Finding The Right Balance Of Treatment
“Triple-positive” refers to breast tumors that are ER-, PR- and HER2-positive. It means the cancer cells grow in response to estrogen , progesterone and a growth-promoting protein that’s on the outside of all breast cells known as HER2. These cancers tend to grow and spread quickly but are very responsive to medical treatment. In Carol’s case, the tumor was small , but cancer had spread to a lymph node.
“Because of my age and cancer type I was 29 in 2015 when this all began Dr. Dormady and I opted for the whole shebang,” says Carol. “Two weeks after I gave birth, we started with targeted chemotherapy.” That included four rounds of Adriamycin and Cytoxan followed by 12 rounds of Taxol and 12 months of Herceptin.
Dr. Shyamali Singhal performed the lumpectomy, which was followed by radiation treatment with Dr. Robert Sinha. “I am now on my last year of five years of hormone treatment with Arimidex to lower my estrogen levels,” says Carol.
When asked if she built in any time for emotional and psychological therapy, she says, “Staying at home with a new healthy, happy baby. That was therapy.” All told, Carol would end up taking a year and a half off from work to concentrate on recovery.
Clinical Endpoints And Statistical Analysis
The primary endpoint was a comparison of prognostic outcomes between patients with triple-positive breast cancer and those with other molecular subtypes. For this endpoint, we obtained RFS outcomes from CMC data and OS outcomes from KBCS data. The secondary endpoint was the efficacy of anti-HER2 therapy for triple-positive breast cancer.
Clinicopathologic features were assessed using the Student t-test, chi-square test, and Fisher exact test. Differences in follow-up times among the intrinsic subtypes were calculated using one-way analysis of variance. Cumulative survival probabilities were estimated using Kaplan-Meier analysis, and differences in survival rates were compared using the log-rank and generalized Wilcoxon tests. Additionally, multivariate analysis was performed using the Cox proportional hazards model. All variables are described as hazard ratios and 95% confidence intervals . A two-sided p-value of < 0.05 was considered significant. All statistical analyses were performed using IBM SPSS software version 22.0 for Windows .
Cancer Alters Your Life And It Never Really Leaves You
For those beginning their cancer journey, Carol has two bits of advice. “Definitely don’t put off getting anything suspicious checked.” She doubts she would have found the cancer early if she weren’t seeing Dr. Khoo regularly. “Lastly, know that cancer never leaves you. Post-cancer PTSD and anxiety is real, even after treatment ends, and that’s OK.”
Because El Camino Health knows that the emotional toll may continue long after cancer treatment ends, they’ve developed the Survivorship Program to support patients like Carol who may have questions or fears about what’s happening with their mind, body or emotions.
Now at age 33, Carol’s 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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With So Much At Stake Carol Seeks A Second Opinion
Dr. Dormady designed a personalized plan of treatment for her, but before beginning Carol sought a second opinion outside the El Camino Health network. She needed more assurance that she wasn’t going to be overtreated and left infertile. The second opinion concurred with Dr. Dormady’s recommended treatment plan.
“I had spoken with a couple other oncologists even before meeting Dr. Dormady,” shares Carol. “But I was really drawn to the level of care at El Camino Health. They deal with cancer every day, but instead of being jaded or callous, they are sincerely caring and personal.”
Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
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Clinical Trials For Stage 4 Breast Cancer
Because of how severe stage 4 breast cancer often is, many treatment options are not as effective as they are in early stages. Many advanced cancer patients turn to clinical trials to seek new treatments. Clinical trials. Before therapies for cancer can be approved by the FDA and are considered standard of care, they need to go through several phases of clinical trials to ensure they are both safe for patients and effective at treating their disease.
Clinical trials are also available for patients of other stages. However, there are fewer available therapies as the disease progresses, so clinical trials are sometimes viewed as the last stage treatment for breast cancer. Breast cancer clinical trials offer the latest drugs in cancer research that target the genetic makeup of the tumor, which can lead to fewer side effects and improved responses to therapies.
Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
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Triple Negative Breast Cancer Facts
1. Hormone treatments is not possible with this type of breast cancer.2. This is a much rarer type of breast cancer that affects a higher rate of Hispanics, African Americans, younger people and people that have a BRACA 1 gene mutation.3. Approximately 80% of BRACA 1 gene mutation tumors are triple negative.4. There is a strong correlation between an autosomal inheritance pattern and TNBC but most studies fall short of calling it a causal relationship.5. This cancer is harder to treat, is more likely to recur in the first five years after treatment and can be more aggressive BUT all of the factors including successful treatment largely depend on the stage in which the cancer is identified and the grade of the tumor.6. TNBC has a higher recurrence rate in the first five years after remission while other cancers like estrogen receptor positive cancers have much lower rates of recurrence during the first five years of remission.7. While TNBC recurs at a higher rate in the first five years once the five year mark passes with each additional year of survival the odds of recurrence is drastically reduced.8. After 5 years the chance of recurrence of TNBC is reduced by 50%.9. With each year after the 5 year mark the chance of recurrence is reduced by an additional 10%-15%.10. Long term survivors have almost a 0% rate that the disease will recur. With other breast cancers the recurrence rate climbs after the first 5 years.
