History Of Breast Diseases
The initial symptoms of cancer are cancerous lesions in the breast . Regarding the family history of disease, the other risk factors associated with breast cancer are in-situ carcinoma, atypical hyperplasia, proliferative lesions and non-proliferative lesions . Breast cancer risks include a family history of breast cancer and benign lesions .
Early Recurrence Vs Late Recurrence
A recurrence of breast cancer at any time can be devastating. While 6% to 10% of breast tumors are diagnosed when the disease is already metastatic , 90% to 94% of metastatic breast cancers represent a distant recurrence of previous early-stage breast cancer .
Since distant metastases are responsible for around 90% of breast cancer deaths, finding ways to reduce the risk of recurrence is critical in improving the survival rate from the disease. Overall, it’s estimated that around 30% of breast cancers will recur at distant sites.
Residual Disease: Adjuvant Treatment Intensification
The risk of disease recurrence after anthracycline/taxane chemotherapy ranges from approximately 10% in patients with stage I disease and up to 25%-50% in patients with stage III disease. These high rates of disease recurrence after standard chemotherapy have driven several trials aimed at investigating adjuvant treatment intensification. Given that capecitabine is known to have activity in metastatic TNBC, several trials have investigated adjuvant treatment intensification with this agent.
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Intake Of Processed Food/diet
According to the WHO, processed foods, such as meat, are confirmed group-1 carcinogen for gastrointestinal cancer and breast malignancy . The excessive use of saturated fats is also considered a carcinogen. The obesity-causing ultra-processed diet plans that are enriched in elements such as sugar, sodium, and fats are thought to be carcinogenic and increase the risk by 11% . Diets that are rich in green vegetables, fresh fruits, protein-enriched grains, and legumes are anti-carcinogenic and therefore reduce the risk of breast cancer . Similarly, diets rich in phyto-estrogen, folate elements, saturated fibers, n-3 PUFA, and vitamin D are regarded as anti-cancer agents . Hence, a low dose consumption of saturated fat and n-6 PUFA has been proposed . The antioxidants found in green tea have also shown anti-carcinogenic properties . Curcuminoids and sulforaphane derived from turmeric are thought to be anti-carcinogens .
What Is Triple Negative Breast Cancer
Triple negative breast cancer is:
- Estrogen receptor-negative
- Progesterone receptor-negative
Most triple negative tumors are basal-like . Basal-like tumors have cells that look similar to those of the outer cells surrounding the mammary ducts.
Triple negative/basal-like tumors are a molecular subtype of breast cancer.
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Is Triple Negative Breast Cancer The Worst Kind
“Triple negative breast cancer is an aggressive cancer that grows quickly, making it more likely to have spread by the time it is diagnosed and to come back after treatment. Therefore, the outlook is generally not as good when compared to other types of breast cancer. To find active triple negative breast cancer clinical trials in your area, you can use Power to search by condition, treatment, or location.” – Anonymous Online Contributor
What This Means For You
If youâve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.
If you were diagnosed with hormone receptor-positive, early-stage breast cancer, itâs likely that your doctor will recommend you take some type of hormonal therapy medicine â either tamoxifen or an aromatase inhibitor depending on your menopausal status â for five to 10 years after surgery.
Chemotherapy after surgery is usually completed in three to six months. If youâre also receiving a targeted therapy, such as Herceptin , with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.
Radiation therapy after surgery can be completed in one to seven weeks.
So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.
Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either donât start taking the medicine or stop taking it early, in many cases because of side effects.
Learn more about Staying on Track With Treatment. You can read about why itâs so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.
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Am I Still At Risk Of Breast Cancer Recurrence If I Have Had A Mastectomy
Yes. You are still at risk of breast cancer recurrence if you have had a bilateral mastectomy . Undergoing a bilateral mastectomy drastically reduces your chances of local or contralateral breast cancer recurrence as almost all of the breast tissue has been removed. However, there is still a chance that residual breast tissue or cancer cells could recur on the chest wall.
If you have had a single mastectomy , you are still at risk of developing cancer in the breast that remains.
It must be noted that having a mastectomy or bi-lateral mastectomy does not reduce your risk of developing cancer in other parts of your body .
Treatment Of Early Tnbc
TNBC isnt treated with hormone therapy or HER2-targeted therapy because its ER-negative and HER2-negative.
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.
Regional Relapse Following Breast Cancer Treatment Carries A Poorer Prognosis
Most localized breast cancers are treated by either breast conserving surgery with radiation therapy, or by mastectomy.
A medical study from 2010 estimates that around 40% of all women with breast cancer will suffer a recurrence.
The prognosis following a breast cancer recurrence is influenced by a number of factors. These include:-
- The Disease Free Interval: This is the time elapsed from diagnois and treatment of the first breast cancer to the recurrence
- The location of the recurrence: Whether the recurrence is in the same breast , or if it recurs in the contralateral breast, regional lymph nodes, or the chest wall .
Patients with breast cancer relapses are typically generally treated with either a salvage mastectomy, or radiation to the chest wall, regional lymph nodes, or both.
Systemic therapy may be implemented at this point. However, this will be determined on an individual basis, based on the likelihood of distant metastasis, characteristics of the tumor, and other factors.
