Making healthy lifestyle choices might also improve your chances of survival.

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Whats The Outlook For Metastatic Breast Cancer

The right treatment plan can improve survival for people with metastatic breast cancer. However, survival rates vary and are dependent on a number of factors including type/biology of the breast cancer, parts of the body involved and individual characteristics. About 1 in 3 women live at least five years after diagnosis. Some live 10 years or longer. Your care team will discuss your prognosis with you in more detail.

New Medications For Metastatic Breast Cancer

Triple positive breast cancer patient doing well after treatment by Loyolas multidisciplinary team

The immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma. In March of 2019 the first immunotherapy drug, Tecentriq was approved for triple-negative breast cancer that is metastatic . As noted above, there are at least a few people who have had excellent responses in clinical trials prior to approval.

PARP inhibitors are also a class of medications that may alter survival rates in the future, particularly among women who have hereditary breast cancer .

For bone metastases, bone-modifying drugs may be effective in treating both metastases, and may reduce the development of further metastases in bone.

Finally, for people who have only a single or a few metastases , treating these metastases locally may be an option. While studies are young, treating oligometastases may improve survival or even lead to long term survival for a minority of people.

In addition, for some people treated with immunotherapy, local radiation may sometimes improve the response of immunotherapy, something known as the abscopal effect. Since immunotherapy is such a recent addition to breast cancer, its not known how common this response may be or if it will be seen at all.

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What Does It Mean To Have Triple Positive Breast Cancer

Triple-positive breast cancer cells have all three types of cell surface receptors used to classify breast cancer: estrogen, progesterone and human epithelial growth factor receptor 2 . About 1 in 5 breast cancers are HER2 positive. About 1 in 10 women have a tumor that is HER2 positive and positive for one hormone receptor.

How Is Stage 4 Breast Cancer Treated

The aim of treatment is to improve the quality and length of life of people with stage 4 breast cancer. Each person will be treated differently based on the disease characteristics and the intended goals of treatment.

Most treatments aim at decreasing the tumor burden and stabilizing the disease. In general, stage 4 cancer treatmentsalthough they may extend life in a significant number of peopleare considered palliative . This is because only a handful of people treated at this stage are cured of their disease.

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From Cured To Stage 4

Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.

Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.

âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â

In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.

âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â

Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.

âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â

And along with mets, she also had to deal with many misconceptions regarding her disease.

The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.

Is Stage 4 Breast Cancer Curable

Breast Cancer Staging

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.

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Survival Rates Of Stage 4 Breast Cancer

Unfortunately, cancer cells often become more difficult to treat and may develop drug resistance once they spread. According to the Australian Institute of Health and Welfare , the 5-year survival rate for women whose breast cancer is metastatic at first diagnosis is 32%, compared to the 91% on average for all breast cancer patients.

Factors affecting survival rate of metastatic breast cancer

Survival rates can provide an estimate of what percentage of patients with the same stage of breast cancer are still alive after a certain period of time . However, they cannot predict how long any specific individual with breast cancer will live. The length of survival time for people with metastatic breast cancer can vary significantly from person to person, but there are a number of factors which can influence this including:

  • Response to treatment
  • The extent and location of metastases
  • The presence of other health issues not related to cancer
  • The specific subtype of breast cancer . This is very important, as some types of cancer can be more aggressive than others and respond differently to treatment.

What Are The Stages Of Breast Cancer

Breast cancer is staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade cancer and three is high grade cancer that grows and spreads rapidly.

The four stages of breast cancer are:

  • Stage I: The tumor is relatively small and localized to the original site, with possible spread to the sentinel lymph nodes, which are the first lymph nodes the cancer is likely to spread to.
  • Stage II: The tumor has grown and spread to a few nearby lymph nodes.
  • Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
  • Stage IV: The cancer has spread to distant parts of the body.

Another highly detailed classification system is the TNM classification system based on tumor size, lymph node involvement and metastatic spread.

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Clinicopathological Characteristics Of Patients

Among 491,913 patients originally identified from SEER database, cases of 33,339 TP-FBCs and 336 TP-MBCs from 2010 to 2017 were included in our study. According to the percentage of TP-FBC/TP-MBC to total FBC/MBC at each year , we firstly showed the trends of the subsets in 8 years . Generally, the subtype of TPBC was more prevalent in males than that in females with the exception of 2012.

Fig. 1

Clinical pathological characteristics of TP-MBC compared with TP-FBC were summarized in Table . TP-MBC patients are significantly older than TP-FBC , patients older than 65years account for almost half in TP-MBC. TP-MBC had less Asian/pacific islanders , more ductal carcinoma , higher clinical stage as well as T stage , N stage , M stage . However, there was no significant difference in tumor grade and surgery status between TP-MBC and TP-FBC.

Table 1 Clinical pathological characteristics of TP-MBC compared with TP-FBC

In Table , data of distant organ metastasis in TP-MBC and TP-FBC was shown. Compared with TP-FBC, TP-MBC patients had higher proportions of bone metastasis and lung metastasis . Significant difference was not found in the brain metastasis or liver metastasis between TP-MBC and TP-FBC.

Table 2 Comparison of distant organ metastasis patterns in TP-MBC and TP-FBC

Living With Stage : The Breast Cancer No One Understands

How a triple-negative breast cancer survivor became cancer-free

Leer en español.

Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.

A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.

âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â

An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.

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Regional Recurrence Within Three Years Carries A Less Favorable Prognosis But Overall Survival Statistics Are Still Good

Generally speaking, if the breast cancer returns regionally lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer.

Five-year overall survival after an isolated chest wall recurrence is 68% and after intra-breast recurrence it is 81%.

In one 2010 medical research study, the ten year overall survival rate was estimated at 84% for women without recurrence. However, this figure goes down to 49% for women with a locoregional recurrence and 72% for women with a second primary tumour.

A large 2015 study examined the impact of the time of the disease free interval on survival rates. For women with a locoregional recurrence that happened in the first 18 months, the ten year overall survival rate is around 30%. The overall 10 year survival rate for those whose recurrence happened within 3 years goes up to 50%. Furthermore, for those who suffered a recurrence after 3 years the ten year overall survival rate increases to 70%.

This recent study clearly demonstrates that the longer the time span since the primary prognosis and treatment to the recurrence, the better the long-term prognosis.

33 30

The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occurred locally and after five years.

However, women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds.

Being Your Own Advocate

While there aren’t currently any studies looking at self-advocacy and survival, being your own advocate can’t hurt in maximizing your survival. Oncology is changing rapidly and it’s difficult for any oncologisteven those who specialize in breast cancerto stay aware of all of the latest research and clinical trials taking place.

It can be helpful to research your cancer yourself. Becoming involved via social media such as Twitter is also an excellent way to learn about the latest research, using the hashtag #bcsm, which stands for breast cancer social media.

Getting a second opinion can be helpful as well, especially from one of the larger cancer centers such as a National Cancer Institute-designated cancer center.

There are ways to learn about opportunities, however, that don’t require traveling for opinions. There are now clinical trial matching services in which a nurse navigator can help to match your particular tumor and characteristics with clinical trials in progress all over the world.

Several of the larger cancer centers are now also offering remote second opinions, in which an oncology team can review your medical information and talk to you on the phone about whether there are any opportunities for treatment for you that may not be available elsewhere.

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