Cancer And The Female Breast
Figure: Breast and Adjacent Lymph Nodes
Figure: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Inside a woman’s breast are 15 to 20 sections, or lobes. Each lobe is made of many smaller sections called lobules. Fibrous tissue and fat fill the spaces between the lobules and ducts . Breast cancer occurs when cells in the breast grow out of control and form a growth or tumor. Tumors may be cancerous or not cancerous .
Additional Information
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30 107:djv048. doi: 10.1093/jnci/djv048. Print 2015 Jun.
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How Can I Take Care Of Myself While Living With Metastatic Breast Cancer
Living with metastatic breast cancer can be challenging. Your care team can help provide physical and emotional support. Talk to them about how you can:
- Eat the most nutritious diet for your needs.
- Exercise regularly.
- Get emotional support, including finding support groups.
- Reach out for help from friends, family and loved ones.
- Find mental health services.
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How Long Can You Live With Stage 4 Breast Cancer
Many patients and caregivers wonder, is stage 4 breast cancer curable, or is stage 4 breast cancer always terminal? This can depend on many factors such as the subtype of disease and the extent of metastasis. Despite stage 4 cancer being the least likely to be cured or go in remission, many patients live for several years after a diagnosis of metastatic cancer. In rare cases, some patients will end up beating metastatic breast cancer. However, once breast cancer is in stage 4, it has spread to other tissues and organs around the body, which can make it more difficult to treat.
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There Are Good Days And Bad Days
There are days when I say to myself, Ive had enough. I cant take it anymore, says Rosen. But I want to keep on living. I love my life. Overall, I have a great life except for the cancer.
Rosen has a few mantras she uses when things get tough. A lot of the tough times are treatment related, she says. I refer to those as bumps in the road, and , This too shall pass.
What Is Triple Negative Breast Cancer
Triple negative breast cancer is the most aggressive kind of breast cancer with high risk of recurrences and poor outcomes. Systemic chemotherapy has significantly improved long term outcomes in early stage patients however, metastatic recurrences still develop in a significant number of patients. Anthracycline and taxane based chemotherapy
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Survival Rate With Metastatic Breast Cancer
Many people wonder about the life expectancy for stage 4 breast cancer . It’s important to note that everyone is different and survival rates vary widely. There are some people who survive many years and even decades with stage 4 disease. At the same time, it’s important to understand that stage 4 breast cancer isn’t curable.
It can be helpful to look at current statistics and consider the many variables that affect life expectancy. While it’s important not to raise false hope, it may help to know the reality that there are some long-term survivors.
Some people want to know the statistics, but many don’t. If you’re living with stage 4 breast cancer, there is absolutely no requirement that you know the prognosis. The information provided here is only for those who truly wish to know what the current research iseven this research has many limitations.
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
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Patients And Data Selection
In this retrospective study, we analyzed data from two different clinical breast cancer data registries in South Korea. The Korean Breast Cancer Society breast cancer registry is a nationwide multicenter registry of data collected from South Korean hospitals between 2006 and 2010. The KBCS approved our research objective and request for data in October 2016. From this registry, we included patients who received an initial diagnosis of breast cancer and underwent breast cancer treatment surgery during the registry period. Patients with ductal carcinoma in situ were excluded. Our study included 31,266 patients, of which 1,740 patients had triple-positive breast cancer . Overall survival data were collected from the Korean National Statistical Information Service, which records the dates of death and other clinical and demographic data of patients.
Schematic diagram of the study cohorts, intrinsic subtype distributions, and list of study endpoints.
CMC=Seoul St. Mary’s Hospital of the Catholic Medical Center KBCS=Korean Breast Cancer Society TNBC=triple-negative breast cancer RFS=recurrence-free survival Lum-A=luminal A subtype HER2=human epidermal growth factor receptor 2 OS=overall survival.
Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:
Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .
AND EITHER No actual tumor is found in the breast.
OR The tumor is smaller than the approximate size of a peanut .
Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.
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Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.
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How Is Metastatic Breast Cancer Treated
The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:
Your care team will plan your treatment based on:
- Body parts cancer has reached.
- Past breast cancer treatments.
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Signs And Symptoms To Know
The signs and symptoms of triple-negative breast cancer are the same as with all breast cancers. It may present as a lump, which is more commonly hard, painless and irregular, but can also be soft, round and painful. Other signs include:
- Breast swelling
- A nipple that turns inward
- Skin changes on the breast or nipple, including redness, dryness, thickening or flaking
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A Note About Statistics
Survival rates are statistics. As such, they tend to tell us how the average person will do with an average triple-negative breast cancer. But people and tumors arent statistics. Some people will do better, and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior, and there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
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