What Factors Contribute To The Risk Of Breast Cancer Recurrence
Whilst it is never completely certain that breast cancer has been cured, there are many treatments available that reduce the risk of recurrence. There are a number of risk factors that can contribute to a breast cancer recurrence.
Your age at first diagnosis Younger women, particularly those who had their first diagnosis under the age of 35, have a greater risk of recurrence. This is because those diagnosed at a young age are more likely to have aggressive features in their breast cancer. Additionally women diagnosed with breast cancer before menopause have a greater risk of recurrence.
Tumour size Women who have a larger breast tumour have a greater risk of recurrence.
Lifestyle factors Lifestyle factors can influence the risk of recurrence. Excess weight is associated with a higher risk of postmenopausal breast cancer and is also associated with a higher risk of breast cancer recurrence and death. Smoking has also been shown to increase the risk of recurrence. Women who exercise regularly appear to have a lower rate of breast cancer recurrence.
Lymph node involvement If cancer is found in lymph nodes at the time of the original breast cancer diagnosis, there is an increased risk of breast cancer recurrence. This is the strongest prognostic factor, and the more nodes involved, the higher the risk of recurrence.
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.
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.
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Treatments For Recurrent Breast Cancer
The following are treatment options for recurrent breast cancer. Recurrent breast cancer means that the cancer has come back after it was treated. Breast cancer can come back in the same area of the breast where it was first found and treated . It can also come back in the other breast or other areas of the body, including the bones, liver, lungs and brain .
Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. The type of treatment given for recurrent breast cancer will depend on:
- if it is a local recurrence or distant metastasis
- the type and number of treatments youve already had for breast cancer
- the hormone receptor status of the cancer
- the HER2 status of the cancer
- if you have reached menopause
- your overall health
Treatments cannot completely cure metastatic breast cancer, but they can control it very well, sometimes for many years. Doctors may offer one treatment until it stops working, and then give another one.
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.
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Am I Still At Risk Of Local Recurrence If I Have Had A Mastectomy
Yes. Local recurrence can also happen after a mastectomy, although the likelihood is usually low.
Some of the signs of local recurrence after mastectomy include
- A lump or raised bump in or under the skin, especially near the previous mastectomy scar
- Changes to the skin, including redness or thickening
After reconstruction a local recurrence can appear at the suture line of the flap or in front of the implant. When its in the skin itself, it is red and raised. Reconstruction rarely if ever hides a recurrence. With implants, the recurrences are in front of the implant. With a flap, the recurrences are not in the flap itself but along the edge of the breast skin.
Local recurrence after mastectomy is often described as a chest wall recurrence, which isnt entirely accurate because it implies that the cancer is in the muscle or bone. But usually such a recurrence appears in the skin and fat where the breast was before, and only rarely does it include the muscle.
Ninety percent of local recurrences following mastectomy happen within the first five years after the mastectomy. Approximately 20 to 30 percent of women with local recurrences after mastectomy have already been diagnosed with metastatic disease, and another 20 to 30 percent will develop it within a few months of diagnosis. Therefore, just as with local recurrences after breast conservation, tests should be done to look for distant disease.
Primary Metastatic Breast Cancer
The prognosis of primary metastatic breast cancer depends on the location of the metastases, but is generally regarded as poorer than that of secondary metastatic tumors . In primary metastatic breast cancer, resection with tumor-free margins improves 5-year overall survival by 40% to 50% . The role of axillary surgery is unclear.
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How To Prevent Breast Cancer From Recurring
Several strategies may be followed to decrease the risk of breast cancer recurrence, such as the following:
- Hormones: If you have a breast cancer type that is positive for hormone receptor, hormone treatment may help reduce your chance of recurrence.
- Chemotherapy: Chemotherapy will reduce cancer recurrence, and those receiving chemotherapy will live longer.
- Radiation therapy: People who have had a breast-saving procedure for breast cancer and people who have a large tumor or inflammatory breast cancer have a reduced chance of recurrence if they have radiation treatment.
