Living With Stage : The Breast Cancer No One Understands
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.
New Medications For Metastatic Breast Cancer
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.
Men With Breast Cancer Have Lower Survival Rates Than Women
- Tags:Locally Advanced-Stage: Stage IIIC, Locally Advanced-Stage: Stage IIIB, Early-Stage: Stage IIIA, Early-Stage: Stage IIB, Early-Stage: Stage IIA, Early-Stage: Stage IB, Early-Stage: Stage IA, and Early-Stage: Stage 0 — DCIS
A study that looked at nearly 1.9 million people diagnosed with breast cancer found that men have lower overall survival compared to women. The characteristics of the breast cancers and undertreatment of male breast cancer seem to account for much of the difference in survival rates.
Overall survival is how long a person lives, whether or not the cancer grows.
The research was published online on Sept. 19, 2019, in JAMA Oncology. Read the abstract of Overall Mortality After Diagnosis of Breast Cancer in Men vs Women.
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Oncogene Expression May Negatively Affect Breast Cancer Outcome
A relatively new addition to the discussion of breast cancer survival statistics and prognosis is oncogene expression.
An oncogene is a tiny fragment of genetic material which is carried in a chromosome and can cause normal cells to become malignant.
The oncogene HER-2, in particular, has been linked to more aggressive breast cancers.
Around one-third of all breast tumours produce the HER-2 oncogene, and these patients tend to have higher rates of recurrence and lower overall breast cancer survival rates.
According to a 2013 Canadian scientific study, the overall 5-year survival rate of HER-2 positive breast cancer is 88.6%. Furthermore, the relapse-free survival rate for 5 years is 79.4%.
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.
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Age At The Time Of Diagnosis Affects Breast Cancer Survival Rates
It has always been known that curiously, young women have a poorer prognosis than older ones
Indeed, one cohort study examined 4,453 women with breast cancer between 1961 and 1991 who were all treated at the same center.
This study found that both ends of the age spectrum fared less well. So, women under the age of 40 years at diagnosis and those over 80 years had a statistically poorer prognosis.
However, for younger women, this may be due to the fact that they often present with higher-grade tumors that tend to be more aggressive and less likely to be hormone receptor-positive. This means that breast cancer may not respond as well to treatment.
So, it is important to bear in mind other factors discussed in this post, such as stage, grade and hormone receptor status play an important role in prognosis.
What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer
In women who have breast-conserving treatment, the chance of recurrence is about 3-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.
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Questions To Ask Your Doctor
Ask your doctor about their thoughts on your 1, 2, 5 and 10 year survival rates to get a personalized estimate. The numbers on this site are survival rates based upon cases of other people with this type of cancer. Use these numbers to ask your doctor what would make your outlook the same or different.
Tip: Use the drop-down at the top of the page to change the survival length from 5 year to 1, 2 or 10 year.
Reviewed by Aaron Simon M.D. Ph.D, Radiation Medicine, UC San Diego
What is Stage and why do I need to know it?
Cancer Stage is a number, typically from 1 to 4, measuring the size of the cancer tumor and if the cancer has spread. Stage 1 means the cancer hasnât spread to other parts of the body, while stage 4 means that it has. Stages 2 and 3 are somewhere in between. Survival rates are typically lower for higher stages.
What is Grade and why do I need to know it?
Some cancers also have a grade. The grade indicates how fast the cancer is growing. Well differentiated means the cancer cells are more like normal cells and growing slower. Poorly differentiated means the cancer cells donât look like normal cells and growing faster. Moderately differentiated grade means the cells are somewhere in between well and poorly differentiated.
What is Histology and why do I need to know it?
Bottom line, confirming stage and grade of cancer with your doctor is important for understanding prognosis and discussing treatment options.
Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.
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Understanding Breast Cancer Survival Rates
Prognosis varies by stage of breast cancer.
Non-invasive and early stage invasive breast cancers have a better prognosis than later stage cancers .
Breast cancer thats only in the breast and has not spread to the lymph nodes has a better prognosis than breast cancer thats spread to the lymph nodes.
The poorest prognosis is for metastatic breast cancer , when the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
Learn more about breast cancer treatment.
Stage 4 Breast Cancer Explained
According to the American Cancer Society , a stage 4 breast cancer diagnosiswhich is often referred to as metastatic breast cancer or terminal breast canceris the disease in its most serious and life-threatening form.
“Stage 4 breast cancer refers to the spread of breast cancer beyond the area of the breast and surrounding lymph nodes,” Debu Tripathy, MD, professor, and chairman of the Department of Breast Medical Oncology, at the University of Texas MD Anderson Cancer Center, told Health. “The more common sites of spread include the bone, lung, liver, and brain.” It’s important to note, however, that according to the NCI, when breast cancer spreads to bones or another area of the body, like the lungs, it does not become bone or lung cancerit’s still breast cancer.