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Morbidity Financial And Social Burdens Of Therapy
Chemotherapy is often feared by patients due to the side effects associated with treatment however, the costs for administering therapy have also become a major burden for both the United States healthcare system as well as the patients it serves. Financial toxicity is not frequently disclosed, and can be materially and psychologically debilitating for patients. Financial hardships induced by the cost of cancer care worsen patient psychological stress and financial insolvency has been identified as a risk factor for early mortality in cancer patients.,
Tumor Size And Lymph Node Status
The risk of recurrence is linked to the size of the original tumor as well as the number of positive lymph nodes, although these factors alone can’t explain all recurrences. In the 2017 study noted earlier, for women who were cancer-free after five years of hormonal therapy, the risk of recurrence was highest for those who had large tumors that had spread to four or more lymph nodes , and lowest with small, node-negative tumors.
The risk of recurrence of these small, node-negative tumors, however, remains significant at roughly 1% per year until at least 20 years post-diagnosis. Due to the life expectancy of metastatic breast cancer , the risk of death lags somewhat behind recurrence.
|Late Recurrence Rate and Lymph Node Status|
|Years After Diagnosis|
Within these ranges, the risk of recurrence was greater in women who had larger tumors than smaller tumors . Tumor grade and Ki-67 had only moderate predictive value, and progesterone receptor status and HER2 status had no predictive value in this study.
It’s noteworthy that women who had one to three positive lymph nodes were twice as likely to have their cancer recur at distant locations between five years and 20 years post-diagnosis than in the first five years, and those who have node-negative tumors were roughly four times more likely to have a late than an early recurrence.
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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.
Understanding Breast Cancer Recurrence
Australia has one of the best survival rates of breast cancer in the world, with 91% of women surviving at least five years past their diagnosis. New Zealand is not far behind with 88% of women surviving five years past their first diagnosis.
This information may come as a relief for those diagnosed with early stages of the disease, as many recurrences appear within five years after the initial treatment, the exception being ER positive breast cancer, as many recurrences will occur after the first five years as within the first five years. But the fear of recurrence , is a common issue faced by women who have had early stage breast cancer. The chance of recurrence is not the same for all breast cancer patients. Understanding the risk of recurrence for your type of breast cancer may help to ease some anxiety.
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What Does Triple Negative Breast Cancer Look Like On A Mammogram
“On a mammogram, triple negative breast cancer most commonly appears as an irregular, non-calcified mass with ill-defined or spiculated margins. Most triple negative breast cancers are discovered during a physical exam in younger women without a prior mammogram. You can find the most recent triple negative breast cancer clinical trials by using Power, which allows you to search trials tailored to your condition, location, and ideal treatment.” – Anonymous Online Contributor
Site Of Locoregional Failure
The site of locoregional failure vary between TNBC and Non-TNBC patients. Nodal relapse as opposed to breast/chest wall relapse is more commonly reported in TNBC patients compared to non-TNBC patients . Wu et al. showed in a cohort of 1,088 patients of whom 146 had TNBC, that 80% and 20% of loco-regional recurrences in non-TNBC patients were in the breast/chest wall and regional nodes respectively, while 50% of locoregional recurrences in TNBC patients were nodal . Noh et al. reported a similar pattern in a cohort of 596 patients with 105 TNBC breast and chest wall recurrences were more common in non-TNBC patients while nodal recurrences were predominantly seen in TNBC . similarly, Haffty et al. showed that TNBC was associated with worse nodal relapse-free rate and cause-specific survival rate than non-TNBC in a cohort of 482 patients and 117 TNBC .
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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 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.
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How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
What Types Of Breast Cancer Have The Highest Recurrence Rates
A study published in the Journal of Clinical Oncology found the risk of recurrence for all breast cancers was highest in the first five years from the initial cancer diagnosis at 10.4%. This was highest between the first and second years after the initial diagnosis. During the first five years after the initial diagnosis, patients with oestrogen receptor positive breast cancer had lower rates of recurrence compared with those with ER negative disease. However, beyond five years, patients with ER positive disease had higher rates of recurrence.
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Impact Of Late Recurrence
The impact of late distant recurrence cannot be stressed enough. Once breast cancer is metastatic, it is no longer curable. While there are some long term survivors with stage 4 breast cancer , the average life expectancy is currently only around three years.
What Is The Survival Rate By Stage For Triple Negative Breast Cancer
Survival rates are a way to discuss the prognosis and outlook of a cancer diagnosis. The number most frequently mentioned is 5-year survival. Many patients live much longer, and some die earlier from causes other than breast cancer. With constant change and improvement in therapies, these numbers also change. Current 5-year survival statistics are based on patients who were diagnosed at least 5 years ago and may have received different therapies than are available today.
Below are the statistics from the National Cancer Institute’s SEER database for the survival of all patients with breast cancer, by tumor stage:
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Epidermal Growth Factor Receptor
The epidermal growth factor receptor is reported in 89% of TNBC and is considered an attractive therapeutic target, particularly in BL2 subtype tumors . The expression of this gene results in primary tumorigenesis and metastasis. The EGFR inhibitor gefitinib lowers the proliferation of cancer cells and increases carboplatin and docetaxel cytotoxicity . Several EGFR inhibitors, such as lapatinib and erlotinib, are currently being tested against TNBC, in addition to cetuximab and panitumumab . The synergistic therapeutic approach of monoclonal antibodies and chemotherapeutics is considered to be more effective. This can be exemplified by the combined use of carboplatin and cetuximab, and cisplatin and cetuximab proved to be more efficacious in patients with advanced TNBC . Additionally, tri-inhibitor therapy, including carboplatin, gefitinib, and docetaxel, enhances TNBC cytotoxicity. Cannabidiol inhibits breast cancer metastasis by interfering with the epidermal growth factor pathway . The epidermal growth factor receptor signaling pathway is presented along with activator and inhibitor points of action, as shown in Figure 2.
FIGURE 3. Inhibition of poly polymerase in BRCA-1/2-associated and sporadic cancers .