- Targeted therapy: If your cancer produces additional HER2 protein, medicines that target that protein may help reduce your chance of cancer recurrence.
- Healthy weight preservation: Keeping a healthy weight might reduce the chance of recurring breast cancer.
- Exercise: Regular workouts can lower the chance of recurrence of breast cancer.
- Eating a healthy diet: Concentrate on adding enough vegetables, fruit, and grain to your diet. If you drink alcohol, only consume one drink a day.
What Is The Outlook For Someone With A Breast Cancer Recurrence
Overall survival rates for breast cancer are generally based on the stage of the cancer at initial diagnosis.
Treatment for local and regional recurrence is often successful. However, theres still a risk of developing distant metastases. Because there are so many variables, its difficult to provide an overall prognosis. Your oncologist can provide a clearer understanding of what to expect for your exact situation.
Metastatic breast cancer can be treated and go into remission, but its not considered curable.
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Signs And Symptoms Of Breast Cancer Recurrence
Recurrent breast cancer is the breast cancer which comes again after the treatment of the original or primary breast cancer. This is due to the survival of a few cancer cells that remain after the elimination of all the cancer cells. When these undetected cancer cells multiply it leads to recurrent breast cancer. Usually this problem occurs after the passing of a few months or years after the initial treatment is given to the patient and the problem goes away.
If the cancer comes back to the same part then it is known as local recurrence and if it spreads to other part of the body then it is known as distant recurrence. The major changes that you will observe in recurrence of breast cancer are different types of pains in the chest, formation of new lumps in the breast or chest wall ,immediate loss of weight and appetite and shortness of breath.
The signs and symptoms of breast cancer recurrence depend upon affected part. This may come up as a lump on the breast or lump on the chest wall or the surgical scar thickens. The mammography will show where the lump occurred initially and what is the location of the lump in the recurrence. Various signs that come up in breast cancer recurrence is divided into three parts. First is a local recurrence, regional recurrence and distant recurrence.
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Will Your Breast Cancer Recur
Breast cancer can recur in anyone who has had breast cancer. Itâs highly unlikely to be a result of anything you did or failed to do.
There are, however, some things that seem to raise your risk of recurrence. These include:
Stage: Scientists use several things to come up with your breast cancer stage . They look at the grade of tumor. This is a measure of how abnormal the cells look compared to similar noncancerous cells. After that, they look at the size of the tumor and how far cancerous cells have spread from the original site to other parts of the body. The higher the stage of your original tumor, the more likely it is to recur.
Age: If youâre a woman and you get breast cancer before age 35, youâre more likely than older women to get it again.
Tumor type: Some types of breast cancer are more aggressive and therefore more likely to return and spread to other parts of your body. These include inflammatory breast cancer and triple-negative breast cancer. This also includes hormone-receptive types. Not only are these more likely to come back, theyâre also harder to treat.
Certain cancer cell behavior: Hormone-receptive cancer cells that donât respond to hormone therapy or cancer cells that donât respond to targeted treatments for the HER2 gene could be a sign of more likely recurrence.
High BMI: Lots of body fat as measured by the body mass index, or BMI, can raise your risk of breast cancer recurrence.
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Recurrent Breast Cancer Treatments
Depending on your personal health history, the extent of your recurrent breast cancer and other factors, your oncologist may recommend one or more of the following treatment options:
- Surgery – in most cases, your doctor will recommend a surgical procedure to remove the cancerous area. Your surgeon will work to preserve as much surrounding healthy tissue as possible. In some cases, you may opt to undergo reconstructive surgery following surgery to treat breast cancer.
- Chemotherapy – you may need to undergo chemotherapy to destroy any microscopic cancerous cells that couldnt be removed surgically. During this treatment, medication is used to destroy cancerous cells. Chemotherapy can be taken via an oral pill or intravenously .