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Stage 4 breast cancer is an uncommon initial diagnosistechnically called de . According to a study published in BMC Cancer in October 2020, only 5-10% of patients receive metastatic breast cancer as their initial diagnosis. Instead, metastatic breast cancer often emerges months or years after someone has already completed treatment for an initial breast cancer diagnosis in an earlier stage.
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Screening For Breast Cancer
Women aged between 50 and 74 are invited to access free screening mammograms every two years via the BreastScreen Australia Program.
Women aged 40-49 and 75 and over are also eligible to receive free mammograms, however they do not receive an invitation to attend.
It is recommended that women with a strong family history of breast or ovarian cancer, aged between 40 and 49 or over 75 discuss options with their GP, or contact BreastScreen Australia on 13 20 50.
Predictors For Breast Cancer Survival Rates
It has to be remembered that every single breast cancer patient has itsown , unique scenario. Thus, prognosis and breast cancer survival rates are a rough guide ONLY.
However, there are consistent predictors for breast cancer survival rates and these include:-
- The stage of breast cancer at the time of diagnosis
- The Grade of the breast cancer
- A patients age at diagnosis
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What Affects Prognosis
There are a number of factors that affect breast cancer prognosis. These include:
- the type of breast cancer
- the grade of the breast cancer
- the size of the breast cancer
For more information see our booklet Understanding your pathology results or visit our pathology report page.
Other factors that may affect your prognosis include your age, menopausal status , lifestyle factors and your general health.
All of these factors will be considered when estimating your prognosis and deciding what treatment youre offered.
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.
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What I Wish People Knew About Metastatic Breast Cancer
Women with metastatic breast cancer think about fighting cancer very differently than women who dont have a stage 4 diagnosis. If you have advanced cancer, these women understand what youre going through.
The term metastatic breast cancer describes breast cancer that has spread beyond the breast to the bones, liver, brain, or another organ. Even if the cancer is found in another organ, its still referred to as breast cancer and is treated as such.
While metastatic breast cancer is terminal and cannot be cured, because of improved treatments more women are living longer than ever with it. Even so, a lack of information and many misconceptions about this diagnosis persist.
Here are several things you should know about metastatic breast cancer and the women who are living with it.
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What Are The Stages Of Breast Cancer
Staging system
The most widely used system in the U.S. is the American Joint Committee on Cancer TNM system. Medical professionals developed a new eighth edition of this staging system for 2018 that includes results of testing for certain biomarkers, including the HER2 protein, estrogen receptor and progesterone , and the results of gene expression assays, in addition to the factors described below.
Besides the information gained from the imaging tests, this system also uses the results from surgical procedures. After surgery, a pathologist looks at the cells from the breast cancer as well as from the lymph nodes. They incorporate this information into the staging, as it tends to be more accurate than the physical exam and X-ray findings alone.
The TNM system uses letters and numbers to describe certain tumor characteristics in a uniform manner. This allows health care providers to stage the cancer and aids communication among health care providers. The following is an abbreviated example of the TNM staging system.
T: This describes the size of the tumor. A number from 0 to 4 follows. Higher numbers indicate a larger tumor or greater spread:
- T1: Tumor is 2 cm or less across
- T2: Tumor is 2 cm-5 cm
- T3: Tumor is more than 5 cm
- T4: Tumor of any size growing into the chest wall or skin
N: This describes the spread to lymph node near the breast. A number from 0 to 3 follows.
M: This letter is followed by a 0 or 1, indicating whether the cancer has spread to other organs.
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What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
What Tumor Factors Threaten My Life More
There are important tumor biology factors not well reflected in survival statistics by breast cancer stage. Below we list a few important factors that carry a higher risk to life beyond just the stage of cancer. You must ask your surgeon or medical oncologist to explain your receptor status and give you a copy of your biopsy pathology report.
Triple Negative Receptor breast cancer
Triple negative breast cancer is considered a more aggressive breast cancer. Invariably it does require chemotherapy. If you have triple negative breast cancer the risk of dying is higher than the standard statistics usually quoted for a particular stage of breast cancer . Learn more about Triple Negative Breast Cancer with our video lesson
HER2-Positive breast cancer
HER2-positive breast cancers are also more aggressive tumors. But the good news is that we now have incredibly effective, targeted chemotherapy and immunotherapy for HER2-positive cancers. Our video lesson covers HER2-Positive Breast Cancer in more detail .
Breast Cancer at a Young Age
Women younger than 40 have a higher chance of being diagnosed with a more advanced stage breast cancer. Also, the specific cancer type younger women develop has a higher chance of being more aggressive . As a result, age is a relative risk factor for survival.
Untreated breast cancer
Teaching everyone to be an expert in their own breast cancer care.
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