- Hormone therapy – if you have hormone receptor-positive breast cancer, your oncologist may recommend you undergo hormone therapy for the hormone estrogen and progesterone.
- Radiation therapy – this treatment uses high-powered energy beams to destroy cancerous cells. You may need to undergo radiation therapy to destroy any microscopic cancerous cells that couldnt be removed surgically.
Treating A Metastatic Recurrence
Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesnât work or stops working, you may be able to try other treatments.
In general, the goal of treatment for metastatic breast cancer isnât to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.
Treatments may include:
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How Long Before Recurrence Is Off The Table
Recurrence is a risk for up to 32 years after a first diagnosis of breast cancer, according to a recent study. Your risk of recurrence after 10 years of remission depends on a number of things like:
- The size of the tumor
- The number of lymph nodes with cancer
- Whether cancer is estrogen receptor-positive
In general, once you have a breast cancer diagnosis, even if you are years in remission, itâs a good idea to be watchful and consult your doctor for regular breast exams and other screenings they think are appropriate. Early detection is the best way to get the best outcome from treatment. Talk to your doctor about the best schedule of checkups for you.
Underlying Mechanisms Of Fatigue
The etiology of fatigue, whether experienced during initial treatment or during survivorship, is far from being definitively characterized. The underlying mechanisms likely vary from patient to patient and the candidate causes surely co-vary considerably. This variability adds to the complexity of understanding this rather vague, but common and potentially disabling complaint. In addition to the usual suspects, such as dysphoric mood, disrupted sleep, anemia, recent studies have suggested some possible novel mechanisms . Thus, fatigue is multiply determined, with a likely mixture of both biological and psychological underpinnings. For example, evidence implicates anemia, ATP, links between the HPA axis, cytokines and circadian rhythms, and vagal afferents.,,,-
Because most previous studies of cancer fatigue involved cross-sectional research designs, the direction of causality between these candidate risk factors and the experience of cancer-related fatigue cannot be determined with certainty. Nonetheless, the literature suggests important possible links between fatigue and a wide range of potential underlying mechanisms.
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Can You Have Breast Cancer Recurrence After A Mastectomy
A bilateral mastectomy, or surgical removal of both breasts, significantly reduces your chances of breast cancer relapse. However, there is still a minimal chance that residual breast tissue or cancer cells could recur on the chest wall.
If youve had a lateral mastectomy, in which only one breast is removed, you can still develop breast cancer in the opposite breast. An annual screening mammogram of the remaining breast is essential to screen for any abnormalities.
Its important to note that a mastectomy does not reduce your risk of getting cancer somewhere else in your body.
Treatment For Recurrent Breast Cancer
Treatment for recurrent breast cancer is based on the type and location of the cancer and other things, including the treatment you had before. Treatment options for local or regional recurrence may include:
- Surgery to remove the cancer.
- For example, if you already had breast-conserving surgery, you may have a mastectomy. The doctor may also remove lymph nodes under the arm.
- Radiation therapy.
- This uses high-dose X-rays to destroy cancer cells and shrink tumors. It may be given after surgery.
- These medicines kill fast-growing cells, including cancer cells and some normal cells.
- Endocrine therapy.
- These medicines block hormones that cause certain cancers to grow. This helps slow or stop cancer growth.
Your doctor will talk with you about your options and then make a treatment plan.
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How Is It Treated
To plan your treatment, your doctor will consider where the cancer is and what type of treatment you had in the past. Your wishes and quality of life are also important factors. Treatment choices may include surgery, medicines like chemotherapy or hormone therapy, and radiation. Sometimes a mix of these treatments is used.
Treatments for breast cancer can cause side effects. Your doctor can tell you what problems to expect and help you find ways to manage them.
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials test new cancer treatments and may be the best choice for you.
If treatments don’t work, a time may come when the goal of your treatment shifts from trying to cure your cancer to keeping you as comfortable as possible. This can allow you to make the most of the time you have left.